European Journal of Epidemiology

, Volume 26, Issue 6, pp 485–492 | Cite as

Maternal smoking during pregnancy and risks of suicidal acts in young offspring

  • Sven Cnattingius
  • Tobias Svensson
  • Fredrik Granath
  • Anastasia Iliadou


Obstetric and neonatal complications have been associated with completed and attempted suicide (suicidal acts) in young offspring. Maternal smoking is one of the most important risk factors for obstetric complications, but the association between prenatal smoking exposure and offspring risk of suicidal acts is unknown. We performed a population-based study of 1,449,333 single births born in Sweden between 1983 and 1996, derived from linked registry data. Maternal smoking and risks of suicidal acts in offspring were estimated using hazard ratios, derived from proportional-hazard models, controlling for potential confounding of parental socio-demographic factors and psychiatric care in first degree relatives. To control for unmeasured familial confounding, a matched case–control analysis of suicidal acts was performed within sibling pairs discordant for prenatal smoking exposure. In the cohort analysis, the adjusted hazard ratio for completed suicide among offspring to women smoking 1–9 cigarettes and at least 10 cigarettes per day were 1.67, 95% confidence interval (CI), 1.29–2.16, and 1.54, 95% CI, 1.12–2.10. For suicidal acts, corresponding hazard ratios were 1.28, 95% CI 1.21–1.35 and 1.48, 95% CI 1.39–1.57, respectively. However, in sibling pairs discordant for suicidal acts and prenatal smoking exposure, we found no evidence that prenatal smoking exposure increased the risk of suicidal acts. We conclude that the association between prenatal smoking exposure and offspring risk of suicidal acts is probably confounded by unmeasured familial factors.


Pregnancy Prenatal Psychiatry Smoking Suicide 



The study was supported by grants from the Swedish Research Council (Project numbers K2007-70P-20518-01-4 and K2007-70 K-20510-01-4).


