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Int J Obes (Lond). 2018 Jul;42(7):1249-1264. doi: 10.1038/s41366-018-0050-0. Epub 2018 Feb 28.

Maternal smoking during pregnancy and offspring overweight: is there a dose-response relationship? An individual patient data meta-analysis.

Author information

1
Division of Epidemiology, Institute of Social Paediatrics and Adolescents Medicine, Ludwig-Maximilians-University Munich, Munich, Germany. lucia.albers@med.uni-muenchen.de.
2
Division of Epidemiology, Institute of Social Paediatrics and Adolescents Medicine, Ludwig-Maximilians-University Munich, Munich, Germany.
3
German Diabetes Center, Institute of Biometrics and Epidemiology, Düsseldorf, 40225, Germany.
4
Department of Clinical Epidemiology (formerly Institute of Preventive Medicine), Bispebjerg and Frederiksberg Hospitals, The Capital Region, Denmark.
5
Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brazil.
6
Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.
7
Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK.
8
Department of Community Child Health,Royal Liverpool Children's Hospital, NHS Trust Alder Hey, Liverpool, UK.
9
Emma Kinderziekenhuis, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
10
Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.
11
Adelaide Medical School, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
12
Child Health, University of Aberdeen, Aberdeen, UK.
13
Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
14
Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA.
15
Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
16
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
17
Institute of Occupational, Social, and Environmental Medicine, University Hospital, Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Occupational, Social, and Environmental Medicine, University Hospital, Neuherberg, Germany.
18
Forschergruppe Diabetes der Technischen Universität München, Munich, Germany.
19
Institut für Diabetesforschung der Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Munich, Germany.
20
Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
21
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
22
Obesity Prevention Program, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA.
23
Rotman Research Institute and Departments of Psychology and Psychiatry, University of Toronto, Toronto, Canada.
24
Hospital for Sick Children and Departments of Physiology and Nutritional Sciences, University of Toronto, Toronto, Canada.
25
Centers for Disease Control and Prevention, Atlanta, USA.
26
Novo Nordisk Foundation Centre for Basic Metabolic Research, and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
27
Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany.
28
Department of Laboratory Medicine, Children and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.

Abstract

BACKGROUND/OBJECTIVES:

A number of meta-analyses suggest an association between any maternal smoking in pregnancy and offspring overweight obesity. Whether there is a dose-response relationship across number of cigarettes and whether this differs by sex remains unclear.

SUBJECT/METHODS:

Studies reporting number of cigarettes smoked during pregnancy and offspring BMI published up to May 2015 were searched. An individual patient data meta-analysis of association between the number of cigarettes smoked during pregnancy and offspring overweight (defined according to the International Obesity Task Force reference) was computed using a generalized additive mixed model with non-linear effects and adjustment for confounders (maternal weight status, breastfeeding, and maternal education) and stratification for sex.

RESULTS:

Of 26 identified studies, 16 authors provided data on a total of 238,340 mother-child-pairs. A linear positive association was observed between the number of cigarettes smoked and offspring overweight for up to 15 cigarettes per day with an OR increase per cigarette of 1.03, 95% CI = [1.02-1.03]. The OR flattened with higher cigarette use. Associations were similar in males and females. Sensitivity analyses supported these results.

CONCLUSIONS:

A linear dose-response relationship of maternal smoking was observed in the range of 1-15 cigarettes per day equally in boys and girls with no further risk increase for doses above 15 cigarettes.

PMID:
29717267
PMCID:
PMC6685293
DOI:
10.1038/s41366-018-0050-0
[Indexed for MEDLINE]
Free PMC Article

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