Although much of children’s motor skills have a heredity component Tirapazamine at least half of the variance is likely to be influenced by the environment It is important to ascertain features of the environment that are responsible so that toxins can be avoided children at risk can be identified and beneficial interventions initiated. drinking ≥4 drinks of alcohol per day; diabetes; taking antidepressant drugs; being deficient in iodine or iron; dietary fish; and postnatal depressive disorder. The child appearing to be most at risk was born of low birth weight (but not due to preterm delivery); or with neonatal problems. exposure to both maternal smoking and Tirapazamine her exposure to passive smoking and adverse scores around the ‘motorsystem cluster’ (which includes tests of motor performance quality of movement and muscular tone).79 The Streissguth study although focussed on prenatal alcohol exposure did look at Tirapazamine the possible effects of prenatal smoking but found no significant effect on motor coordination.73 However a UK study of 13207 children in the National 1958 Birth Cohort found smoking during pregnancy Tirapazamine to be associated with subtly reduced motor competence of offspring BCLX particularly around the nondominant side at age 11.80 In Canada 503 adolescents aged 12-18 years were tested for motor dexterity; there was no association with history of fetal exposure to maternal smoking.81 Elsewhere 320 adolescents aged 16 who had been followed from birth Tirapazamine were evaluated. There were significant and impartial associations of maternal prenatal smoking with processing velocity and deficits in visual-motor coordination.82 Thus it is possible that there may be some deficits in motor skills with prenatal cigarette smoking. The likelihood of a complex association has been evidenced by the demonstration of gene-environment conversation (between maternal smoking measured using cord blood cotinine and genes associated with the metabolism of nicotine) and fine motor skills at two years of age.83 Cannabis and hard drugs Willford and colleagues showed that maternal prenatal exposure to cannabis had similar adverse effects on processing velocity and deficits in visual-motor coordination in offspring at age 16 as they had found with prenatal cigarette smoking (see above) – and since cannabis exposure usually involves using tobacco at the same time it is possible that this mixture is important rather than the cannabis to the medication had lower psychomotor developmental indexes and reduced motor quality compared to the non-exposed.122 In Canada 32 pregnant women were prescribed an SSRI: compared with controls their offspring exhibited scores significantly lower around the gross motor subscale of the BSID-III and this was not explained by underlying maternal depressive disorder.123 In Australia 22 infants of women who had taken antidepressants in pregnancy were compared with 19 non-exposed. The authors report that ‘children exposed to antidepressant medication in pregnancy scored lower on motor sub-scales in particular on fine motor scores than non-exposed children’; there was no association between maternal depressive disorder and neurodevelopment.124 A small study of 6 neonates exposed to SSRIs compared with 61 controls Tirapazamine showed differences in autonomic and gross motor activity between those who were or were not uncovered after controlling for active maternal psychiatric illness.125 The most reliable study on this topic used linked maternal prenatal prescription to offspring development data in Denmark.126 There routinely at age 7-10 months the child undertakes the BOEL test a psychomotor developmental test from which the items on hearing were excluded. The proportion of children failing this test was compared between 82 women who had taken benzodiazepines in pregnancy 50 taking antidepressants 145 anticonvulsants 63 neuroleptic drugs and 722 controls. All the children born to women taking the drugs had elevated odds of failing the test – the adjusted odds ratios were 8.1 for the benzodiazepines 8 for antidepressants 15.5 for anticonvulsants and 4.1 for neuroleptics. However the study was unable to assess whether the medications or the disorders were responsible. A systematic review of offspring outcomes relating to mothers taking antidepressants prenatally considered all publications from 1973 to February 2010.127 Although the authors’ overall conclusion was that there were few demonstrable adverse effects they only found two studies that specifically examined motor function: both reported adverse effects as described above.122 126 Postnatal depressive disorder has been shown to have an adverse association with offspring motor development in Barbados where 226 infants were studied at six months of age 128 and in Bangladesh where 652 infants were examined at 8-9 months.120 However no similar effects on motor development were.