Second-hand Smoke Linked To Psychological Problems In Kids

Children whose mothers were exposed to second-hand smoke while they were pregnant have more symptoms of serious psychological problems compared to the offspring of women who had no prenatal exposure to smoke, according to a new University of Washington study.

Writing in the current issue of Child Psychiatry and Human Development, UW psychologists Lisa Gatzke-Kopp and Theodore Beauchaine provide the first evidence linking mothers’ second-hand smoke exposure while pregnant to their children’s attention deficit hyperactivity disorder (ADHD) and conduct disorder. Psychologists call these behaviors externalizing psychopathology and their symptoms include aggressive behavior, ADHD, defiance and conduct disorder, which encompasses truancy, fighting, school failure, breaking rules, substance use, stealing and destruction of property.

The research also supports a 2006 report by the U.S. Surgeon General that found passive smoke exposure poses a substantial risk to the general health of those who breathe the smoke, as well as to the fetuses of pregnant women.

Gatzke-Kopp and Beauchaine compared patterns psychopathology among three groups of 7- to 15-year-old children, all of whom had significant behavioral and/or emotional problems. One group experienced no prenatal smoke exposure. The second was made up of children whose mothers smoked during the final two trimesters of pregnancy. The third consisted of children whose mothers were exposed to second-hand smoke at work or in the home in the last two trimesters during pregnancy. A total of 171 children, primarily boys, and 133 women participated in the project.

The UW researchers found that those children whose mothers had been exposed to tobacco smoke either by smoking or by being around smokers when they were pregnant had more symptoms of ADHD and conduct disorder than children whose mothers spent their pregnancies in a smoke-free environment. However, they did not show more symptoms of emotional disorders such as depression or anxiety.

“This is a matter of severity,” said Gatzke-Kopp, a post-doctoral researcher.

“Children with these disorders have a range of behaviors that stretch from problematic to severe. It is a continuum based on the number of symptoms, and children who were exposed to smoke exhibited more symptoms.”

She and Beauchaine controlled for a number of other factors including family income, parents’ substance use, birth weight and parents’ anti-social behavior, but second-hand exposure to smoking persisted as the primary predictor of conduct disorder and ADHD.

Nicotine, an alkaloid compound in tobacco, is believed to be the chemical that causes these behavior problems in children. Animal studies have shown that nicotine affects brain development during the second and third trimesters of pregnancy, causing changes in brain regions critical to the development of externalizing psychopathology in humans.

“Evidence suggests that the dopamine system in the brain gets over stimulated during pregnancy,” Beauchaine said. Dopamine is a brain chemical that plays an important role in behavior and cognition, among other functions. “

“As a consequence, children who were exposed to smoke in utero have colic and are hard to sooth as infants. As toddlers they are overactive and oppositional. Later on they are irritable, inattentive and low on pleasure.”

Gatzke-Kopp and Beauchaine believe a message needs to be distributed widely that regardless of how women are exposed to tobacco smoke, either directly or second-hand smoke, their unborn children’s behavior can be affected.

Gene Discovered Which Increases Risk Of Gallstones

Scientists at the University of Bonn, together with colleagues from Romania, have discovered a gene variant that significantly increases the risk of developing gallstones (Hepatology No. 46, 11 July 2007, DOI 10.1002/hep.21847). It is estimated that one in ten Europeans has this variant in their hereditary disposition. For those affected, the likelihood of developing a gallstone in the course of their life is two to three times higher. The relevant gene contains the instructions for building a molecular pump which transports cholesterol from the liver into the bile ducts — cholesterol being the substance from which most gallstones are formed. The genetic modification appears to cause this pump to work permanently at high speed. Gallstones are a common disorder: in Germany alone more than 170,000 gallbladder operations a year are performed.

Gallstones occur very frequently, affecting 15 to 20 per cent of all Germans, usually without noticeable symptoms. But in around a quarter of cases the stones will announce their presence at some time in the form of a painful colic. In the end they often have to be operated. “Gallstones are among the gastrointestinal problems that incur the highest treatment costs,” says Professor Dr. Frank Lammert, the Bonn-based specialist for internal medicine.

Gallstones tend to be found at high levels within certain families. In particular, studies of twins provide evidence of a genetic component that boosts risk levels. “We reckon that environmental influences, like the wrong diet, are 70 to 80 per cent responsible for the disorder,” explains Lammert who works in the university hospital’s Department I headed by Professor Dr. Tilman Sauerbruch. “The rest is caused by genes.”

