A systematic review of maternal smoking during pregnancy and fetal measurements with meta-analysis
Open accessAbstract
BACKGROUND: Maternal smoking during pregnancy is linked to reduced birth weight but the gestation at onset of this relationship is not certain. We present a systematic review of the literature describing associations between maternal smoking during pregnancy and ultrasound measurements of fetal size, together with an accompanying meta-analysis. METHODS: Studies were selected from electronic databases (OVID, EMBASE and Google Scholar) that examined associations between maternal smoking or smoke exposure and antenatal fetal ultrasound measurements. Outcome measures were first, second or third trimester fetal measurements. RESULTS: There were 284 abstracts identified, 16 papers were included in the review and the meta-analysis included data from eight populations. Maternal smoking was associated with reduced second trimester head size (mean reduction 0.09 standard deviation (SD) [95% CI 0.01, 0.16]) and femur length (0.06 [0.01, 0.10]) and reduced third trimester head size (0.18 SD [0.13, 0.23]), femur length (0.27 SD [0.21, 0.32]) and estimated fetal weight (0.18 SD [0.11, 0.24]). Higher maternal cigarette consumption was associated with a lower z score for head size in the second (mean difference 0.09 SD [0, 0.19]) and third (0.15 SD [0.03, 0.26]) trimesters compared to lower consumption. Fetal measurements were not reduced for those whose mothers quit before or after becoming pregnant compared to mothers who had never smoked. CONCLUSIONS: Maternal smoking during pregnancy is associated with reduced fetal measurements after the first trimester, particularly reduced head size and femur length. These effects may be attenuated if mothers quit or reduce cigarette consumption during pregnancy.
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Cessation of smoking before and shortly after becoming pregnant was not associated with SGA.
“A previous systematic review showed that cessation of smoking before and shortly after becoming pregnant was not associated with SGA and this suggests that the mechanisms affecting fetal growth predominantly act beyond the first trimester [46].”
From Associations between periconceptional lifestyle behaviours and adverse pregnancy outcomes (2021) · cites this paper as [46]
The Discussion reports that cessation before or shortly after becoming pregnant was not associated with reduced fetal size and suggests that effects on growth act predominantly in the second half of pregnancy. The Results measure fetal size, however, rather than reporting whether cessation was associated with small for gestational age (SGA). (LLM, conf=0.88)
Experimental — accuracy not yet measuredMechanisms affecting fetal growth predominantly act beyond the first trimester.
“A previous systematic review showed that cessation of smoking before and shortly after becoming pregnant was not associated with SGA and this suggests that the mechanisms affecting fetal growth predominantly act beyond the first trimester [46].”
From Associations between periconceptional lifestyle behaviours and adverse pregnancy outcomes (2021) · cites this paper as [46]
The Discussion says that cessation before or shortly after conception was not associated with reduced fetal size and suggests that mechanisms affecting fetal growth act predominantly in the second half of pregnancy. This supports the citing sentence’s proposed timing, but the source reports fetal size, not the stated SGA outcome. (LLM, conf=0.86)
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- Authors
- Abraham, M., Alramadhan, S., Iniguez, C., Duijts, L., Jaddoe, V. W. V., Den Dekker, H. T., Crozier, S., Godfrey, K. M., Hindmarsh, P., Vik, T., Jacobsen, G. W., Hanke, W., Sobala, W., Devereux, G., & Turner, S.
- Affiliations
- University of Aberdeen (GB)
- Erasmus MC (NL)
- University Hospital Southampton NHS Foundation Trust (GB)
- University College London (GB)
- Norwegian University of Science and Technology (NO)
- Nofer Institute of Occupational Medicine (PL)
- Corresponding author
- Turner, Steve
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2017-02-23
- Volume
- 12
- Issue
- 2
- Pages
- e0170946
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5322900
- OpenAlex
- W2589713358
- Cited by
- 282
- References
- 35
- Citations by year
- 2026: 13 · 2025: 23 · 2024: 36 · 2023: 41 · 2022: 30 · 2021: 56 · 2020: 36 · 2019: 20 · 2018: 23 · 2017: 3
- FWCI
- 4.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- BIBSYS Brage (BIBSYS (Norway)) (acceptedVersion, cc-by)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- European Cooperation in Science and Technology
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- smoking during pregnancy, fetal growth, fetal head circumference, femur length, estimated fetal weight, cigarette consumption, smoking cessation, prenatal tobacco exposure, birth weight
- MeSH terms
- Birth Weight, Female, Fetal Growth Retardation, Head, Humans, Pregnancy, Pregnancy Trimester, First, Pregnancy Trimester, Second, Pregnancy Trimester, Third, Smoking, Tobacco Smoke Pollution, Fetal Development
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