Objective Exposure to cigarette smoking during pregnancy has been robustly associated with cord blood DNA methylation. However, little is known about such effects on the placenta; in particular, whether cigarette smoking before pregnancy could also induce epigenetic alterations in the placenta of former smokers is unknown.
Design and resultsPlacental DNA methylation levels were measured in 568 women and compared among nonsmokers and women either smoking during their pregnancy or who had ceased smoking before pregnancy. An Epigenome Wide Association Study identified 344 Differentially Methylated Regions (DMRs) significantly associated with maternal smoking status. Among these 344 DMRs, 262 showed "reversible" alterations of DNA methylation, only present in the placenta of current smokers, whereas 44 were also found altered in former smokers, whose placenta had not been exposed directly to cigarette smoking. This observation was further supported by a significant demethylation of LINE-1 sequences in the placentas of both current (-0.43 (-0.83 to -0.02)) and former smokers (-0.55 (-1.02 to -0.08)) compared to nonsmokers. A comparative analysis of the epigenome landscape based on the ENCODE placenta data demonstrated an enrichment of all 344 DMRs in enhancers histone marks. Additionally, smoking-associated DMRs were found near and/or overlapping with 13 imprinting gene clusters encompassing 18 imprinted genes. Conclusions DNA methylation patterns alterations were found in 344 genomic regions in the placenta of women smoking during their pregnancy, including 44 DMRs and LINE-1 elements, where methylation changes persisted in former smokers, supporting the hypothesis of an "epigenetic memory" of exposure to cigarette smoking before pregnancy. Enhancers regions, including imprinting control regions were also particularly affected by placenta methylation changes associated to smoking, suggesting a biological basis for the sensitivity of these regions to tobacco exposure and mechanisms by which fetal development could be impacted. Despite an increasing awareness of smoking associated risks in pregnancy and although smoking cessation is recognized as one of the most effective actions for improving mothers' and children's health (1), between 5 and 20 % of women continue to smoke during pregnancy in the United States and Europe (2, 3), with a prevalence of about 8% in Germany, 14% in Spain, 12% in UK and 17% in France (3). Maternal smoking during pregnancy is the most frequent preventable cause of adverse pregnancy outcomes (4) including placental abruption, placenta previa (5), preterm delivery (6) and some congenital anomalies (7). It has also been causally associated with intrauterine growth restriction (8). In the long term, maternal smoking in pregnancy is associated with adverse outcomes on child's respiratory (9, 10) and cardiometabolic health (11,12), neurodevelopment (13) and cancer (14-16). Despite this large amount of evidence supporting the effects of maternal smoking on the placenta, fetus and child, the molecul...