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Table 1 Maternal smoking during pregnancy and child health outcomes

From: The impact of pre and perinatal lifestyle factors on child long term health and social outcomes: a systematic review

Study Aim Methods Outcome measure Findings Notes Quality assessment
Blair et al., 1996 [26] To investigate the effect of exposure to tobacco smoke on the sudden infant death syndrome Two year population based case-control study Participants: 195 babies who died and 780 matched controls SIDS A dose response was associated with exposure to tobacco smoke. Maternal smoking during pregnancy was significantly related to SIDS (OR = 2.10 [95% CI:1.24-3.54]) in the multivariate analysis. After adjustment, paternal smoking had an additional independent effect (OR = 2.50 [95% CI: 1.48- 4.22]) Adjusted for a good amount of covariates. Moderate
Fertig, 2010 [52] To examine the importance of selection on the effect of prenatal smoking by using three British cohorts Data from 3 UK birth cohort studies used providing a large data set of 45,400 participants. Birth weight The effect of prenatal smoking in 2000 on low birth weight is over 50% greater than in 1958 and is approximately double with respect to the probability of a low birth weight birth conditional on gestation. Selection could explain as much as 50% of the current association between prenatal smoking and the probability of low birth weight birth. Adjusted for a good amount of covariates. Strong
Golding et al., 1990 [14] Association between child cancer and factors during pregnancy, labour and delivery and other maternal aspects. Case-control study of 132 children. Development of childhood cancer was recorded. Child cancer Childhood cancer was associated with antenatal smoking (OR = 2.69 [95%CI:1.05-6.89]). Logistic regression showed independent relationship between childhood cancer and maternal smoking (OR = 2.5 [95% CI:1.20-5.08]) Some covariates accounted for. Moderate
Hawkins et al., 2009 [18] Association between risk factors (including birth weight and smoking during pregnancy) obesity. Prospective cohort study using data from the Millennium Cohort Study (n = 13,188) Childhood obesity Early childhood obesity was associated with maternal smoking during pregnancy (1-9 cigarettes daily: OR = 1.34 [1.17-1.54] fully adjusted; 10-19 cigarettes: OR = 1.49 [1.26-1.75] fully adjusted). Adjusted for a good amount of covariates. Strong
Henderson et al., 2001 [13] Association between smoking during pregnancy, environmental tobacco smoke (ETS) exposure and wheezing illness of infants of 6 months old Longitudinal cohort studies from the UK and Czech Republic (n = 14,269). Wheeze In the UK, infant wheeze was significantly associated with maternal smoking during pregnancy OR = 1.30 [95% CI: 1.09-1.56] adjusted). Adjusted for a good amount of covariates. Moderate
Koshy et al., 2011 [19] Association between children’s weight and height and cigarette smoke exposure during mothers’ pregnancy Use 2 UK cross-sectional surveys from 1998 and 2006 (n = 3038) Childhood obesity Smoking during pregnancy was associated with an increase in the likelihood of obesity in children (OR = 1.61[95% CI: 1.19–2.18]) Some covariates included. Moderate
Larsson & Montgomery (2011) [28] To assess the association between smoking during pregnancy and poorer motor competence among offspring Longitudinal study of 13,207 families in GB followed up to age 11. Hand control and coordination assessed using known measures. After adjustment, heavy smoking during pregnancy was significantly associated with poorer performance in PUM (picking up matches) task for the non-dominant hand in both boys (Coeff = 1.474 [95% CI: 0.47-2.48 p = .004] and girls (Coeff = 1.203 [95% CI: 0.15-2.26 p = .026]). It also negatively affected boys’ performance in CD (copying design test score) (Coeff = −0.185 [95% CI:-0.32 - -0.05 p = .006]). Good covariates Moderate
Little et al. 2004 [27] Association between smoking and orofacial clefts Case-control study of 438 children from England and Scotland. Orofacial clefts Maternal smoking during pregnancy had a positive association with cleft lip with or without cleft palate (CL+/-P)(OR = 1.9 [95% CI:1.1-3.1] adjusted), and cleft palate (CP) (OR = 2.3 [95% CI:1.3-4.1] adjusted). A dose-response was observed for both CL+/-P (p value = 0.012) and CP (p value = 0.004). Passive smoking of mothers also had weak effect. Adjusted for a good amount of covariates. Moderate
Pang et al. 2003 [53] Association between parental preconceptional smoking and maternal smoking in pregnancy, and risk of developing cancer in childhood UK based case control study using children diagnosed with malignancy or CNS tumour under 15 years (n = 3838) and matched controls (n = 7629). Childhood cancer Significant monotonic decreasing trends in risk were found in relation to the amount of cigarettes smoked by the mother during pregnancy for all child cancers, leukaemia, lymphoma, CNS tumours and other solid tumours (p < 0.001, p = 0.03, p = 0.01 and P = 0.03 respectively), with ORs statistically significantly below 1 among heavy smokers. For primitive neuroectodermal tumours the OR was 0.55 (P = 0.01). Some covariates included. Strong
Power et al. 2010 [20] Association between maternal smoking during pregnancy and risk factors for CVD Prospective UK cohort study following members up to age 45 years (n = 8815). Risk factors of CVD in adulthood Maternal smoking during pregnancy was associated with an increased likelihood of obesity in adult offspring classified by BMI (OR = 1.40 [95% CI: 1.25–1.56]) and high waist circumference (OR = 1.32 [95% CI: 1.19–1.47]) Adjusted for a good amount of covariates. Strong
