Changes in parental smoking during pregnancy and risks of adverse birth outcomes and childhood overweight in Europe and North America: An individual participant data meta-analysis of 229,000 singleton births.
<h4>Background</h4>Fetal smoke exposure is a common and key avoidable risk factor for birth complications and seems to influence later risk of overweight. It is unclear whether this increased risk is also present if mothers smoke during the first trimester only or reduce the number of ci...
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2020-08-01
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| Online Access: | https://doi.org/10.1371/journal.pmed.1003182 |
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| author | Elise M Philips Susana Santos Leonardo Trasande Juan J Aurrekoetxea Henrique Barros Andrea von Berg Anna Bergström Philippa K Bird Sonia Brescianini Carol Ní Chaoimh Marie-Aline Charles Leda Chatzi Cécile Chevrier George P Chrousos Nathalie Costet Rachel Criswell Sarah Crozier Merete Eggesbø Maria Pia Fantini Sara Farchi Francesco Forastiere Marleen M H J van Gelder Vagelis Georgiu Keith M Godfrey Davide Gori Wojciech Hanke Barbara Heude Daniel Hryhorczuk Carmen Iñiguez Hazel Inskip Anne M Karvonen Louise C Kenny Inger Kull Debbie A Lawlor Irina Lehmann Per Magnus Yannis Manios Erik Melén Monique Mommers Camilla S Morgen George Moschonis Deirdre Murray Ellen A Nohr Anne-Marie Nybo Andersen Emily Oken Adriëtte J J M Oostvogels Eleni Papadopoulou Juha Pekkanen Costanza Pizzi Kinga Polanska Daniela Porta Lorenzo Richiardi Sheryl L Rifas-Shiman Nel Roeleveld Franca Rusconi Ana C Santos Thorkild I A Sørensen Marie Standl Camilla Stoltenberg Jordi Sunyer Elisabeth Thiering Carel Thijs Maties Torrent Tanja G M Vrijkotte John Wright Oleksandr Zvinchuk Romy Gaillard Vincent W V Jaddoe |
| author_facet | Elise M Philips Susana Santos Leonardo Trasande Juan J Aurrekoetxea Henrique Barros Andrea von Berg Anna Bergström Philippa K Bird Sonia Brescianini Carol Ní Chaoimh Marie-Aline Charles Leda Chatzi Cécile Chevrier George P Chrousos Nathalie Costet Rachel Criswell Sarah Crozier Merete Eggesbø Maria Pia Fantini Sara Farchi Francesco Forastiere Marleen M H J van Gelder Vagelis Georgiu Keith M Godfrey Davide Gori Wojciech Hanke Barbara Heude Daniel Hryhorczuk Carmen Iñiguez Hazel Inskip Anne M Karvonen Louise C Kenny Inger Kull Debbie A Lawlor Irina Lehmann Per Magnus Yannis Manios Erik Melén Monique Mommers Camilla S Morgen George Moschonis Deirdre Murray Ellen A Nohr Anne-Marie Nybo Andersen Emily Oken Adriëtte J J M Oostvogels Eleni Papadopoulou Juha Pekkanen Costanza Pizzi Kinga Polanska Daniela Porta Lorenzo Richiardi Sheryl L Rifas-Shiman Nel Roeleveld Franca Rusconi Ana C Santos Thorkild I A Sørensen Marie Standl Camilla Stoltenberg Jordi Sunyer Elisabeth Thiering Carel Thijs Maties Torrent Tanja G M Vrijkotte John Wright Oleksandr Zvinchuk Romy Gaillard Vincent W V Jaddoe |
| author_sort | Elise M Philips |
| collection | DOAJ |
| description | <h4>Background</h4>Fetal smoke exposure is a common and key avoidable risk factor for birth complications and seems to influence later risk of overweight. It is unclear whether this increased risk is also present if mothers smoke during the first trimester only or reduce the number of cigarettes during pregnancy, or when only fathers smoke. We aimed to assess the associations of parental smoking during pregnancy, specifically of quitting or reducing smoking and maternal and paternal smoking combined, with preterm birth, small size for gestational age, and childhood overweight.<h4>Methods and findings</h4>We performed an individual participant data meta-analysis among 229,158 families from 28 pregnancy/birth cohorts from Europe and North America. All 28 cohorts had information on maternal smoking, and 16 also had information on paternal smoking. In total, 22 cohorts were population-based, with birth years ranging from 1991 to 2015. The mothers' median age was 30.0 years, and most mothers were medium or highly educated. We used multilevel binary logistic regression models adjusted for maternal and paternal sociodemographic and lifestyle-related characteristics. Compared with nonsmoking mothers, maternal first trimester smoking only was not associated with adverse birth outcomes but was associated with a higher risk of childhood overweight (odds ratio [OR] 1.17 [95% CI 1.02-1.35], P value = 0.030). Children from mothers who continued smoking during pregnancy had higher risks of preterm birth (OR 1.08 [95% CI 1.02-1.15], P value = 0.012), small size for gestational age (OR 2.15 [95% CI 2.07-2.23], P value < 0.001), and childhood overweight (OR 1.42 [95% CI 1.35-1.48], P value < 0.001). Mothers who reduced the number of cigarettes between the first