The British Journal of Psychiatry (2009) 195: 294-300. doi: 10.1192/bjp.bp.108.062471
© 2009 The Royal College of Psychiatrists
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Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring

Stanley Zammit, PhD

Department of Psychological Medicine, School of Medicine, Cardiff University, and University of Bristol, UK

Kate Thomas, BSc MSc

Department of Social Medicine, University of Bristol

Andrew Thompson, MA, MMedSci, MRCPsych

Academic Unit of Psychiatry, University of Bristol

Jeremy Horwood, BSc

Department of Social Medicine, University of Bristol

Paulo Menezes, PhD

Academic Unit of Psychiatry, University of Bristol

David Gunnell, PhD

Department of Social Medicine, University of Bristol

Chris Hollis, PhD DCH MRCPsych

Division of Psychiatry, University of Nottingham, UK

Dieter Wolke, Dip (Psych) PhD

Department of Psychology and Health Research Institute, University of Warwick, UK

Glyn Lewis, PhD and Glynn Harrison, MD FRCPsych

Academic Unit of Psychiatry, University of Bristol UK

Correspondence: Stanley Zammit, Department of Psychological Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, Wales, UK. Email: zammits{at}Cardiff.ac.uk

Declaration of interest

None.

Background

Adverse effects of maternal substance use during pregnancy on fetal development may increase risk of psychopathology.

Aims

To examine whether maternal use of tobacco, cannabis or alcohol during pregnancy increases risk of offspring psychotic symptoms.

Method

A longitudinal study of 6356 adolescents, age 12, who completed a semi-structured interview for psychotic symptoms in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort.

Results

Frequency of maternal tobacco use during pregnancy was associated with increased risk of suspected or definite psychotic symptoms (adjusted odds ratio 1.20, 95% CI 1.05–1.37, P = 0.007). Maternal alcohol use showed a non-linear association with psychotic symptoms, with this effect almost exclusively in the offspring of women drinking >21 units weekly. Maternal cannabis use was not associated with psychotic symptoms. Results for paternal smoking during pregnancy and maternal smoking post-pregnancy lend some support for a causal effect of tobacco exposure in utero on development of psychotic experiences.

Conclusions

These findings indicate that risk factors for development of non-clinical psychotic experiences may operate during early development. Future studies of how in utero exposure to tobacco affects cerebral development and function may lead to increased understanding of the pathogenesis of psychotic phenomena.


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