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Cited by 2Telomeres, Telomerase, and SenescenceSmoking Behavior and CessationPrenatal Substance Exposure Effects

Maternal smoking during pregnancy and newborn telomere length (TL): a systematic review and meta-analysis of observational studies

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Moshfeghinia, Reza, Ghahremani, Mahla, Ghasemi, Amir Reza, Mostafavi, Sara, Mohagheghzadeh, Hoorad, Maharlouei, Najmeh, Ahmadi, Jamshid, Vardanjani, Hossein Molavi·2025·BMC Pregnancy and Childbirth
DOI 10.1186/s12884-025-08273-wPMC PMC12822185
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Abstract

BACKGROUND: Telomeres indicate cellular aging. Shortened telomeres are linked to various diseases and mortality, influenced by factors like inflammation, genetics, and environmental exposures, including smoking. Assessing newborn telomere length (TL) and maternal smoking association remains unexplored. A systematic review aims to fill this gap, potentially advancing clinical understanding and guiding future research. METHODS: This systematic review involved searching six English electronic databases—PubMed, Scopus, PsycINFO, Web of Science, Embase, and CINAHL Complete—for records from their inception until February 2024. The review focused solely on observational studies. Included studies assessed the impact of maternal smoking during pregnancy on the TL of newborns. The quality of these studies was evaluated using the Newcastle–Ottawa quality assessment scale. A random-effect model was employed, and the statistical analysis was conducted with Stata software version 17. RESULTS: Eight of 485 initial studies were included for systematic and five for meta-analysis. Eight studies involving 2,797 participants investigated prenatal smoking’s impact on infant telomere length, predominantly using qPCR and umbilical cord blood cells for measurement of TL. Five studies with 1,822 participants assessed the effect of maternal smoking during pregnancy on newborn TL, revealing a significant negative correlation (-0.19 [-0.32, -0.09]). Despite high heterogeneity (I2: 85.57%), no publication bias was found. Sensitivity analysis, excluding one study, showed a stronger correlation (-0.27 [-0.36, -0.17]) and reduced heterogeneity (I2: 53.21%). Subgroup analysis by nationality indicated a slightly stronger correlation in North American studies (-0.21 [-0.30, -0.12]) compared to Asian studies (-0.17 [-0.52, 0.17]). No significant differences were observed (p = 0.85). CONCLUSION: A meta-analysis found maternal smoking in pregnancy correlates negatively with neonatal telomere length, impacting aging. Urgent awareness and further research are needed for preventive measures.

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  • Maternal stress, smoking, air pollution and heavy-metal exposure during pregnancy are associated with shorter or altered newborn telomere length, although effect direction and magnitude vary by exposure window, tissue and assay.

    “Maternal stress, smoking, air pollution and heavy-metal exposure during pregnancy have been associated with shorter or altered newborn TL, although effect direction and magnitude vary by exposure window, tissue and assay [122,123,124,125,126].”

    From Placental Pathophysiology and Developmental Programming of Adult Cardiometabolic Risk: A Narrative Review of Pregnancy Exposures (2026) · cites this paper as [125]

    The Discussion reports that most studies found shorter newborn telomere length with maternal smoking, while some found longer telomeres or no association. It also mentions maternal stress and air pollution as influences on early-life telomere length, but does not establish the claimed prenatal associations for air pollution or heavy-metal exposure. The passages do not substantiate tissue and assay as reasons for the variation across all four exposures. (LLM, conf=0.87)

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  • Pooled evidence supports shorter newborn telomere length after maternal smoking and an overall inverse association with prenatal metal exposure, with more consistent findings for cadmium and later-pregnancy exposure.

    “Pooled evidence supports shorter newborn TL after maternal smoking and an overall inverse association with prenatal metal exposure, with more consistent findings for cadmium and later-pregnancy exposure [124,125].”

    From Placental Pathophysiology and Developmental Programming of Adult Cardiometabolic Risk: A Narrative Review of Pregnancy Exposures (2026) · cites this paper as [125]

  • These associations show that prenatal exposures can coincide with early differences in telomere biology; they do not establish that neonatal telomere length mediates adult disease.

    “These associations show that prenatal exposures can coincide with early differences in telomere biology; they do not establish that neonatal TL mediates adult disease.”

    From Placental Pathophysiology and Developmental Programming of Adult Cardiometabolic Risk: A Narrative Review of Pregnancy Exposures (2026) · cites this paper as [125]

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Authors
Moshfeghinia, R., Ghahremani, M., Ghasemi, A. R., Mostafavi, S., Mohagheghzadeh, H., Maharlouei, N., Ahmadi, J., & Vardanjani, H. M.
Affiliations
  • Shiraz University of Medical Sciences (IR)
  • Arak University of Medical Sciences (IR)
  • Ankara Medipol Üniversitesi (TR)
Corresponding author
  • Moshfeghinia, Reza
  • Vardanjani, Hossein Molavi
ORCID
Venue
BMC Pregnancy and Childbirth
Publisher
Springer Science and Business Media LLC
Published
2025-12-16
Volume
26
Issue
1
Pages
67-67
ISSN
1471-2393 (ISSN-L)
DOI
10.1186/s12884-025-08273-w
PMC
PMC12822185
OpenAlex
W4417414324
Cited by
2
References
46
Citations by year
2026: 2
FWCI
0.26
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Pregnancy and Childbirth (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Physiology › Telomeres, Telomerase, and Senescence
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
Keywords
smoking during pregnancy, prenatal tobacco exposure, cellular aging, umbilical cord blood, maternal smoking
MeSH terms
Female, Humans, Infant, Newborn, Pregnancy, Prenatal Exposure Delayed Effects, Smoking, Telomere, Telomere Shortening, Observational Studies as Topic

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