Professor Lammert — working together with his colleagues Dr. Frank Gruenhage, Maja Walier and Professor Dr. Thomas Wienker as well as scientists at the University Clinic of Cluj-Napoca in Romania — has been searching for the specific genes involved. And he has succeeded, thanks to a study covering 178 women and men from 84 families. They all suffer from gallstones. In 21.4 per cent of cases the subjects were found to be carrying a particular gene variant. In healthy individuals studied as a control group, this variant also occurred, but only at a frequency of 8.6 per cent.

Cholesterol pump at full speed

“The mutation concerns what is known as the ABCG8-gene,” Dr. Gruenhage explains. “It contains the instructions for building a pump responsible for transporting the blood lipid cholesterol from the liver into the bile ducts.” Most of the gallstones consist to a high degree of crystallised cholesterol. The medical researcher concludes that, “The genetic alteration probably makes the pump run permanently at high speed.”

The researchers now hope that their finding will have positive consequences for prevention and therapy. Professor Lammert thinks that, “It may be possible for certain patients to be helped with drug treatments in future, thus avoiding the need for an operation.” However, the genetic contribution to the common problem of gallstones has not been fully explained by this study: “We believe there are at least three or four other gene variants that increase gallstone risk,” says the medical scientist.

Colicky Babies And Postpartum Depression

A compelling connection exists between colicky babies and postpartum depression, according to a study conducted by a Brown Medical School professor and Rhode Island Department of Health family health experts.

The study is the first to establish a link between colic and depression using a large sample of demographically diverse women. Results will be presented in May at the Pediatric Academic Societies’ 2006 Annual Meeting in San Francisco. The meeting is the largest academic pediatric gathering in the world.

Pamela High, M.D., served as lead. High is a clinical professor of pediatrics at Brown Medical School and director of developmental-behavioral pediatrics at Hasbro Children’s Hospital. She is also head of the Infant Behavior, Cry and Sleep Program run by the Brown Center for the Study of Children at Risk, which is supported by Women & Infants Hospital of Rhode Island.

The research team also included staff from the Rhode Island Department of Health’s Division of Family Health, who provided data and analytical support. They are Hannah Kim, senior epidemiologist; Samara Viner-Brown, chief of data and evaluation and director of the Pregnancy Risk Assessment Monitoring System, or PRAMS; and Rachel Cain, PRAMS coordinator.

High warned that the work does not show a direct cause-and-effect relationship between a fussy baby and a depressed mom. “We can’t say that inconsolability causes depression or that depression causes inconsolability,” High said. “However, we did find a link between the two. And this won’t surprise anyone who knows a mother coping with a fussy baby.”

High directs the Infant Behavior, Cry and Sleep Program – known locally as the Colic Clinic – in Providence. High and other Colic Clinic staff have helped hundreds of families having trouble with their infants’ crying. After conducting an exam and taking a medical history, clinic staffers help new mothers and fathers console their babies, pinpoint the cause of the crying, and take care of their own needs.

A 2005 Brown Medical School study of 93 mothers seen at the Colic Clinic showed that 45 percent reported moderate to severe depressive symptoms. Barry Lester, head of the Brown Center for the Study of Children at Risk, led the study.

“At the clinic, it is not unusual to see mothers who are very tired and sometimes very anxious and depressed,” High said. “Moms are trying hard to understand their child’s needs and meet those needs. Sometimes they feel inadequate when they can’t console their baby.”

The study is based on responses to the Rhode Island PRAMS, an ongoing, confidential survey of women who have recently given birth. The state is one of 32 participating in PRAMS, which is funded by the federal Centers for Disease Control and Prevention and aims to improve the health of new mothers and their babies. Each month, women are randomly chosen to receive the survey, which covers topics such as prenatal care, smoking, and nutrition and breast-feeding.

High is a member of the Rhode Island PRAMS steering committee. The committee was able to choose a few state-specific questions that would be added to the standard survey. The survey already asked about depression. Wondering if there was a connection to colic, High suggested another: “How inconsolable is your baby?”

The new question appeared on Rhode Island’s first PRAMS survey, administered in 2002, and again in 2003. A total of 4,214 new mothers got the questionnaire and 2,927 responded. The majority of mothers were white, married, had household incomes of more than $40,000 per year and had health insurance. Most of their babies were between two and four months of age.

The results: 19 percent of mothers reported moderate to severe symptoms of postpartum depression, and 8 percent reported that their babies were difficult to console. Responses showed a strong connection between the two. Mothers reporting depression were more than twice as likely to report infant inconsolability, and women with inconsolable babies were more than two times as likely to report depression. Even when other variables were controlled – such as age, race and income – the two were closely related.

“Depression and inconsolability are strong predictors of one another,” High said. “One in three women with fussy infants acknowledged that they were depressed.”

Researchers say the study sends a clear message to pediatricians: If you are treating a colicky baby, check on the moms, too. Ask them how they are feeling and if they have support from family and friends. When appropriate, refer women to mental health providers.

