Maternal smoking during pregnancy and child overweight: Systematic review and meta-analysis

Obesity Prevention Program, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA.
International journal of obesity (2005) (Impact Factor: 5). 03/2008; 32(2):201-10. DOI: 10.1038/sj.ijo.0803760
Source: PubMed


Perform a systematic review of studies reporting on the association between maternal prenatal cigarette smoking and child overweight.
Meta-analysis of observational studies.
Medline search and review of reference lists among studies published through June 2006.
Included studies reported an association between maternal smoking during pregnancy and risk of overweight among children at least 2 years of age. We did not include in the meta-analysis studies that provided only a continuous measure of adiposity, although those studies are discussed separately.
Based on results of 84 563 children reported in 14 observational studies, children whose mothers smoked during pregnancy were at elevated risk for overweight (pooled adjusted odds ratio (OR) 1.50, 95% CI: 1.36, 1.65) at ages 3-33 years, compared with children whose mothers did not smoke during pregnancy. The pooled estimate from unadjusted odds ratios (OR 1.52, 95% CI: 1.36, 1.69) was similar to the adjusted estimate, suggesting that sociodemographic and behavioral differences between smokers and nonsmokers did not explain the observed association. Although we observed evidence for publication bias, simulating a symmetric set of studies yielded a similar estimate (OR 1.40, 95% CI: 1.26, 1.55).
Prenatal smoking exposure appears to increase rates of overweight in childhood. In parts of the world undergoing the epidemiologic transition, the continuing increase in smoking among young women could contribute to spiraling increases in rates of obesity-related health outcomes in the 21st century.

