Prenatal exposure to cigarettes in infants with obstructive sleep apneas
Abstract
OBJECTIVE: To investigate the effect of prenatal smoking on infant respiratory behavior during sleep. METHODS: A questionnaire concerning family habits and infants' history was completed for 550 healthy infants before a 9-hour night polysomnographic study. Because the data for 41 infants were not available for analysis, 509 subjects were studied: 115 were newborns evaluated within 1 week after birth, and 394 were healthy infants admitted at 11 weeks of life (range 5 to 29 weeks) after various research protocols. RESULTS: According to the smoking frequency of the mothers during pregnancy, the subjects were defined as "nonsmokers" (no cigarette smoked during pregnancy; n = 400), "light smokers" (1 to 9 cigarettes per day; n = 37), or "smokers" (10 or more cigarettes per day; n = 72). Compared with nonsmokers and light smokers, "smoking" mothers had a significant increase in the number of episodes of uterine bleeding during the pregnancy. Their infants had lower birth weights and more frequent episodes of profuse sweating during sleep. Infants of smokers also had more frequent and longer obstructive sleep apneas than those of the two other groups. For infants of smokers the relative risk for obstructive apneas was 2.76 (95% confidence interval: 1.63 to 4.69; P = .001). The relation between prenatal smoking and postnatal manifestation of obstructive sleep apneas demonstrated a dose-response pattern. Paternal smoking during pregnancy increased the risk of obstructive apneas only in the infants of smoking mothers, but not in those of the two other groups. Maternal smoking after birth did not add significantly to the risk of obstructive apneas. The effect of smoking was seen in older infants, as well as in the newborn not yet exposed to ambient cigarette smoke. A stepwise logistic regression, using obstructive sleep apneas as the dependent variable identified three significant independent variables: smoking during pregnancy (P = .001), profuse sweating during sleep (P = .001), and birth weight (P = .010). No explanation was found for the effect of prenatal smoking on obstructive sleep apneas. CONCLUSION: Prenatal smoking by mothers correlated with an increase in frequency and length of obstructive apneas and a decrease in birth weight of their infants. The infants were under greater risk for obstructive apnea if both parents smoked. Explanations for our results are unknown to us, but these findings may be of interest in the study of infant breathing behavior and epidemiological characteristics of sudden infant death syndrome.
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Tobacco exposure during pregnancy impairs infant cardiorespiratory function.
“Maternal smoking and smokeless tobacco use during pregnancy are associated with increased risk of neonatal apnea, while maternal smoking is also associated with a decreased arousal response.”
From Developmental toxicity of nicotine: A transdisciplinary synthesis and implications for emerging tobacco products (2017) · cites this paper as [112]
Maternal smoking and smokeless tobacco use during pregnancy are associated with increased neonatal apnea.
“Maternal smoking and smokeless tobacco use during pregnancy are associated with increased risk of neonatal apnea”
From Developmental toxicity of nicotine: A transdisciplinary synthesis and implications for emerging tobacco products (2017) · cites this paper as [112]
Infants aged 1-7 months show altered cortisol response to stress.
“infants aged 1-7 months showed altered cortisol response to stress.”
From Developmental toxicity of nicotine: A transdisciplinary synthesis and implications for emerging tobacco products (2017) · cites this paper as [134]
Maternal smoking is associated with a reduced arousal response.
“while maternal smoking is also associated with a decreased arousal response.”
From Developmental toxicity of nicotine: A transdisciplinary synthesis and implications for emerging tobacco products (2017) · cites this paper as [112]
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“This alteration may help to explain the greater incidence of sleep disordered breathing in neonates born to smoking mothers (Kahn et al., 1994; Calhoun et al., 2010).”
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ResultPrenatal smoking and drinking are associated with altered newborn autonomic functions
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“smoking to alterations in regulation of infant respiration, specifically regarding the literature reporting increases in the frequency and length of obstructive apneas.(46) Evidence from animal studies indicates maternal smoking leads to nicotineinduced cholinergic sensitivity of respiratory neurons of neonatal mice,(…”
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Gozal, D., & Gozal, D. (2019) · Elsevier eBooks · doi:10.1016/b978-0-323-44887-1.00081-x · Cited by 5 · see citing works
Prenatal cigarette smoke exposure and postnatal respiratory responses to hypoxia and hypercapnia
Pendlebury, J. D., Yusuf, K., Bano, S., Lumb, K. J., Schneider, J. M., & Hasan, S. U. (2011) · Pediatric Pulmonology · doi:10.1002/ppul.21578 · Cited by 4 · see citing works
Redefining insomnia: from neural dysregulation to personalized therapeutics
Arias-Carrión, Ó. (2025) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2025.2564709 · Cited by 5 · see citing works
“Maternal smoking during pregnancy has been associated with respiratory-related sleep disturbances in infancy, including an increased risk of obstructive apnea [114] and ongoing sleep difficulties during childhood [115].”
Disorders of Breathing during Sleep
Gozal, D., & Kheirandish, L. (2006) · Elsevier eBooks · doi:10.1016/b978-0-7216-3695-5.50078-x · Cited by 4 · see citing works
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“On a relevé, chez les nourrissons de mères fumeuses, un nombre plus important d’apnées obstructives du sommeil avec un seuil d’éveil plus élevé spontanément [9], en hypoxie [10, 11] ou en réponse à des stimuli sonores [12].”
Cardiac Autonomic Modulation and Sleep-Disordered Breathing in Children
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Chapter 47 Reducing the risk of sudden infant death
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Self-citationMaternal smoking during pregnancy and sleep problems in 2-month-old infants
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Self-citationA quest for a histaminergic or orexinergic biomarker for sudden infant death syndrome
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Risk factors of sudden infant death syndrome and risk factors for sleep disturbances
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“…effects of nicotine exposure on foetal and infant development with obvious nervous system involvement, including breathing disturbances in sleep (Kahn et al., 1994), altered maturation of visual evoked potentials (Scher et al., 1998) as well as language and intellectual impairments (Olds,…”
BackgroundSelf-citationInfant temperament characteristics related to sudden infant death syndrome and its risk factors
Kelmanson, I. A. (2006) · Early Child Development and Care · doi:10.1080/03004430500147292 · Cited by 1 · see citing works
“Obstructive sleep apneas are also known to be associated with total shorter sleep time and frequent arousals (Kahn et al., 1994).”
BackgroundSelf-citationDrug Abuse Neurotoxicity: Alcohol and Nicotine as Developmental Stressors
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- Authors
- Kahn, A., Groswasser, J., Sottiaux, M., Kelmanson, I., Franco, P., Rebuffat, E., Dramaix, M., & Wayenberg, J. L.
- Venue
- PEDIATRICS
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 1994-05-01
- Volume
- 93
- Issue
- 5
- Pages
- 778-783
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W1586785783
- Cited by
- 117
- References
- 0
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 3 · 2019: 5 · 2018: 3 · 2017: 1 · 2016: 5 · 2015: 3 · 2014: 3 · 2013: 4 · 2012: 2
- FWCI
- 1.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Keywords
- maternal smoking, smoking during pregnancy, obstructive sleep apnea, infant sleep, birth weight, paternal smoking, dose-response relationship, neonates
- MeSH terms
- Adolescent, Adult, Fathers, Female, Humans, Infant, Infant, Newborn, Male, Mothers, Pregnancy, Prenatal Exposure Delayed Effects, Prospective Studies, Sleep Apnea Syndromes, Smoking, Logistic Models
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