The association between maternal smoking during pregnancy and performance on Criterion-Referenced Competency Tests (CRCT) among 1st Grade students in Georgia Público

Feng, Jia (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/hx11xg162?locale=es
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Abstract


Background: Smoking during pregnancy has been reported to be associated with poorer
cognitive function test scores. The objective of this study is to assess whether maternal smoking
during pregnancy is associated with poorer performance on Criterion-Referenced Competency
Tests (CRCT) among 1st Grade students in Georgia.
Methods: This study is a retrospective cohort study, in which electronic birth certificates of
children born to Georgia resident mothers from 1998 to 2003 were deterministically linked with
individual CRCT educational records taken from 2004 to 2010, for students of Grade 1 in
Georgia. Maternal smoking during pregnancy, the exposure variable, was recorded on birth
certificates. Binary fail/pass levels for CRCT Reading, Reading, English/Language Arts (ELA)
and Mathematics tests were defined using standardized scaled scores. The pass/fail levels were
the dependent variables in logistic and log-binomial models, with adjustment for maternal age at
the time of birth; alcohol consumption during pregnancy; marital status; maternal education;
prenatal care status; delivery funded by Medicaid or not; whether having prior adverse birth
outcomes; child's sex; race/ethnicity; whether being preterm birth; low birth weight; small for
gestational age; and parity status.
Results: In models adjusted for maternal and child characteristics, maternal smoking during
pregnancy compared to non-smoking was associated with an increased risk of poor school
performance. The risk ratios were 1.17 (1.13-1.21) for Reading test, 1.13 (1.10-1.16) for ELA test
and 1.14 (1.10-1.17) for Mathematics test. These risk ratios remained statistically significant
when we further adjusted for smoking-related adverse birth outcomes, including preterm birth,
low birth weight and small for gestational age. Our results also indicated that for any CRCT test,
there was a dose-response relationship between maternal smoking during pregnancy and the risk
of poor offspring school performance (p-value < 0.001).
Conclusion: These results suggested that maternal smoking during pregnancy may have long-
term effects on offspring school performance. Although the association may not be causal, it
emphasizes the early preventive efforts health education and public health campaigns about the
harmful effects of cigarette smoking by pregnant women.

Table of Contents

TABLE OF CONTENTS

LIST OF TABLES .......................................................................................................ix
LIST OF FIGURES .....................................................................................................xii
INTRODUCTION .........................................................................................................1
LITERATURE REVIEW ..................................................................................................4
Maternal Smoking during Pregnancy .............................................................................4
Offspring Cognitive Development .................................................................................8
Criterion-Referenced Competency Tests (CRCT) Scores .................................................14
METHODS ...............................................................................................................15
Specific Aim ............................................................................................................15
Hypotheses .............................................................................................................15
Study Design ..........................................................................................................15
Georgia Birth-Education dataset and Sample ...............................................................16
Measures ...............................................................................................................16
Maternal Smoking during Pregnancy ..........................................................................16
Child Academic Performance .....................................................................................17
Covariates ..............................................................................................................17
Analyses ................................................................................................................20
Missing Data ...........................................................................................................22
Human Subjects Review ...........................................................................................22
RESULTS ................................................................................................................23
Sample Characteristics .............................................................................................23
Crude Analyses .......................................................................................................26

The Association between Maternal Smoking during Pregnancy and Covariates..................26

The Association between Study Outcomes and Covariates ............................................26
Regression Analyses ................................................................................................27
Dose-Response Analyses of Maternal Smoking during Pregnancy on CRCT Test Results ....29
DISCUSSION .........................................................................................................31
Findings ................................................................................................................31
Direct vs. Indirect Effects of Maternal Smoking during Pregnancy on Offspring School
Performance
..........................................................................................................31
Interaction with Child's Race ....................................................................................32
Dose-Response of Maternal Smoking during Pregnancy on Offspring School
Performance
..........................................................................................................33
Strengths and Weaknesses ......................................................................................35
Conclusion .............................................................................................................37
REFERENCES ..........................................................................................................38
TABLES ..................................................................................................................45
FIGURES AND FIGURE LEGENDS ................................................................................95
APPENDIX A - IRB APPROVAL ....................................................................................97

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