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    • "All models were adjusted for parity, maternal education, paternal smoking at the start of pregnancy, and housing tenure. Because maternal prenatal smoking itself is associated with overweight in the offspring (Oken et al., 2007; Ino, 2010), we have analyzed separately the children whose mothers themselves smoked during pregnancy. In line with the evidence in the literature that various effects of cigarette smoking are sex specific (e.g., Zaren et al., 2000), together with the results from our earlier studies (Miller et al., 2014; Northstone et al., 2014; Pembrey et al., 2006), we have analyzed the male and female offspring separately and, where appropriate, have tested for interactions with sex. "
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    ABSTRACT: Objectives Previously, in the Avon Longitudinal Study of Parents and Children (ALSPAC), we have shown different sex-specific birth anthropometric measurements contingent upon whether or not prenatal smoking was undertaken by paternal grandmother (PGM), maternal grandmother (MGM), and the study mother (M). The findings raised the question as to whether there were long-term associations on the growth of the study children over time. Methods Measures of weight, height, body mass index, waist circumference, lean mass, and fat mass of children in the ALSPAC study from 7 to 17 years of age were used. We compared growth in four categories at each age: PGM+M- with PGM-M-; MGM+M- with MGM-M-; PGM+M+ with PGM-M+; MGM+M+ with MGM-M+; and adjusted for housing tenure, maternal education, parity, and paternal smoking at the start of the study pregnancy. ResultsWe found that if the PGM had, but the study mother had not, smoked in pregnancy, the girls were taller and both genders had greater bone and lean mass. However, if the MGM had smoked prenatally but the mother had not (MGM+M-), the boys became heavier than expected with increasing agean association that was particularly due to lean rather than fat mass, reflected in increased strength and fitness. When both the maternal grandmother and the mother had smoked (MGM+M+) girls had reduced height, weight, and fat/lean/bone mass when compared with girls born to smoking mothers whose own mothers had not smoked (MGM-M+). Conclusions This study indicates that smoking in humans can have sex-specific transgenerational effects. Am. J. Hum. Biol. 26:731-739, 2014. (c) 2014 The Authors American Journal of Human Biology Published by Wiley Periodicals, Inc.
    Full-text · Article · Nov 2014 · American Journal of Human Biology
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    • "There is speculation that the effect of intrauterine tobacco exposure on childhood obesity may depend largely on cigarette smoking during the first trimester, whereas the additional impact of smoking throughout pregnancy might be due to confounding by sociodemographics [8] or residual confounding by genetic and family environmental factors [7, 10]. However, a systematic review of studies reporting on the association between maternal prenatal cigarette smoking and elevated risk for childhood overweight suggested that sociodemographic and behavioral differences between smokers and nonsmokers did not explain the observed association [26]. The review suggested that prenatal smoke exposure led to about 50% increase in the risk of being overweight in childhood. "
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    ABSTRACT: Aim: To investigate the association between maternal smoking during pregnancy, second-hand tobacco smoke (STS) exposure, education level, and preschool children's wheezing and overweight. Methods: This cohort study used data of the KANC cohort--1,489 4-6-year-old children from Kaunas city, Lithuania. Multivariate logistic regression was employed to study the influence of prenatal and postnatal STS exposure on the prevalence of wheezing and overweight, controlling for potential confounders. Results: Children exposed to maternal smoking during pregnancy had a slightly increased prevalence of wheezing and overweight. Postnatal exposure to STS was associated with a statistically significantly increased risk of wheezing and overweight in children born to mothers with lower education levels (OR 2.12; 95% CI 1.04-4.35 and 3.57; 95% CI 1.76-7.21, accordingly). Conclusions: The present study findings suggest that both maternal smoking during pregnancy and STS increase the risk of childhood wheezing and overweight, whereas lower maternal education might have a synergetic effect. Targeted interventions must to take this into account and address household smoking.
    Full-text · Article · Jul 2014 · BioMed Research International
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    • "Birth weight is now known to be related to functional and ‘human capital’ outcomes in adult life, including height, muscle strength, cognitive ability and educational attainment [9]. Other early life exposures have shown associations with later health including, among others, maternal gestational diabetes (an example of fetal over-nutrition) [10], maternal smoking [11] and patterns of infant feeding [12]. Interactions have been demonstrated, between genotype and birth weight, and between birth weight and childhood growth or social circumstances, in relation to later outcomes [13,14]. "
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    ABSTRACT: In this issue, Keinan-Boker summarises the main studies that have followed up offspring of women exposed to famine during pregnancy and calls for the establishment of a national cohort of Holocaust survivors and their offspring to study inter-generational effects. She suggests that the study would consolidate the fetal origins theory and lead to translational applications to deal with the inter-generational effects of the Holocaust. Barker suggested that alterations in the nutritional supply during critical stages of intra-uterine development permanently alter the structure and metabolism of fetal organs which he termed 'fetal programming' (now known as developmental origins of health and disease). The famine studies have played an important role in refining the hypothesis by allowing a 'quasi-experimental' setting that would otherwise have been impossible to recreate. The developmental origins hypothesis provides a framework to link genetic, environmental and social factors across the lifecourse and offers a primordial preventive strategy to prevent non-communicable disease. Although the famine studies have provided valuable information, the results from various studies are inconsistent. It is perhaps unsurprising given the problems with collecting and interpreting data from famine studies. Survival bias and information bias are key issues. With mortality rates being high, survivors may differ significantly from non-survivors in factors which influence disease development. Most of the data is at ecological level; a lack of individual-level data and poor records make it difficult to identify those affected and assess the severity of effect. Confounding is also possible due to the varying periods and degrees of food deprivation, physical punishment and mental stress undergone by famine survivors. Nonetheless, there would be value in setting up a cohort of Holocaust survivors and their offspring and Keinan-Boker correctly argues that they deserve special attention. National support is essential as the study may re-open old wounds. The study will need to be appropriately planned and resourced. If properly designed, it may provide further insight into the developmental origins hypothesis and suggest translational applications. It may also influence provision of support to women and children affected by man-made wars and famines that continue to happen across the world.
    Full-text · Article · Jun 2014 · Israel Journal of Health Policy Research
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