The Stress Responses of Fetuses and Infants Whose Mothers Smoked During Pregnancy: Genes, Hormones and Psychological Modulators

Detailed Description of the Proposed Research

Design overview. A large cohort of pregnant women will be recruited, and those who meet criteria will be divided into two groups according to their testimony regarding their smoking behavior and saliva cotinine screening, as in our previous studies. At 3-time points, the antenatal period, 2-days and 6-months of age; we will assess infants' responses to challenges using biochemical, behavioral, and subjective measures. The challenges selected are "proven" stressors and previous research has demonstrated their effectiveness in eliciting stress-reactions (e.g., increased cortisol). In parallel, we will obtain an obstetric history (from medical records), demographics, measure of symptomology, information on smoking and drinking habits, life stresses, and family cohesion at each time point, plus information about mothers' feelings/behavior and mothers' ratings of infants "regulatory" behavior after birth. The antenatal and neonatal sessions will be carried out in Hadassah Hospital and the 6-month session in the developmental laboratory at Hebrew University. Genetic material will be collected from parents and their infant at childbirth.

Recruitment Women smokers will be recruited will be recruited by nurses in well-baby clinics (where physicians do routine prenatal check-ups), gynecologists, midwives, and by advertisement. In addition, we will recruit women at the time of routine checks in Hadassah hospital (Nuchal translucency test) at 12 weeks, triple/quadra test blood testing at 16 weeks, early (14-16 weeks) and advanced (20-22 week) fetal anatomy scan, and glucose test at 24-28 weeks) (supervised by Dr. Mankuta). In all, we will recruit 150 women for the "smoking" group, using the following inclusion criteria: smokes at least 10 cigarettes a day (i.e., habitual smokers) no abuse of alcohol or drugs, no chronic physical disability, 22-35 years of age, living with partner, speaks English, Hebrew, or Russian, natural conception). A (second) group of 150 women who meet inclusion criteria (except smoking) and matched in age, education, gender of infant, and parity to the "smokers" will serve as controls. At recruitment and each time-point, mothers (and their spouses) who agree to participate in the research protocol will be interviewed for smoking habits (Fagerstrom Tolerance Questionnaire, FTQ) as detailed in our previous studies on smoking. At recruitment, women will be explicitly told that we are not encouraging smoking and will provide resources if, at any time, during the study, they want to stop smoking.

Antenatal period (Dr. David Mankuta)

The prenatal session will be carried out at 34-36 weeks of gestation (by last menstrual period and confirmed by early ultrasound) and will consist of 3 phases: (1) waiting room- in which mothers receive instructions, (2) ultrasound- to evaluate limb movement before and after vibroacoustic stimulation (VAS), as well as measures of fetuses' well-being (cardiotocograph test, biophysical profile), and (3) post exam- administration of questionnaires.