The association between maternal smoking during pregnancy andperformance on Criterion-Referenced Competency Tests (CRCT) among1st Grade students in Georgia Public

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 longterm 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

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

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Mot-clé	Maternal smoking during pregnancy does-response offspring school performance
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University
Partnering Agencies	University, college or educational institution (other than Emory)

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