Maternal smoking during pregnancy and offspring overweight: is there a dose–response relationship? An individual patient data meta-analysis
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Background/objectives A number of meta-analyses suggest an association between any maternal smoking in pregnancy and offspring overweight obesity. Whether there is a dose-response relationship across number of cigarettes and whether this differs by sex remains unclear. Subject/methods Studies reporting number of cigarettes smoked during pregnancy and offspring BMI published up to May 2015 were searched. An individual patient data meta-analysis of association between the number of cigarettes smoked during pregnancy and offspring overweight (defined according to the International Obesity Task Force reference) was computed using a generalized additive mixed model with non-linear effects and adjustment for confounders (maternal weight status, breastfeeding, and maternal education) and stratification for sex. Results Of 26 identified studies, 16 authors provided data on a total of 238,340 mother-child-pairs. A linear positive association was observed between the number of cigarettes smoked and offspring overweight for up to 15 cigarettes per day with an OR increase per cigarette of 1.03, 95% CI = [1.02-1.03]. The OR flattened with higher cigarette use. Associations were similar in males and females. Sensitivity analyses supported these results. Conclusions A linear dose-response relationship of maternal smoking was observed in the range of 1-15 cigarettes per day equally in boys and girls with no further risk increase for doses above 15 cigarettes.
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A meta-analysis of 26 studies (n=238,340 mother-child pairs) found an overall increased OR for offspring exposed to maternal smoking during pregnancy being overweight or obese (OR=1.26; 95% CI = [1.22-1.29]).
“They found an overall increased ORs in offspring exposed to maternal smoking during pregnancy compared with offspring of mothers who did not smoke being overweight or obese (OR = 1.26; 95% CI = [1.22–1.29]).”
From Prenatal nicotine exposure during pregnancy results in adverse neurodevelopmental alterations and neurobehavioral deficits (2023) · cites this paper as [151]
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Experimental — accuracy not yet measuredThe odds of a child being obese or overweight increased linearly up to 10-15 cigarettes per day, levelling out for doses higher than 15 cigarettes per day.
“Assessing the dose-response relationship for both overweight and obesity in relation to the number of cigarettes smoked daily during pregnancy on a continuous scale, they found that the odds of a child being obese or overweight increased linearly up to 10–15 cigarettes per day, levelling out for doses higher than 15 cigarettes per day [151].”
From Prenatal nicotine exposure during pregnancy results in adverse neurodevelopmental alterations and neurobehavioral deficits (2023) · cites this paper as [151]
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- Authors
- Albers, L., Sobotzki, C., Kuß, O., Ajslev, T., Batista, R. F., Bettiol, H., Brabin, B., Buka, S. L., Cardoso, V. C., Clifton, V. L., Devereux, G., Gilman, S. E., Grzeskowiak, L. E., Heinrich, J., Hummel, S., Jacobsen, G. W., Jones, G., Koshy, G., Morgen, C. S., Oken, E., Paus, T., Pausova, Z., Rifas-Shiman, S. L., Sharma, A. J., da Silva, A. A., Sørensen, T. I., Thiering, E., Turner, S., Vik, T., & von Kries, R.
- Affiliations
- Ludwig-Maximilians-Universität München (DE)
- Deutsches Diabetes-Zentrum e.V. (DE)
- Frederiksberg Hospital (DK)
- Liverpool School of Tropical Medicine (GB)
- Brown University (US)
- Universidade de São Paulo (BR)
- The University of Adelaide (AU)
- University of Aberdeen (GB)
- Harvard University (US)
- Helmholtz Munich (DE)
- Norwegian University of Science and Technology (NO)
- University of Tasmania (AU)
- Centers for Disease Control and Prevention (US)
- University of Copenhagen (DK)
- Corresponding author
- Albers, Lucia
- ORCID
- Albers, Lucia
- Sobotzki, Christina
- Kuß, Oliver
- Ajslev, Teresa
- Brabin, Bernard
- Buka, Stephen L
- Cardoso, Viviane C
- Clifton, Vicki L
- Devereux, Graham
- Gilman, Stephen E
- Grzeskowiak, Luke E
- Heinrich, Joachim
- Hummel, Sandra
- Jacobsen, Geir W
- Jones, Graeme
- Koshy, Gibby
- Morgen, Camilla Schmidt
- Oken, Emily
- Sharma, Andrea J
- Sørensen, Thorkild IA
- Thiering, Elisabeth
- Vik, Torstein
- Venue
- International Journal of Obesity
- Published
- 2018-02-28
- Volume
- 42
- Issue
- 7
- Pages
- 1249-1264
- ISSN
- 0307-0565 (ISSN-L)
- 1476-5497
- PMC
- PMC6685293
- OpenAlex
- W2792151868
- Cited by
- 57
- References
- 87
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 11 · 2023: 6 · 2022: 11 · 2021: 6 · 2020: 6 · 2019: 8 · 2018: 3
- FWCI
- 0.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- International Journal of Obesity (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (acceptedVersion, other-oa)
- PubMed Central (acceptedVersion)
- LSTM Online Archive (Liverpool School of Tropical Medicine) (acceptedVersion)
- eCite Digital Repository (University of Tasmania) (submittedVersion)
- UTAS Research Repository (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Site cant be reached (submittedVersion, other-oa)
- Funders
- March of Dimes Foundation
- Wellcome Trust (102215/2/13/2), 102215)
- University of Bristol (102215/2/13/2)
- National Research Foundation (102215)
- Deutsche Forschungsgemeinschaft
- Danmarks Grundforskningsfond
- Fundação de Amparo à Pesquisa do Estado de São Paulo
- Conselho Nacional de Desenvolvimento Científico e Tecnológico
- Augustinus Fonden
- National Institutes of Health (CC999999)
- Medical Research Council (102215, 102215/2/13/2)
- National Health and Medical Research Council (102215/2/13/2)
- National Institute of Child Health and Human Development (HD034568)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R37HD034568, R01HD034568)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- smoking during pregnancy, offspring obesity, dose-response relationship, number of cigarettes smoked, offspring body mass index, sex differences, prenatal tobacco exposure
- MeSH terms
- Adult, Child, Child Development, Child, Preschool, Dose-Response Relationship, Drug, Female, Humans, Infant, Infant, Newborn, Male, Pregnancy, Prenatal Exposure Delayed Effects, Smoking, Body Mass Index, Sex Distribution, Pregnant People, Pregnant Women, Pediatric Obesity
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