Psychological Medicine

Original Articles

Disentangling the relationships between maternal smoking during pregnancy and co-occurring risk factors

J. M. Ellingsona1a2, M. E. Rickerta1, P. Lichtensteina3, N. Långströma3 and B. M. D'Onofrioa1 c1

a1 Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA

a2 Department of Psychological Sciences, University of Missouri, Columbia, MO, USA

a3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden


Background Maternal smoking during pregnancy (SDP) has been studied extensively as a risk factor for adverse offspring outcomes and is known to co-occur with other familial risk factors. Accounting for general familial risk factors has attenuated associations between SDP and adverse offspring outcomes, and identifying these confounds will be crucial to elucidating the relationship between SDP and its psychological correlates.

Method The current study aimed to disentangle the relationship between maternal SDP and co-occurring risk factors (maternal criminal activity, drug problems, teen pregnancy, educational attainment, and cohabitation at childbirth) using a population-based sample of full- (n=206 313) and half-sister pairs (n=19 363) from Sweden. Logistic regression models estimated the strength of association between SDP and co-occurring risk factors. Bivariate behavioral genetic models estimated the degree to which associations between SDP and co-occurring risk factors are attributable to genetic and environmental factors.

Results Maternal SDP was associated with an increase in all co-occurring risk factors. Of the variance associated with SDP, 45% was attributed to genetic factors and 53% was attributed to unshared environmental factors. In bivariate models, genetic factors accounted for 21% (non-drug-, non-violence-related crimes) to 35% (drug-related crimes) of the covariance between SDP and co-occurring risk factors. Unshared environmental factors accounted for the remaining covariance.

Conclusions The genetic factors that influence a woman's criminal behavior, substance abuse and her offspring's rearing environment all influence SDP. Therefore, the intergenerational transmission of genes conferring risk for antisocial behavior and substance misuse may influence the associations between maternal SDP and adverse offspring outcomes.

(Received July 12 2011)

(Revised October 12 2011)

(Accepted October 14 2011)

(Online publication November 25 2011)


c1 Address for correspondence: Dr B. M. D'Onofrio, Department of Psychological and Brain Sciences, Indiana University, 1101 East 10th St, Bloomington, IN 47405, USA. (Email:


Preliminary analyses of this work were presented at the Behavior Genetics Association Conference (June 2011, Newport, Rhode Island).