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Int J Obes (Lond). 2019 Apr;43(4):652-662. doi: 10.1038/s41366-018-0238-3. Epub 2018 Oct 19.

Fetal exposure to maternal active and secondhand smoking with offspring early-life growth in the Healthy Start study.

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Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.
Center for Evidence-based Policy, Oregon Health and Science University, Portland, OR, USA.
Department of Epidemiology, Oregon Health and Science University-Portland State University School of Public Health, Portland, OR, USA.
Department of Environmental and Occupational Health, Colorado School of Public Health, Aurora, CO, USA.
Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA.
Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
Department of Pediatrics, University of Colorado School of Medicine, Aurora CO, USA.



Previous studies have modeled the association between fetal exposure to tobacco smoke and body mass index (BMI) growth trajectories, but not the timing of catch-up growth. Research on fetal exposure to maternal secondhand smoking is limited.


To explore the associations between fetal exposure to maternal active and secondhand smoking with body composition at birth and BMI growth trajectories through age 3 years.


We followed 630 mother-child pairs enrolled in the Healthy Start cohort through age 3 years. Maternal urinary cotinine was measured at ~ 27 weeks gestation. Neonatal body composition was measured using air displacement plethysmography. Child weight and length/height were abstracted from medical records. Linear regression models examined the association between cotinine categories (no exposure, secondhand smoke, active smoking) with weight, fat mass, fat-free mass, and percent fat mass at birth. A mixed-effects regression model estimated the association between cotinine categories and BMI.


Compared to unexposed offspring, birth weight was significantly lower among offspring born to active smokers (-343-g; 95% CI: -473, -213), but not among offspring of women exposed to secondhand smoke (-47-g; 95% CI: -130, 36). There was no significant difference in the rate of BMI growth over time between offspring of active and secondhand smokers (p = 0.58). Therefore, our final model included a single growth rate parameter for the combined exposure groups of active and secondhand smokers. The rate of BMI growth for the combined exposed group was significantly more rapid (0.27 kg/m2 per year; 95% CI: 0.05, 0.69; p < 0.01) than the unexposed.


Offspring prenatally exposed to maternal active or secondhand smoking experience rapid and similar BMI growth in the first three years of life. Given the long-term consequences of rapid weight gain in early childhood, it is important to encourage pregnant women to quit smoking and limit their exposure to secondhand smoke.

[Available on 2019-10-01]

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