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Grandmother's smoking when pregnant with the mother and asthma in the grandchild: the Norwegian Mother and Child Cohort Study
Open accessAbstract
BACKGROUND: A trans-generational influence of prenatal tobacco smoke exposure on asthma development has been proposed but the evidence remains sparse. METHODS: We examined the grandmother's smoking when pregnant with the mother in relation to asthma outcomes in the grandchild (current asthma at 36 months (N=53 169, cases=3013), current asthma at 7 years (N=25 394, cases=1265) and dispensed asthma medications at 7 years in the Norwegian Prescription Database (N=45 607, cases=1787)) within the Norwegian Mother and Child Cohort Study (MoBa). We calculated adjusted RR (adj. RR) and 95% CIs using log binomial regression. RESULTS: A total of 23.5% of mothers reported that their mother smoked when pregnant with them. The grandmother's smoking when pregnant with the mother was positively associated with asthma at 36 months (adj. RR 1.15 (95% CI 1.06 to 1.24)), asthma at 7 years (adj. RR 1.21 (95% CI 1.07 to 1.37)) and dispensed asthma medications at 7 years (adj. RR 1.15 (95% CI 1.04 to 1.26)). This positive association did not differ significantly by the mother's smoking status when pregnant with the child (p values for multiplicative interaction >0.1). CONCLUSIONS: The grandmother's smoking when pregnant with the mother increased the risk of asthma in the grandchild independent of the mother's smoking status. However, given limited information on the grandmother's socioeconomic status, asthma status and other factors, unmeasured confounding may be present.
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“The Norwegian Mother and Child Cohort Study also found a strong association between grandmaternal smoking during pregnancy and childhood asthma.84”
From Impact of Tobacco Smoke and Nicotine Exposure on Lung Development (2016) · cites this paper as [84]
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“The authors of this study hypothesised that transgenerational epigenetic changes associated with DNA methylation could explain this finding.(36) In our study, we did not collect data on the smoking habits of grandmothers, although this would be an interesting variable to analyse in future studies.”
BackgroundChildren and the European Respiratory Society: from silos to synergies
Gappa, M., Bush, A., Ersu, R. H., Soto‐Martínez, M. E., Mœller, A., Pijnenburg, M. W. H., Singh, V., Vijverberg, S. J. H., & Zar, H. J. (2023) · European Respiratory Journal · doi:10.1183/13993003.01692-2023 · Cited by 7
McNabb-Kelada, N. A., Burke, T., Jayaraman, S., Mills, L. J., Torre, A. I. D. L., Silvia, M., Schrader, H., Nacci, D. E., Clark, B. W., & Whitehead, A. (2025) · Environmental Science & Technology · doi:10.1021/acs.est.5c05887 · Cited by 6
Environmental Contributions to Respiratory Disease in Children
Sly, P. D., & Bush, A. (2019) · Elsevier eBooks · doi:10.1016/b978-0-323-44887-1.00004-3 · Cited by 6
Unfriendly Fire: How the Tobacco Industry is Destroying the Future of Our Children
Bush, A., Ferkol, T., Valiulis, A., Mazur, A., Chkhaidze, I., Maglakelidze, T., Sargsyan, S., Boyajyan, G. A., Cirstea, O., Доан, С. І., et al. (2021) · Acta medica Lituanica · doi:10.15388/amed.2020.28.1.6 · Cited by 7
“Transgenerational effects? Two large studies have shown that if a grandmother is a smoker, even if her own daughter does not smoke, her daughter’s children, her grandchildren, are more likely to develop asthma [28, 29].”
BackgroundKordas, K., & Park, A. (2015) · International Journal of Epidemiology · doi:10.1093/ije/dyv132 · Cited by 6
McAlinden, K. D., Naidu, V. G. M., Sohal, S. S., & Sharma, P. K. (2020) · American Journal of Physiology-Lung Cellular and Molecular Physiology · doi:10.1152/ajplung.00230.2019 · Cited by 6
RetractedPerinatal Exposure to Nicotine Alters Sperm RNA Profiles in Rats
Wang, H., Liu, J., Gao, J., Yan, W., & Rehan, V. K. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.893863 · Cited by 9
“Epidemiological studies have shown that grandma’s smoking when pregnant with the mother increases the risk of asthma in the grandchild independent of the mother’s smoking status, suggesting a potential transgenerational effect of perinatal smoking on the incidence of childhood asthma (88, 89).”