“This study is a terrific example of the use of survey data to further our understanding of maternal and child health issues and develop recommendations for improving public health practices,” Viner-Brown said. “It also shows the benefits of partnerships between state governments, universities and hospitals.”

Babies’ cries linked to their neurological and medical status

Leading researchers in colic and infant development say that a simple analysis of babies’ cries can provide a window into their neurological and medical status.

In a research review in the current issue of Mental Retardation and Developmental Disabilities, Linda LaGasse, PhD, and Barry Lester, PhD, with the Bradley Hasbro Children’s Research Center (BHCRC) and Brown Medical School looked at previous studies that analyzed the acoustics of a baby’s cry. The authors cite the characteristics of a cry that can indicate problems in a baby’s nervous system, as well as sudden infant death syndrome (SIDS). In addition, they cite the importance of how parents react to their squalling offspring.

“The cry signal has enormous potential diagnostic value; for example, very high pitched cries can tell us that something may be wrong with the infant, so the cry signal can be an early warning that leads to further neurological testing,” says LaGasse.

Overall, studies have repeatedly shown that infants at medical risk (like premature babies), and infants who have been exposed to lead or drugs, cry at a higher and more variable frequency than normal, but at lower amplitude, and with short utterances. These types of cry signals point toward a capacity problem in the respiratory system as well as an increased tension and instability of neural control of the vocal tract.

“Given the results of earlier studies relating cry characteristics to known neurological compromise, these findings suggest that at-risk infants have undetected neurological damage and that cry analysis may be able to identify these infants when no other symptoms are present,” says Lester.

In looking at cry analyses on sudden infant death syndrome, researchers found that high resonance and changes in the cry mode were consistent markers associated with SIDS. Resonance is the characteristic of a sound’s richness and depth that help humans distinguish a C note on a piano versus a guitar, and mode changes are noisy, broken-sounding cries that indicate poor neural control of the vocal track.

While someone might be able to point out a noisy cry, there is little evidence that a high resonance is distinguishable from a low resonance by an untrained listener.

“Instead, resonance is identified by a computerized analysis of the cry signal in the studies cited in the paper — this is why a detailed analysis of the cry signal is an important part of understanding the ‘full message’ of the cry,” says LaGasse.

The authors also note that parents tend to understand the nature of their babies’ cries well, and stress the importance of parental reaction to cries.

“Parents can usually tell the difference between pain and non-pain cries which guides the urgency of their care taking, and helps parents deal with infants with colic,” says LaGasse.

But parent perception of their infant’s cry may be affected by conditions such as depression or age of parent which can lead to action or nonaction which may be out of sync with the infant’s needs. The most extreme case is “shaken baby syndrome” where the cry triggers aggression rather than concern in the caretaker.

Lester and LaGasse say that clinicians should be aware of how parents respond (or don’t respond) to their baby’s crying, especially in light of the high prevalence of depression in young mothers.

“Helping parents to correctly interpret their infants’ cries can optimize development particularly in high risk infants who may have atypical signals or high risk parents who may misperceive a normal cry,” they write.

Colicky Babies And Postpartum Depression

A compelling connection exists between colicky babies and postpartum depression, according to a study conducted by a Brown Medical School professor and Rhode Island Department of Health family health experts.

The study is the first to establish a link between colic and depression using a large sample of demographically diverse women. Results will be presented in May at the Pediatric Academic Societies’ 2006 Annual Meeting in San Francisco. The meeting is the largest academic pediatric gathering in the world.

Pamela High, M.D., served as lead. High is a clinical professor of pediatrics at Brown Medical School and director of developmental-behavioral pediatrics at Hasbro Children’s Hospital. She is also head of the Infant Behavior, Cry and Sleep Program run by the Brown Center for the Study of Children at Risk, which is supported by Women & Infants Hospital of Rhode Island.

The research team also included staff from the Rhode Island Department of Health’s Division of Family Health, who provided data and analytical support. They are Hannah Kim, senior epidemiologist; Samara Viner-Brown, chief of data and evaluation and director of the Pregnancy Risk Assessment Monitoring System, or PRAMS; and Rachel Cain, PRAMS coordinator.

High warned that the work does not show a direct cause-and-effect relationship between a fussy baby and a depressed mom. “We can’t say that inconsolability causes depression or that depression causes inconsolability,” High said. “However, we did find a link between the two. And this won’t surprise anyone who knows a mother coping with a fussy baby.”

High directs the Infant Behavior, Cry and Sleep Program – known locally as the Colic Clinic – in Providence. High and other Colic Clinic staff have helped hundreds of families having trouble with their infants’ crying. After conducting an exam and taking a medical history, clinic staffers help new mothers and fathers console their babies, pinpoint the cause of the crying, and take care of their own needs.

