Effect of Prenatal Smoke Exposure on Birth Weight: The Moderating Role of Maternal Depressive Symptoms.
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Introduction:Both prenatal smoke exposure and depression have been linked to lower birth weight, a risk factor for morbidity and mortality. Few studies have looked at the interaction between these risk factors and none have used a biomarker to objectively measure prenatal smoke exposure. The current study sought to examine independent and interactive effects of cotinine and depression on birth weight. The effect of race was also explored. Method:Data were drawn from a prospective study of pregnant women (N=568) in the southeastern U.S. Maternal demographic, health information, depressive symptoms, and birth data were collected via self-report and medical record abstraction. Prenatal blood samples were assayed for cotinine. Results:Controlling for covariates, multiple regression analyses indicated that both cotinine and depressive symptoms independently predicted lower birth weight and a significant interaction was also observed. Upon probing the interaction, a negative association between cotinine levels and birth weight was found in the context of higher depression but not lower depression scores. Similarly, logistic regression analyses revealed a significant interaction between cotinine and depression, such that cotinine predicted having a baby < 2500 g among women who fell above the indicated cut-off score. African American women had the highest levels of cotinine and lowest weight babies; however, race was not a significant moderator. Conclusions:Results suggest prenatal smoke exposure has a greater negative effect on birth weight for women endorsing co-occurring depressive symptoms. Findings can inform targeted interventions and assist medical providers with identifying women at increased risk for poor perinatal outcomes. Implications:Despite the common occurrence of smoking during pregnancy and prenatal depression, the interaction between these risk factors on birth weight has rarely been examined. Further, the extant results have been mixed, likely due in part to difficulties in measurement. The current study was the first to use prenatal cotinine to assess bias-free, continuous levels of prenatal smoke exposure. Results indicate that prenatal cotinine was a significant predictor of birth weight only in the context of maternal depressive symptoms. These findings have important implications for mitigating negative perinatal outcomes for pregnant women and their children.
Published Version (Please cite this version)
Schechter, Julia, Elizabeth K Do, Junfeng Jim Zhang, Cathrine Hoyo, Susan K Murphy, Scott H Kollins and Bernard Fuemmeler (2018). Effect of Prenatal Smoke Exposure on Birth Weight: The Moderating Role of Maternal Depressive Symptoms. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco. 10.1093/ntr/nty267 Retrieved from https://hdl.handle.net/10161/18071.
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Dr. Zhang joined the Duke Faculty in fall 2013 from the University of Southern California where he had been a professor of environmental and global health and the director of Environmental and Biomarkers Analysis Laboratory since 2010. His prior positions include professor, department chair, and associate dean at the Rutgers School of Public Health. Dr. Zhang has more than 290 peer-reviewed publications. His work has been featured in major international media such as the Time, the New York Times, BBC, ABC, CBS, Yahoo News, etc. His early work on characterizing sources of non-methane greenhouse gases made him one of the officially recognized contributor to the 2007 Nobel Peace Prize awarded to IPCC. He is the 2012 recipient of the Jeremy Wesolowski Award, the highest award of the International Society of Exposure Science. He also received a Distinguished Alumni Award from the Rutgers Graduate School.
Dr. Zhang’s research interests include developing novel biomarkers of human exposure and health effects, assessing health and climate co-benefits of air pollution interventions, and examining biological mechanisms by which environmental exposures exert adverse health effects. Dr. Zhang has led a number of international collaborations to study air pollution health effects and underlying pathophysiologic mechanisms. These studies integrate epidemiological and toxicological approaches into natural experiment designs. He has conducted several indoor air purification intervention studies to evaluate the effectiveness of personal exposure reduction in improving health outcomes in China. Currently, he is conducting intervention trials of residential air purification in older adults with a heart disease history and adults at risk for Type 2 diabetes living in Los Angels where air pollution levels are high. He is co-leading a project to study whether and how particulate matter pollution affects respiratory viral infections in two cities of Mongolia.
Dr. Murphy is a tenured Associate Professor in the Department of Obstetrics and Gynecology and serves as Chief of the Division of Reproductive Sciences. As a molecular biologist with training in human epigenetics, her research interests are largely centered around the role of epigenetic modifications in health and disease.
Dr. Murphy has ongoing projects on gynecologic malignancies, including approaches to eradicate ovarian cancer cells that survive chemotherapy and later give rise to recurrent disease. Dr. Murphy is actively involved in many collaborative projects relating to the Developmental Origins of Health and Disease (DOHaD).
Her lab is currently working on preconception environmental exposures in males, particularly on the impact of cannabis on the sperm epigenome and the potential heritability of these effects. They are also studying the epigenetic and health effects of in utero exposures, with primary focus on children from the Newborn Epigenetics STudy (NEST), a pregnancy cohort she co-founded who were recruited from central North Carolina between 2005 and 2011. Dr. Murphy and her colleagues continue to follow NEST children to determine relationships between prenatal exposures and later health outcomes.
Scott H. Kollins, PhD received his undergraduate degree in psychology from Duke and his Master’s and Doctorate degrees in Clinical Psychology from Auburn University. After completing his clinical internship at the University of Mississippi Medical Center, where he served as Chief Intern, he joined the faculty of the Department of Psychology at Western Michigan University for three years, before joining the Duke faculty in 2000. Dr. Kollins has published more than 125 scientific papers in peer-reviewed journals. Over the past 10 years, his research has been supported by 6 different federal agencies, including NICHD, NIDA, NIMH, NIEHS, NINDS, and EPA, and he currently holds a mid-career K24 award from NIDA. He has also served as PI on more than 40 industry-funded clinical trials and is a consultant to a number of pharmaceutical companies in the area of ADHD clinical psychopharmacology. He has served as a standing member of the Child Psychopathology and Developmental Disabilities study section and also served as an ad-hoc reviewer for 10 additional NIH study sections and 7 international granting agencies. He is an Associate Editor for the Journal of Attention Disorders and has reviewed for more than 50 different peer-reviewed journals. He is an elected member of the College on Problems of Drug Dependence and the American College of Neuropsychopharmacology. Dr. Kollins is a licensed clinical psychologist and maintains a practice through the ADHD Program’s outpatient clinic. His research interests are in the areas of psychopharmacology and the intersection of ADHD and substance abuse, particularly cigarette smoking.
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