Power et al. 2003 [22] To investigate growth trajectories and predictive factors for those with low birth weight and high adult BMI Birth cohort study followed up to age 33. Full data available for 7017 participants. Adulthood obesity Maternal smoking during pregnancy was associated with an increased likelihood of obesity in adult offspring classified by BMI for both males (OR = 1.79 [95% CI: 1.37-2.29] and females (OR = 2.27 [95% CI: 1.79-2.86]). Some covariates adjusted for. Strong
Power and Jefferies 2002 [21] Association between maternal smoking during pregnancy and obesity risk through childhood to age 33 Prospective GB cohort study of 5839 born in 1958. Assessed obesity status (BMI) at age 33. Adulthood obesity Maternal smoking during pregnancy was associated with an increased likelihood of obesity in adult offspring classified by BMI for both males (OR = 1.56 [95% CI: 1.22-2.00] and females (OR = 1.41 [95% CI: 1.12-1.79]. Good range of covariates. Strong
Ramadas et al. 2007 [15] 1. Association between the IL1RN gene polymorphisms with asthma; and 2. association between the gene (IL1RN)-environment (smoke exposure) interactions and asthma UK based prospective cohort study. Outcome measure: Asthma, airway obstruction and BHR Asthma The rs2234678 genotype GG was significantly associated with repeated measurements of asthma in children of mothers who smoked during pregnancy (ETS-2 group: OR 4.43, CI 1.62–12.1, p = 0.0037) but not in children without maternal smoking exposure during pregnancy (ETS-0 or ETS-1). This suggests that exposure to maternal smoking may be more detrimental to some children than others. Some covariates adjusted for. Moderate
Sadeghnejad et al. 2008 [16] To investigate whether there is a combined effect of interleukin-I3 gene polymorphisms and tobacco smoke on persistent childhood wheezing and asthma UK based cohort study followed up to age 10 (n = 791) Outcomes were wheezing and persistent childhood asthma Wheezing and asthma Maternal smoking during pregnancy was associated with early onset persistent wheeze (OR = 2.93, p < 0.0001). However, the effect of maternal smoking during pregnancy was stronger in children with certain genetic features (OR = 5.58 and OR =1.29, respectively; p for interaction = 0.014). When analyzing asthma instead of wheezing, the interaction was statistically significant (p = 0.03) for persistent asthma. Children with a CCG/CCG haplotype pair had an OR of 5.57 (95% CI 2.13 to 14.63, p = 0.0005) for ETS-2 on persistent asthma. For subjects with haplotype pairs other than CCG/CCG, the OR was 1.32 (95% CI 0.57 to 3.04, p = 0.587). Some covariates adjusted for. Moderate
Severson et al. 1993 [54] Association between parental smoking and alcohol consumption and childhood AML. Case control study in the US and Canada. Childhood cancer (Acute Myeloid Leukemia (AML)) No statistically significant associations were found for maternal cigarette smoking when exposures were restricted to the month immediately preceding pregnancy; the first, second, or third trimester of pregnancy; or during the time the mother was nursing the index child. Some covariates adjusted for. Moderate
Sorahan et al. 1995 [55] Association between any childhood cancer and consumption of alcohol and tobacco. Case-control study in England and Wales. Childhood cancer There was no association between maternal smoking and childhood cancer (P = 0.602). Only class, maternal and paternal age controlled for. Moderate
Sorahan and Lancashire 2004 [56] Relation between parental cigarette smoking and hepatoblastoma Case-control study in UK. 43 cases of hepatoblastoma and 5777 controls Childhood cancer Positive associations were found between hepatoblastoma risks and both maternal and paternal smoking. The largest relative risk is shown in the fuller model for both parents being smokers (RR = 2.69, P < 0.05, 95% CI 1.18–6.13). Good range of covariates. Moderate
Strachan et al. 1996 [17] The relationship between incidence of wheezing illness from birth to age 33 and perinatal, medical, social, environmental, and lifestyle factors Prospective longitudinal study across the UK. 18,559 participants followed to age 33 Asthma and wheeze Maternal smoking during pregnancy was associated with increased incidence of childhood wheezing (OR = 1.72 [95% CI: 1.11-2.67]), when compared to cohort members whose mother never smoked. Birth order, birth weight and birth weight for gestation were not significant independent risk factors. Good range of covariates. Strong
Thomas et al. 2007 [23] To explore how prenatal exposures known to be associated with low birth weight effect glucose metabolism in midlife. UK cohort study of 7518 cohort members born in 1958. Adult metabolism (diabetes) No association was found between maternal smoking and blood glucose levels in offspring after accounting for birth weight for gestational age (BGA) and adult adiposity. Some covariates adjusted for. Strong
Toschke et al. 2007 [24] To look at the association between maternal smoking and type 2 diabetes. GB prospective cohort study. 5214 cohort members from NCDS and 6069 from BCS70. Diabetes No association between diabetes and postnatal maternal smoking was observed. Good range of covariates Moderate
Toschke et al. 2003 [25] Association between smoking in pregnancy and appetite control in offspring GB prospective cohort study 10,557 cohort members born 1958 Appetite control An association was found between maternal smoking during pregnancy and offspring appetite control in adulthood (OR = 1.22 [95% CI: 1.01-1.48]). Some covariates adjusted for. Moderate