Objective: To determine the association between type, chronicity, and severity of childhood hardships and smoking status during pregnancy, preterm birth (PTB), and low birth weight (LBW).
Design: Prospective cohort study.
Setting: The National Child Development Study, a nationally representative study of births in Great Britain in 1958.
Participants: Four thousand eight-hundred sixty-five women with at least 1 singleton live birth.
Main exposures: Hardship during childhood, indicated by several variables, including financial/structural hardship, lack of parental interest in education, family dysfunction, violence/mental health issues, and family structure.
Main outcome measures: Smoking in pregnancy, LBW, and PTB.
Results: A consistent and graded association was seen between all types of childhood hardships and smoking status during pregnancy (odds ratio [OR] for 4 or more hardships, 2.02; 95% confidence interval [CI], 1.58-2.58; P < .001 for all comparisons). Most hardships were also associated with risk of LBW and PTB, with associations between number of hardships and both outcomes persisting after controlling for smoking status and adult social class (for LBW, OR, 1.51; 95% CI, 1.10-2.06; for PTB, OR, 1.44; 95% CI, 1.08-1.92).
Conclusion: Childhood hardships have an enduring impact on future pregnancy outcomes, in part through their association with smoking during pregnancy and adult socioeconomic position.