BackgroundYim, G., Roberts, A., Ascherio, A., Wypij, D., Kioumourtzoglou, M., & Weisskopf, M. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.18824 · Cited by 6
Looking beyond the magic bullet: Novel asthma drugs or education, which works better?
Masekela, R., Levin, M. E., Jeena, P. M., Annamalai, M., Naidoo, V., Niekerk, A. V., Hawarden, D., Emanuel, S., Katz, H., Zar, H. J., et al. (2018) · South African Medical Journal · doi:10.7196/samj.2018.v108i8.13163 · Cited by 5
“There is significant evidence of chronic ETS exposure associated with asthma exacerbations in preschool children and suggestive evidence of this in older children (evidence level D).[23,24] Indoor air pollution”
BackgroundThe sins of the mothers: does grandmaternal smoking influence the risk of asthma in children?
Henderson, A. J. (2015) · Thorax · doi:10.1136/thoraxjnl-2014-206643 · Cited by 5
Liu, J., Perret, J. L., Lodge, C., Vicendese, D., Bowatte, G., Lowe, A. J., Idrose, N. S., Frith, P. A., Wood-Baker, R. R., Mishra, G. D., et al. (2025) · Thorax · doi:10.1136/thorax-2024-222482 · Cited by 4
Barrezueta, L. B., Rodríguez, M. M., Cardador, M. P., Ballester, I. T., López-Casillas, P., Carrasco, J. M., & Vázquez, A. P. (2020) · Anales de Pediatría · doi:10.1016/j.anpedi.2020.05.025 · Cited by 4
Passive smoking and allergic diseases in childhood: a systematic review
Ikeda, M., Kikkawa, T., Korematsu, S., Suzuki, S., Terada, A., & Fujii, Y. (2021) · Nihon Shoni Arerugi Gakkaishi The Japanese Journal of Pediatric Allergy and Clinical Immunology · doi:10.3388/jspaci.35.152 · Cited by 4
Approaches to reduce the risk of severe asthma in children with preschool wheeze
Bush, A., & Schaub, B. (2025) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2025.2491722 · Cited by 5
“Two large studies of grandmother-grandchild pairs showed that, the grandmother’s children were more likely to smoke if she smoked; but that, even if her daughters did not smoke, their children, her grandchildren, were more likely to have asthma [32,33].”
Lønnebotn, M., El-Merhie, N., Holloway, J. W., Horsnell, W. G. C., Krauss‐Etschmann, S., Real, F. G., & Svanes, C. (2018) · Challenges · doi:10.3390/challe9020042 · Cited by 4
“Thorax, 2015 [97] Increased asthma risk in grandchildren caused by grand-maternal smoking during pregnancy, independent of the mother’s smoking status.”
BackgroundEarly-life Tobacco Smoke/Nicotine Exposure and Offspring Health
Kuniyoshi, K. M., Hang, B., & Rehan, V. K. (2020) · Springer eBooks · doi:10.1007/978-981-15-3797-4_2 · Cited by 6
Berlin, I. (2018) · Revue des Maladies Respiratoires · doi:10.1016/j.rmr.2017.11.011 · Cited by 4
Paul, S. T., Raimond, K., & Kanaga, E. G. M. (2018) · Advances in intelligent systems and computing · doi:10.1007/978-981-13-1882-5_51 · Cited by 3
Wang, C., Qu, Y., Niu, H., Pan, Y., He, Y., Liu, J., Yao, N., Wang, H., Guo, Y., Yang, P., et al. (2021) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s295553 · Cited by 3
“Notably, ETS exposure may cause an increase in symptoms of respiratory disease.(17,18) To date, the effects of some environmental factors on the respiratory system of children have been demonstrated.”
