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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