A 2005 Brown Medical School study of 93 mothers seen at the Colic Clinic showed that 45 percent reported moderate to severe depressive symptoms. Barry Lester, head of the Brown Center for the Study of Children at Risk, led the study.

“At the clinic, it is not unusual to see mothers who are very tired and sometimes very anxious and depressed,” High said. “Moms are trying hard to understand their child’s needs and meet those needs. Sometimes they feel inadequate when they can’t console their baby.”

The study is based on responses to the Rhode Island PRAMS, an ongoing, confidential survey of women who have recently given birth. The state is one of 32 participating in PRAMS, which is funded by the federal Centers for Disease Control and Prevention and aims to improve the health of new mothers and their babies. Each month, women are randomly chosen to receive the survey, which covers topics such as prenatal care, smoking, and nutrition and breast-feeding.

High is a member of the Rhode Island PRAMS steering committee. The committee was able to choose a few state-specific questions that would be added to the standard survey. The survey already asked about depression. Wondering if there was a connection to colic, High suggested another: “How inconsolable is your baby?”

The new question appeared on Rhode Island’s first PRAMS survey, administered in 2002, and again in 2003. A total of 4,214 new mothers got the questionnaire and 2,927 responded. The majority of mothers were white, married, had household incomes of more than $40,000 per year and had health insurance. Most of their babies were between two and four months of age.

The results: 19 percent of mothers reported moderate to severe symptoms of postpartum depression, and 8 percent reported that their babies were difficult to console. Responses showed a strong connection between the two. Mothers reporting depression were more than twice as likely to report infant inconsolability, and women with inconsolable babies were more than two times as likely to report depression. Even when other variables were controlled – such as age, race and income – the two were closely related.

“Depression and inconsolability are strong predictors of one another,” High said. “One in three women with fussy infants acknowledged that they were depressed.”

Researchers say the study sends a clear message to pediatricians: If you are treating a colicky baby, check on the moms, too. Ask them how they are feeling and if they have support from family and friends. When appropriate, refer women to mental health providers.

“This study is a terrific example of the use of survey data to further our understanding of maternal and child health issues and develop recommendations for improving public health practices,” Viner-Brown said. “It also shows the benefits of partnerships between state governments, universities and hospitals.”

New study links colic, maternal depression to family problems

Some families with new babies face excessive infant crying, or colic. And some new mothers go through maternal post-partum depression (PPD) following childbirth. Neither situation is considered healthy, but a recent study published in the Infant Mental Health Journal has found that the combined impact of colic and PPD can have a highly toxic outcome. Researchers have linked colicky babies and maternal depression to decrease in overall family functioning.

“We found that severe depressive symptoms in the mothers were related to fussy, or difficult infant temperament, more parenting stress, lower parental self-esteem and more family-functioning problems,” says senior author Barry Lester, PhD with the Bradley Hasbro Children’s Research Center (BHCRC) and Brown Medical School.

Dr. Lester founded the Colic Clinic at the Infant Development Center at Women and Infant’s Hospital in Providence, RI, and is the foremost colic researcher in the country. His new book Why is My Baby Crying? was published last month by Harper-Collins and is touted as ‘the parent’s survival guide for coping with crying problems and colic’.

“Colic is ultimately defined by the parental threshold for infant crying,” says Lester and his co-authors, “so one possibility is that cry-related problems like colic act as a catalyst for dysfunction in already stressed families.”

Examples of family dysfunction might include poor communication, confusion over roles, difficulty in solving family problems, poor family interaction and a lack of emotional responsiveness.

Other studies have shown that depression can alter the way a mother perceives and responds to her baby’s cry signals. In light of this, the authors conclude that the co-occurrence of infant colic and maternal depression might be especially risky for infant development outcomes such as behavior skills or forming relationships.

“Forty-four percent of the women showing up at the Colic Clinic are depressed which is pretty devastating and now we have evidence to show that it’s harmful to the whole family,” says Lester.

Maternal postpartum depression (PPD) has been described as the most common unrecognized postpartum complication and occurs in 15 to 20 percent of women following childbirth. According to the American Psychiatric Association, PPD symptoms include loss of pleasure or interest in usual activities coupled with sleep or appetite changes, loss of energy and/or recurrent thoughts of death for at least 2 weeks.

The authors hope the study will prompt pediatricians to ask more questions about parental and family well-being during an infant’s regular check-up.

“By recognizing the potential risk that crying and maternal depression presents, pediatric healthcare providers have an opportunity to refer treatment that could potentially prevent future problems within the family,” the authors conclude.