  1. 1.
    Suicide Prevention (SUPRE). World Health Organization. Accessed 24 June 2010.
  2. 2.
    Nock MK, Borges G, Bromet EJ, Alonso J, Angermeyer M, Beautrais A, Bruffaerts R, Chiu WT, de Girolamo G, Gluzman S, de Graaf R, Gureje O, et al. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. Br J Psychiatry. 2008;192:98–105.PubMedCrossRefGoogle Scholar
  3. 3.
    Bridge JA, Goldstein TR, Brent DA. Adolescent suicide and suicidal behavior. J Child Psychol Psychiatry. 2006;47:372–94.PubMedCrossRefGoogle Scholar
  4. 4.
    Baldessarini RJ, Hennen J. Genetics of suicide: an overview. Harv Rev Psychiatry. 2004;12:1–13.PubMedGoogle Scholar
  5. 5.
    Kendler KS. Twin studies of psychiatric illness: an update. Arch Gen Psychiatry. 2001;58:1005–14.PubMedCrossRefGoogle Scholar
  6. 6.
    Mann JJ. Neurobiology of suicidal behaviour. Nat Rev Neurosci. 2003;4:819–28.PubMedCrossRefGoogle Scholar
  7. 7.
    Hultman CM, Sparén P, Takei N, Murrary RM, Cnattingius S. Prenatal and perinatal risk factors for schizophrenia, affective psychosis, and reactive psychosis of early onset: case-control study. BMJ. 1999;318:421–6.PubMedGoogle Scholar
  8. 8.
    Gale CR, Martyn CN. Birth weight and later risk of depression in a national birth cohort. Br J Psychiatry. 2004;184:28–33.PubMedCrossRefGoogle Scholar
  9. 9.
    Mittendorfer-Rutz E, Rasmussen F, Wasserman D. Restricted fetal growth and adverse maternal psychosocial and socioeconomic conditions as risk factors for suicidal behaviour of offspring: a cohort study. Lancet. 2004;364:1135–40.PubMedCrossRefGoogle Scholar
  10. 10.
    Riordan DV, Selvaraj S, Stark C, Gilbert JS. Perinatal circumstances and risk of offspring suicide. Birth cohort study. Br J Psychiatry. 2006;189:502–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Salk L, Lipsitt LP, Sturner WQ, Reilly BM, Levat RH. Relationship of maternal and perinatal conditions to eventual adolescent suicide. Lancet. 1985;1:624–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Jacobson B, Bygdeman M. Obstetric care and proneness of offspring to suicide as adults: case-control study. BMJ. 1998;317:1346–9.PubMedGoogle Scholar
  13. 13.
    Cnattingius S. The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine Tob Res. 2004;6(Suppl 2):S125–40.PubMedCrossRefGoogle Scholar
  14. 14.
    Diaz FJ, James D, Botts S, Maw L, Susce MT, de Leon J. Tobacco smoking behaviors in bipolar disorder: a comparison of the general population, schizophrenia, and major depression. Bipolar Disord. 2009;11:154–65.PubMedCrossRefGoogle Scholar
  15. 15.
    Nilsson E, Lichtenstein P, Cnattingius S, Murray RM, Hultman CM. Women with schizophrenia: pregnancy outcome and infant death among their offspring. Schizophr Res. 2002;58:221–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Olausson P, Engel JA, Soderpalm B. Involvement of serotonin in nicotine dependence: processes relevant to positive and negative regulation of drug intake. Pharmacol Biochem Behav. 2002;71:757–71.PubMedCrossRefGoogle Scholar
  17. 17.
    Malone KM, Waternaux C, Haas GL, Cooper TB, Li S, Mann JJ. Cigarette smoking, suicidal behavior, and serotonin function in major psychiatric disorders. Am J Psychiatry. 2003;160:773–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Hughes JR. Smoking and suicide: a brief overview. Drug Alcohol Depend. 2008;98:169–78.PubMedCrossRefGoogle Scholar
  19. 19.
    National Board of Health and Welfare. The Swedish medical birth register: a summary of content and quality. Accessed 24 June 2010.
  20. 20.
    Statistics Sweden, Background facts. Multigeneration register 2005—a description of content and quality. Population and Welfare Statistics 2006:5. Accessed 24 June 2010.
  21. 21.
    Centre for Epidemiology, Inpatient diseases in Sweden 1987–2008. The National Board of Health and Welfare, Sweden. Accessed 24 June 2010.
  22. 22.
    The National Board of Health and Welfare, Causes of Death 2007. Centre for epidemiology, The National Board of Health and Welfare, Sweden. Accessed 24 June 2010.
  23. 23.
    Statistics Sweden, Educational attainment of the population 2006. ISSN: 1654-3483. Accessed 24 June 2010.
  24. 24.
    Niklasson A, Ericson A, Fryer JG, Karlberg J, Lawrence C, Karlberg P. An update of the Swedish reference standards for weight, length and head circumference at birth for given gestational age (1977–1981). Acta Paediatr Scand. 1991;80:756–62.PubMedCrossRefGoogle Scholar
  25. 25.
    Schnoll RA, Johnson TA, Lerman C. Genetics and smoking behavior. Curr Psychiatry Rep. 2007;9:349–57.PubMedCrossRefGoogle Scholar
  26. 26.
    Hawton K, van Heeringen K. Suicide. Lancet. 2009;373:1372–81.PubMedCrossRefGoogle Scholar
  27. 27.
    Currier D, Mann JJ. Stress, genes and the biology of suicidal behavior. Psychiatr Clin North Am. 2008;31:247–69.PubMedCrossRefGoogle Scholar
  28. 28.
    Rujescu D, Thalmeier A, Moller HJ, Bronisch T, Giegling I. Molecular genetic findings in suicidal behavior: what is beyond the serotonergic system? Arch Suicide Res. 2007;11:17–40.PubMedCrossRefGoogle Scholar
  29. 29.
    US Department of Health and Human Services. Surgeon General 2001. Factors influencing tobacco use among women Women and smoking. A report from the Surgeon General. Rockville, MD: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health; 2001. pp. 453–546.Google Scholar
  30. 30.
    Gilman SE, Breslau J, Subramanian SV, Hitsman B, Koenen KC. Social factors, psychopathology, and maternal smoking during pregnancy. Am J Public Health. 2008;98:448–53.PubMedCrossRefGoogle Scholar
  31. 31.
    Lindblad F, Hjern A. ADHD after fetal exposure to maternal smoking. Nicotine Tob Res. 2010;12:408–15.PubMedCrossRefGoogle Scholar
  32. 32.
    Lundberg F, Cnattingius S, D’Onofrio B, Altman D, Lambe M, Hultman C, Iliadou A. Maternal smoking during pregnancy and intellectual performance in young adult Swedish male offspring. Paediatr Perinat Epidemiol. 2010;24:79–87.PubMedCrossRefGoogle Scholar
  33. 33.
    George L, Granath F, Johansson AL, Cnattingius S. Self-reported nicotine exposure and plasma levels of cotinine in early and late pregnancy. Acta Obstet Gynecol Scand. 2006;85:1331–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Cnattingius S, Lindmark G, Meirik O. Who continues to smoke while pregnant? J Epidemiol Community Health. 1992;46:218–21.PubMedCrossRefGoogle Scholar
  35. 35.
    Kramer MS. Intrauterine growth and gestational duration determinants. Pediatrics. 1987;80:502–11.PubMedGoogle Scholar
  36. 36.
    Huizink AC, Mulder EJ. Maternal smoking, drinking or cannabis use during pregnancy and neurobehavioral and cognitive functioning in human offspring. Neurosci Biobehav Rev. 2006;30:24–41.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Sven Cnattingius
    • 1
  • Tobias Svensson
    • 1
  • Fredrik Granath
    • 1
  • Anastasia Iliadou
    • 2
  1. 1.Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital at Karolinska InstitutetKarolinska InstitutetStockholmSweden
  2. 2.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden

Personalised recommendations