Maternal smoking during pregnancy and failure of the georgia first grade criterion-referenced competency test

Background Maternal smoking during pregnancy (MSDP) has been reported to be associated with impaired measures of cognitive function, but it remains unclear whether exposure to MSDP has an impact upon offspring school performance. We examined the association between MSDP and failure of the Criterion-Referenced Competency Tests (CRCT) among Georgia first grade students. Methods A retrospective cohort was created by deterministically linking 331 531 children born in Georgia from 1998 to 2002 (inclusive) to their individual CRCT education records from 2005 to 2009. We evaluated the association between MSDP (yes/no) and failure of the CRCT Reading, English/Language Arts (ELA), and Mathematics tests, with adjustment for maternal and child sociodemographic characteristics and birth outcomes. Log-binomial models estimated the risk ratios and 95% confidence intervals. Conditional models were fitted to paired sibling data. Results MSDP was associated with CRCT failure with an adjusted risk ratios for Reading: 1.16 [95% CI 1.12, 1.21]; ELA: 1.12 [95%CI 1.10, 1.15]; and Mathematics: 1.13 [95%CI 1.10, 1.16]. The association remained significant in paired sibling analyses. Conclusions MSDP may have independent long-term effects on offspring school performance, which does not appear to be through smoking-related adverse birth outcomes.