Heavy maternal tobacco use during pregnancy is linked to an increased risk of schizophrenia in offspring, according to a study published in the American Journal of Psychiatry.

Alan Brown, MD, MPH, professor of epidemiology and clinical psychiatry at the Columbia University Mailman School of Public Health in New York, and colleagues conducted a population-based, nested case-control study of live births in Finland between 1983 and 1998. The researchers identified 977 children with schizophrenia through a national registry who were matched to controls based on date of birth, sex, and residence.

Heavy nicotine exposure was associated with a 38% increased risk of schizophrenia; heavy smoking was determined by the presence of cotinine, a reliable biomarker of nicotine. In addition to an increased schizophrenia risk, smoking during pregnancy has been linked to low birth weight and attentional difficulties.

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“Nicotine readily crosses the placenta into the fetal bloodstream, specifically target[ing] fetal brain development, causing short- and long-term changes in cognition, and potentially contribut[ing] to other neurodevelopmental abnormalities,” noted Dr Brown.

“These findings underscore the value of ongoing public health education on the potentially debilitating, and largely preventable, consequences that smoking may have on children over time,” Dr Brown concluded. “It is of interest to examine maternal cotinine in relation to bipolar disorder, autism, and other psychiatric disorders.”


  1. Niemelä S, Sourander A, Surcel H-M, et al. Prenatal nicotine exposure and risk of schizophrenia among offspring in a national birth cohort. Am J Psychiat. 2016; doi: 10.1176/appi.ajp.2016.15060800