Dear Editor,

In their most interesting paper on psychiatric disorders in SGA and VLBW adolescents, Indredavik et al.[1] conclude that a biological cause-effect seems plausible to explain the association between psychiatric symptoms and disorders by the age of 14 and VLBW. Consequently, the most relevant question here is how to prevent the development of such disorders.

A possible - and preventable - cause of these findings could be maternal smoking during pregnancy. There is an impressive amount of data indicating that maternal prenatal smoking can cause low birthweight - though not in all women equally severe [2] - and there is also sufficient data demonstrating that passive smoking can cause alterations in the development of the brain [3], and is associated with psychiatric behaviour and disorders [4]. It would be most interesting if the authors could correlate the information on prenatal maternal smoking, if available. Obviously, immaturity of the brain and damaging neonatal incidents are likely to play a role as well, but premature birth and neonatal complications have also been attributed to prenatal maternal smoking [5].

References

(1). M S Indredavik, T Vik, S Heyerdahl, S Kulseng, P Fayers, and A-M Brubakk. Psychiatric symptoms and disorders in adolescents with low birth weight. Arch. Dis. Child. Fetal Neonatal Ed. 2004; 89: F445-F450.

(2). Bush PG, Mayhew TM, Abramovich DR, Aggett PJ, Burke MD, Page KR. A quantitative study on the effects of maternal smoking on placental morphology and cadmium concentration. Placenta 2000;21(2-3):247-56.

(3). Slotkin, T. A. 1998. Fetal nicotine or cocaine exposure: which one is worse? J Pharmacol Exp Ther 285(3):931-45.

(4). Eskenazi B, Castorina R. Association of prenatal maternal or postnatal child environmental tobacco smoke exposure and neurodevelopmental and behavioral problems in children. Environ Health Perspect 1999;107(12):991- 1000.

(5). Andres RL, Day MC. Perinatal complications associated with maternal tobacco use. Semin Neonatol 2000;5(3):231-41.