BackgroundHenderson, A. J. (2019) · Elsevier eBooks · doi:10.1016/b978-0-323-44887-1.00042-0 · Cited by 2
Grandmaternal smoking during pregnancy and grandchild health: A systematic review and meta-analysisPreprint
Zhang, G.-Q., Luo, Y., Zhang, H., Li, Z., Kankaanranta, H., Wennergren, G., Sheikh, A., & Nwaru, B. I. (2022) · Research Square · doi:10.21203/rs.3.rs-1625650/v1 · Cited by 2
Ratih, S. P., Choo, W. Y., Farid, N. D. N., Romadlona, N. A., Humairo, M. V., & Suprobo, N. R. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-104977 · Cited by 1
Understanding recurrent wheezing: A parent’s guide
Kiatvitchukul, T., Dokkham, P., Jeephet, K., & Srisingh, K. (2026) · World Journal of Clinical Pediatrics · doi:10.5409/wjcp.v15.i1.113430 · Cited by 1
Childhood Environmental Exposures and Adult Disease
Bush, A. (2026) · Pediatric Pulmonology · doi:10.1002/ppul.71591 · Cited by 1
Long term lung health in children: new emerging threats and preventive strategies
Baraldi, E., Bonadies, L., Grutta, S. L., Souëf, P. N. L., Noah, T. L., Oloyede, I. P., Zar, H. J., & Bush, A. (2026) · Paediatric Respiratory Reviews · doi:10.1016/j.prrv.2026.06.001 · Cited by 1
Berlin, I. (2019) · Bulletin de l Académie Nationale de Médecine · doi:10.1016/j.banm.2019.07.011 · Cited by 2
Andenæs, R., & Schwartz, C. E. (2016) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s98784 · Cited by 1
“For example, chronic heavy smoking in adulthood is a significant risk factor for insomnia.(20,21,23) In contrast, habitual physical activity is protective, reducing the prevalence of insomnia(24) and improving sleep quality.”
BackgroundGrandmaternal smoking during pregnancy and asthma in grandchildren
Bråbäck, L., Olsson, D., & Forsberg, B. (2019) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2019.03.036 · Cited by 1
Normal Lung Function from Childhood to Old Age
Bush, A., & Morgan, M. D. L. (2020) · Wiley eBooks · doi:10.1002/9781118597309.ch24 · Cited by 1
(2015) · Thorax · doi:10.1136/thoraxjnl-2014-205777corr1 · Cited by 1
Metadata
- Authors
- Magnus, M. C., Haberg, S. E., Karlstad, O., Nafstad, P., London, S. J., & Nystad, W.
- Affiliations
- Norwegian Institute of Public Health (NO)
- National Institutes of Health (US)
- Corresponding author
- Magnus, M. C.
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2015-01-08
- Volume
- 70
- Issue
- 3
- Pages
- 237-243
- ISSN
- 0040-6376 (ISSN-L)
- PMC
- PMC5034931
- OpenAlex
- W2117150043
- Cited by
- 112
- References
- 36
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 4 · 2023: 4 · 2022: 11 · 2021: 15 · 2020: 10 · 2019: 12 · 2018: 16 · 2017: 6 · 2016: 12 · 2015: 12
- FWCI
- 11.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01es75558-11-0-1)
- National Institute of Neurological Disorders and Stroke (2UO1 NS047537-06A1, U01NS047537, 1 UO1 NS 047537‐01)
- National Institute of Environmental Health Sciences (N01 ES075558, Z01ES049019, Z01ES025045, ZIAES049019)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Keywords
- transgenerational effects, smoking during pregnancy, prenatal tobacco exposure, childhood asthma, asthma treatment, asthma risk, multiplicative interaction, unmeasured confounding
- MeSH terms
- Adult, Asthma, Child, Child, Preschool, Female, Humans, Mothers, Norway, Pregnancy, Prenatal Exposure Delayed Effects, Drug Prescriptions, Risk Factors, Smoking, Confounding Factors, Epidemiologic, Cohort Effect, Databases, Factual
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