and third trimester, without quitting, still had a higher risk of small size for gestational age. However, the corresponding risk estimates were smaller than for women who continued the same amount of cigarettes throughout pregnancy (OR 1.89 [95% CI 1.52-2.34] instead of OR 2.20 [95% CI 2.02-2.42] when reducing from 5-9 to ≤4 cigarettes/day; OR 2.79 [95% CI 2.39-3.25] and OR 1.93 [95% CI 1.46-2.57] instead of OR 2.95 [95% CI 2.75-3.15] when reducing from ≥10 to 5-9 and ≤4 cigarettes/day, respectively [P values < 0.001]). Reducing the number of cigarettes during pregnancy did not affect the risks of preterm birth and childhood overweight. Among nonsmoking mothers, paternal smoking was associated with childhood overweight (OR 1.21 [95% CI 1.16-1.27], P value < 0.001) but not with adverse birth outcomes. Limitations of this study include the self-report of parental smoking information and the possibility of residual confounding. As this study only included participants from Europe and North America, results need to be carefully interpreted regarding other populations.<h4>Conclusions</h4>We observed that as compared to nonsmoking during pregnancy, quitting smoking in the first trimester is associated with the same risk of preterm birth and small size for gestational age, but with a higher risk of childhood overweight. Reducing the number of cigarettes, without quitting, has limited beneficial effects. Paternal smoking seems to be associated, independently of maternal smoking, with the risk of childhood overweight. Population strategies should focus on parental smoking prevention before or at the start, rather than during, pregnancy. |
| format | Article |
| id | doaj-art-f2c2a5ad6746471aaea64a98ec0cd1fa |
| institution | Kabale University |
| issn | 1549-1277 1549-1676 |
| language | English |
| publishDate | 2020-08-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Medicine |
| spelling | doaj-art-f2c2a5ad6746471aaea64a98ec0cd1fa2025-08-20T03:25:19ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762020-08-01178e100318210.1371/journal.pmed.1003182Changes in parental smoking during pregnancy and risks of adverse birth outcomes and childhood overweight in Europe and North America: An individual participant data meta-analysis of 229,000 singleton births.Elise M PhilipsSusana SantosLeonardo TrasandeJuan J AurrekoetxeaHenrique BarrosAndrea von BergAnna BergströmPhilippa K BirdSonia BrescianiniCarol Ní ChaoimhMarie-Aline CharlesLeda ChatziCécile ChevrierGeorge P ChrousosNathalie CostetRachel CriswellSarah CrozierMerete EggesbøMaria Pia FantiniSara FarchiFrancesco ForastiereMarleen M H J van GelderVagelis GeorgiuKeith M GodfreyDavide GoriWojciech HankeBarbara HeudeDaniel HryhorczukCarmen IñiguezHazel InskipAnne M KarvonenLouise C KennyInger KullDebbie A LawlorIrina LehmannPer MagnusYannis ManiosErik MelénMonique MommersCamilla S MorgenGeorge MoschonisDeirdre MurrayEllen A NohrAnne-Marie Nybo AndersenEmily OkenAdriëtte J J M OostvogelsEleni PapadopoulouJuha PekkanenCostanza PizziKinga PolanskaDaniela PortaLorenzo RichiardiSheryl L Rifas-ShimanNel RoeleveldFranca RusconiAna C SantosThorkild I A SørensenMarie StandlCamilla StoltenbergJordi SunyerElisabeth ThieringCarel ThijsMaties TorrentTanja G M VrijkotteJohn WrightOleksandr ZvinchukRomy GaillardVincent W V Jaddoe<h4>Background</h4>Fetal smoke exposure is a common and key avoidable risk factor for birth complications and seems to influence later risk of overweight. It is unclear whether this increased risk is also present if mothers smoke during the first trimester only or reduce the number of cigarettes during pregnancy, or when only fathers smoke. We aimed to assess the associations of parental smoking during pregnancy, specifically of quitting or reducing smoking and maternal and paternal smoking combined, with preterm birth, small size for gestational age, and childhood overweight.<h4>Methods and findings</h4>We performed an individual participant data meta-analysis among 229,158 families from 28 pregnancy/birth cohorts from Europe and North America. All 28 cohorts had information on maternal smoking, and 16 also had information on paternal smoking. In total, 22 cohorts were population-based, with birth years ranging from 1991 to 2015. The mothers' median age was 30.0 years, and most mothers were medium or highly educated. We used multilevel binary logistic regression models adjusted for maternal and paternal sociodemographic and lifestyle-related characteristics. Compared with nonsmoking mothers, maternal first trimester smoking only was not associated with adverse birth outcomes but was associated with a higher risk of childhood overweight (odds ratio [OR] 1.17 [95% CI 1.02-1.35], P value = 0.030). Children from mothers who continued smoking during pregnancy had