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


Autoři: Elise M. Philips aff001;  Susana Santos aff001;  Leonardo Trasande aff003;  Juan J. Aurrekoetxea aff008;  Henrique Barros aff011;  Andrea von Berg aff013;  Anna Bergström aff014;  Philippa K. Bird aff016;  Sonia Brescianini aff017;  Carol Ní Chaoimh aff018;  Marie-Aline Charles aff020;  Leda Chatzi aff021;  Cécile Chevrier aff022;  George P. Chrousos aff023;  Nathalie Costet aff022;  Rachel Criswell aff024;  Sarah Crozier aff026;  Merete Eggesbø aff027;  Maria Pia Fantini aff028;  Sara Farchi aff029;  Francesco Forastiere aff029;  Marleen M. H. J. van Gelder aff030;  Vagelis Georgiu aff032;  Keith M. Godfrey aff026;  Davide Gori aff028;  Wojciech Hanke aff034;  Barbara Heude aff020;  Daniel Hryhorczuk aff035;  Carmen Iñiguez aff010;  Hazel Inskip aff026;  Anne M. Karvonen aff037;  Louise C. Kenny aff019;  Inger Kull aff039;  Debbie A. Lawlor aff041;  Irina Lehmann aff043;  Per Magnus aff044;  Yannis Manios aff045;  Erik Melén aff014;  Monique Mommers aff046;  Camilla S. Morgen aff047;  George Moschonis aff049;  Deirdre Murray aff019;  Ellen A. Nohr aff051;  Anne-Marie Nybo Andersen aff048;  Emily Oken aff052;  Adriëtte J. J. M. Oostvogels aff053;  Eleni Papadopoulou aff054;  Juha Pekkanen aff037;  Costanza Pizzi aff056;  Kinga Polanska aff034;  Daniela Porta aff029;  Lorenzo Richiardi aff056;  Sheryl L. Rifas-Shiman aff052;  Nel Roeleveld aff030;  Franca Rusconi aff057;  Ana C. Santos aff011;  Thorkild I. A. Sørensen aff048;  Marie Standl aff059;  Camilla Stoltenberg aff060;  Jordi Sunyer aff010;  Elisabeth Thiering aff059;  Carel Thijs aff046;  Maties Torrent aff065;  Tanja G. M. Vrijkotte aff053;  John Wright aff066;  Oleksandr Zvinchuk aff067;  Romy Gaillard aff001;  Vincent W. V. Jaddoe aff001
Působiště autorů: The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands aff001;  Department of Pediatrics, Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands aff002;  Department of Pediatrics, New York University School of Medicine, New York City, New York, United States of America aff003;  Department of Environmental Medicine, New York University School of Medicine, New York City, New York, United States of America aff004;  Department of Population Health, New York University School of Medicine, New York City, New York, United States of America aff005;  New York Wagner School of Public Service, New York City, New York, United States of America aff006;  New York University College of Global Public Health, New York City, New York, United States of America aff007;  Subdirección de Salud Pública Gipuzkoa, San Sebastián, Spain aff008;  Instituto de Investigación Sanitaria BIODONOSTIA, San Sebastián, Spain aff009;  CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain aff010;  EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal aff011;  Department of Public Health and Forensic Sciences and Medical Education, Unit of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal aff012;  Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany aff013;  Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden aff014;  Centre for Occupational and Environmental Medicine Stockholm County Council, Stockholm, Sweden aff015;  Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom aff016;  Centre for Behavioural Science and Mental Health, Istituto Superiore di Sanità, Rome, Italy aff017;  Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland aff018;  Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, University College Cork, Cork, Ireland aff019;  Université de Paris, CRESS, INSERM, INRA, Paris, France aff020;  Department of Preventive Medicine, University of Southern California, Los Angeles, United States of America aff021;  Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environment et travail)–UMR_S 1085, Rennes, France aff022;  First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Aghia Sophia Children’s Hospital, Athens, Greece aff023;  Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway aff024;  Maine-Dartmouth Family Medicine Residency, Augusta, Maine, United States of America aff025;  MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom aff026;  Department of Exposure and Environmental Epidemiology, Norwegian Institute of Public Health, Oslo, Norway aff027;  The Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy aff028;  Department of Epidemiology, Lazio Regional Health Service, Rome, Italy aff029;  Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands aff030;  Radboud REshape Innovation Center, Radboud University Medical Center, Nijmegen, the Netherlands aff031;  Department of Social Medicine, University of Crete, Heraklion, Greece aff032;  NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom aff033;  Department of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland aff034;  Center for Global Health, University of Illinois College of Medicine, Chicago, Illinois, United States of America aff035;  Department of Statistics and Computational Research, Universitat de València, València, Spain aff036;  Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland aff037;  Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland aff038;  Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden aff039;  Sachs' Children and Youth Hospital, Stockholm, Sweden aff040;  MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, United Kingdom aff041;  Population Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom aff042;  Department of Environmental Immunology/Core Facility Studies, Helmholtz Centre for Environmental Research–UFZ, Leipzig, Germany aff043;  Division of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway aff044;  Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece aff045;  Department of Epidemiology, Care and Public Health Research Institute, Maastricht University Maastricht, the Netherlands aff046;  National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark aff047;  Department of Public Health, Section of Epidemiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark aff048;  Department of Dietetics, Nutrition and Sport, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia aff049;  Paediatrics & Child Health, University College Cork, Cork, Ireland aff050;  Research Unit for Gynaecology and Obstetrics, Institute for Clinical Research, University of Southern Denmark, Denmark aff051;  Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States of America aff052;  Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, the Netherlands aff053;  Department of Environmental Exposures and Epidemiology, Domain of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway aff054;  Department of Public Health, University of Helsinki, Helsinki, Finland aff055;  Department of Medical Sciences, University of Turin, Turin, Italy aff056;  Unit of Epidemiology, "Anna Meyer" Children's University Hospital, Florence, Italy aff057;  The Novo Nordisk Foundation Center for Basic Metabolic Research, Section on Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark aff058;  Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany aff059;  Norwegian Institute of Public Health, Oslo, Norway aff060;  Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway aff061;  ISGlobal, Institute for Global Health, Barcelona, Spain aff062;  Universitat Pompeu Fabra (UPF), Barcelona, Spain aff063;  Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany aff064;  Ib-salut, Area de Salut de Menorca, Palma, Spain aff065;  Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford, United Kingdom aff066;  Department of Medical and Social Problems of Family Health, Institute of Pediatrics, Obstetrics and Gynecology, Kyiv, Ukraine aff067
Vyšlo v časopise: 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 Med 17(8): e32767. doi:10.1371/journal.pmed.1003182
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003182

Souhrn

Background

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.

Methods and findings

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.

Conclusions

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.

Klíčová slova:

Birth – Birth weight – Body mass index – Medical risk factors – Pregnancy – Preterm birth – Smoking habits – Overweight


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