Effect of maternal smoking during pregnancy on children's educational test performance

The detrimental effects of maternal smoking during pregnancy on fetal development are well known; however, less is known about whether prenatal smoking leads to persistent neurocognitive compromise. We examined 1) whether self-reported smoking during pregnancy among non-Hispanic black and white mothers in North Carolina was associated with their children's later performance on end of grade (EOG) reading and mathematics tests; and 2) whether this association operated through infant birthweight and gestational age. We linked the North Carolina birth record data with EOG testing datasets. Multiple linear regression was used to model fourth grade reading and math EOG test scores. Ordered logistic regression was applied to subject specific achievement scale measures, which use four categories to indicate mastery level. All models adjusted for maternal characteristics including age, race, marital status, and educational attainment. We also controlled for infant sex and whether the child participated in the school free and reduced lunch program. Maternal smoking during pregnancy is negatively associated with performance on reading and math EOG test scores (P < .001) and level of academic achievement in both subject matters (P < .001). Controlling for infant birthweight and gestational age only slightly attenuated this association; thus, suggesting that smoking during pregnancy not only operates through birth outcomes but is also directly linked to EOG performance. These results emphasize the public health importance of warning against smoking during pregnancy and the potential need for early educational intervention among children born to mothers who smoke during pregnancy.