Maternal smoking during pregnancy and risk to boys’ conduct disturbance: an examination of the causal hypothesis

Background We undertook this study to determine whether the widely replicated link between maternal smoking and conduct disturbance (Cd) is better explained by a model of direct causation or of mother–offspring transmission of a latent Cd variable. Methods Family data collected on 538 adolescent twin boys from the Virginia Twin Study of Adolescent Behavioral Development (VTSABD) was used to compare two alternative models: 1) a model composed of a latent transmissible factor that influences mother’s juvenile conduct symptoms, smoking during pregnancy, and subsequent Cd and smoking in her adolescent boys; and 2) a model specifying a direct causal path from mother’s smoking to child Cd. Results The maternal–offspring transmission model fit the data as well as a model specifying a direct causal path from maternal smoking to child Cd. Conclusions Our results suggest that the association between maternal smoking during pregnancy and boys’ Cd symptoms may be attributed to the transmission of a latent Cd factor and not to a direct effect of the smoking. Our results challenge previous findings of a direct effect of prenatal smoke exposure on risk to Cd once other etiologic factors are considered.