higher risks of preterm birth (OR 1.08 [95% CI 1.02-1.15], P value = 0.012), small size for gestational age (OR 2.15 [95% CI 2.07-2.23], P value < 0.001), and childhood overweight (OR 1.42 [95% CI 1.35-1.48], P value < 0.001). Mothers who reduced the number of cigarettes between the first and third trimester, without quitting, still had a higher risk of small size for gestational age. However, the corresponding risk estimates were smaller than for women who continued the same amount of cigarettes throughout pregnancy (OR 1.89 [95% CI 1.52-2.34] instead of OR 2.20 [95% CI 2.02-2.42] when reducing from 5-9 to ≤4 cigarettes/day; OR 2.79 [95% CI 2.39-3.25] and OR 1.93 [95% CI 1.46-2.57] instead of OR 2.95 [95% CI 2.75-3.15] when reducing from ≥10 to 5-9 and ≤4 cigarettes/day, respectively [P values < 0.001]). Reducing the number of cigarettes during pregnancy did not affect the risks of preterm birth and childhood overweight. Among nonsmoking mothers, paternal smoking was associated with childhood overweight (OR 1.21 [95% CI 1.16-1.27], P value < 0.001) but not with adverse birth outcomes. Limitations of this study include the self-report of parental smoking information and the possibility of residual confounding. As this study only included participants from Europe and North America, results need to be carefully interpreted regarding other populations.<h4>Conclusions</h4>We observed that as compared to nonsmoking during pregnancy, quitting smoking in the first trimester is associated with the same risk of preterm birth and small size for gestational age, but with a higher risk of childhood overweight. Reducing the number of cigarettes, without quitting, has limited beneficial effects. Paternal smoking seems to be associated, independently of maternal smoking, with the risk of childhood overweight. Population strategies should focus on parental smoking prevention before or at the start, rather than during, pregnancy.https://doi.org/10.1371/journal.pmed.1003182 |
| spellingShingle | Elise M Philips Susana Santos Leonardo Trasande Juan J Aurrekoetxea Henrique Barros Andrea von Berg Anna Bergström Philippa K Bird Sonia Brescianini Carol Ní Chaoimh Marie-Aline Charles Leda Chatzi Cécile Chevrier George P Chrousos Nathalie Costet Rachel Criswell Sarah Crozier Merete Eggesbø Maria Pia Fantini Sara Farchi Francesco Forastiere Marleen M H J van Gelder Vagelis Georgiu Keith M Godfrey Davide Gori Wojciech Hanke Barbara Heude Daniel Hryhorczuk Carmen Iñiguez Hazel Inskip Anne M Karvonen Louise C Kenny Inger Kull Debbie A Lawlor Irina Lehmann Per Magnus Yannis Manios Erik Melén Monique Mommers Camilla S Morgen George Moschonis Deirdre Murray Ellen A Nohr Anne-Marie Nybo Andersen Emily Oken Adriëtte J J M Oostvogels Eleni Papadopoulou Juha Pekkanen Costanza Pizzi Kinga Polanska Daniela Porta Lorenzo Richiardi Sheryl L Rifas-Shiman Nel Roeleveld Franca Rusconi Ana C Santos Thorkild I A Sørensen Marie Standl Camilla Stoltenberg Jordi Sunyer Elisabeth Thiering Carel Thijs Maties Torrent Tanja G M Vrijkotte John Wright Oleksandr Zvinchuk Romy Gaillard Vincent W V Jaddoe Changes in parental smoking during pregnancy and risks of adverse birth outcomes and childhood overweight in Europe and North America: An individual participant data meta-analysis of 229,000 singleton births. PLoS Medicine |
| title | Changes in parental smoking during pregnancy and risks of adverse birth outcomes and childhood overweight in Europe and North America: An individual participant data meta-analysis of 229,000 singleton births. |
| title_full | Changes in parental smoking during pregnancy and risks of adverse birth outcomes and childhood overweight in Europe and North America: An individual participant data meta-analysis of 229,000 singleton births. |
| title_fullStr | Changes in parental smoking during pregnancy and risks of adverse birth outcomes and childhood overweight in Europe and North America: An individual participant data meta-analysis of 229,000 singleton births. |
| title_full_unstemmed | Changes in parental smoking during pregnancy and risks of adverse birth outcomes and childhood overweight in Europe and North America: An individual participant data meta-analysis of 229,000 singleton births. |
| title_short | Changes in parental smoking during pregnancy and risks of adverse birth outcomes and childhood overweight in Europe and North America: An individual participant data meta-analysis of 229,000 singleton births. |
| title_sort | changes in parental smoking during pregnancy and risks of adverse birth outcomes and childhood overweight in europe and north america an individual participant data meta analysis of 229 000 singleton births |
| url | https://doi.org/10.1371/journal.pmed.1003182 |
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