Maternal smoking status during pregnancy and low birth weight in offspring: systematic review and meta-analysis of 55 cohort studies published from 1986 to 2020

Di, Hongkun; Gan, Yong; Lǚ, Kai; Wang, Chao; Zhu, Yi; Meng, Xin; Xia, Wenfang; Xu, Minzhi; Feng, Jing; Tian, Qingfeng; He, Yan; Nie, Zhiqiang; Liu, Jun’an; Lu, Zuxun

doi:10.1007/s12519-021-00501-5

Cited by 48 publications

(14 citation statements)

References 74 publications

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“… 37 , 38 There have also been some reports that caffeine is associated with an increased risk of FGR 10 , 11 and several meta-analyses have demonstrated an increased risk of lower birthweights. 3 , 4 In our study, we did not observe any such risk after multivariable adjustment that included an objective measure of smoking. We hypothesized that this is because there is a strong correlation between paraxanthine and smoking, that has been recognized elsewhere 26 and that was more fully controlled for in our regression models by using an objective measure to assess smoking.…”

Section: Discussioncontrasting

confidence: 56%

“…These recommendations come from decades of research that have assessed their relationship with pregnancy complications. For instance, smoking during pregnancy is associated with an increased risk of fetal growth restriction (FGR), 1 spontaneous pre-term birth 2 and low birthweight 3 , 4 but a reduced risk of pre-eclampsia (PE). 5 The paradoxical effect on PE risk is thought to be related to the effects of smoking on pro-angiogenic proteins, such as increasing placental growth factor (PlGF), and anti-angiogenic proteins, such as decreasing soluble fms-like tyrosine kinase 1 (sFlt-1), 6 though data are inconclusive.…”

Section: Introductionmentioning

confidence: 99%

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Objective measures of smoking and caffeine intake and the risk of adverse pregnancy outcomes

Selvaratnam,

Sovio,

Cook

et al. 2023

International Journal of Epidemiology

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Background In pregnancy, women are encouraged to cease smoking and limit caffeine intake. We employed objective definitions of smoking and caffeine exposure to assess their association with adverse outcomes. Methods We conducted a case cohort study within the Pregnancy Outcome Prediction study to analyse maternal serum metabolomics in samples from 12, 20, 28 and 36 weeks of gestational age. Objective smoking status was defined based on detectable cotinine levels at each time point and objective caffeine exposure was based on tertiles of paraxanthine levels at each time point. We used logistic and linear regression to examine the association between cotinine, paraxanthine and the risk of pre-eclampsia, spontaneous pre-term birth (sPTB), fetal growth restriction (FGR), gestational diabetes mellitus and birthweight. Results There were 914 and 915 women in the smoking and caffeine analyses, respectively. Compared with no exposure to smoking, consistent exposure to smoking was associated with an increased risk of sPTB [adjusted odds ratio (aOR) = 2.58, 95% CI: 1.14 to 5.85)] and FGR (aOR = 4.07, 95% CI: 2.14 to 7.74) and lower birthweight (β = –387 g, 95% CI: –622 g to –153 g). On univariate analysis, consistently high levels of paraxanthine were associated with an increased risk of FGR but that association attenuated when adjusting for maternal characteristics and objective—but not self-reported—smoking status. Conclusions Based on objective data, consistent exposure to smoking throughout pregnancy was strongly associated with sPTB and FGR. High levels of paraxanthine were not independently associated with any of the studied outcomes and were confounded by smoking.

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Section: Discussioncontrasting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Objective measures of smoking and caffeine intake and the risk of adverse pregnancy outcomes

Selvaratnam,

Sovio,

Cook

et al. 2023

International Journal of Epidemiology

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“…We also found evidence of an association between higher I:Cr and higher birth weight, up to a threshold of around 200 μg/g, but not for UIC. The potential size of the associations identified was relatively modest compared to other established modifiable risk factors for lower birth weight and SGA, such as smoking [ 46 , 47 , 48 ], alcohol [ 49 , 50 ] and caffeine [ 51 , 52 , 53 ], and small enough to be potentially explained by bias in study design, analysis, or selective publication. There was no evidence of an association with preterm delivery, though only two studies reported results for spontaneous preterm delivery.…”

Section: Discussionmentioning

confidence: 95%

Maternal Iodine Status and Birth Outcomes: A Systematic Literature Review and Meta-Analysis

et al. 2023

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Background & aims: Iodine is important for thyroid function during pregnancy to support fetal growth, but studies of maternal iodine status and birth outcomes are conflicting. We aimed to quantify the association between iodine status and birth outcomes, including potential threshold effects using nonlinear dose–response curves. Methods: We systematically searched Medline and Embase to 10 October 2022 for relevant cohort studies. We conducted random-effects meta-analyses of urinary iodine concentration (UIC), iodine:creatinine ratio (I:Cr), and iodide intake for associations with birth weight, birth weight centile, small for gestational age (SGA), preterm delivery, and other birth outcomes. Study quality was assessed using the Newcastle-Ottawa scale. Results: Meta-analyses were conducted on 23 cohorts with 42269 participants. Birth weight was similar between UIC ≥ 150 μg/L and <150 μg/L (difference = 30 g, 95% CI −22 to 83, p = 0.3, n = 13, I2 = 89%) with no evidence of linear trend (4 g per 50 μg/L, −3 to 10, p = 0.2, n = 12, I2 = 80%). I:Cr was similar, but with nonlinear trend suggesting I:Cr up to 200 μg/g associated with increasing birthweight (p = 0.02, n = 5). Birthweight was 2.0 centiles (0.3 to 3.7, p = 0.02, n = 4, I2 = 0%) higher with UIC ≥ 150 μg/g, but not for I:Cr. UIC ≥ 150 μg/L was associated with lower risk of SGA (RR = 0.85, 0.75 to 0.96, p = 0.01, n = 13, I2 = 0%), but not with I:Cr. Conclusions: The main risk of bias was adjustment for confounding, with variation in urine sample collection and exposure definition. There were modest-sized associations between some measures of iodine status, birth weight, birth weight centile, and SGA. In pregnancy, we recommend that future studies report standardised measures of birth weight that take account of gestational age, such as birth weight centile and SGA. Whilst associations were modest-sized, we recommend maintaining iodine sufficiency in the population, especially for women of childbearing age on restricted diets low in iodide.

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“…We relied on a review of the literature and a directed acyclic graph (DAG) to identify possible confounders, including maternal age [ 27 ], family monthly income per capita (< 2500 RMB; 2500–4000 RMB; >4000 RMB) [ 28 ], parental education level (junior high school or below; senior middle school; junior college; bachelor’s degree or above) [ 29 ], maternal pre-pregnancy BMI [ 30 ], paternal BMI [ 31 ], parity (multipara; nulliparous) [ 32 ], maternal metabolic dysfunctions (yes; no) [ 33 ], alcohol use (yes; no) [ 34 ], tobacco use (yes; no) [ 35 ], maternal iron supplementation (yes; no) [ 36 ], maternal folic acid supplementation (yes; no) [ 37 ] during pregnancy, and sex of children (male; female) [ 38 ] (Figure S1 ).…”

Section: Methodsmentioning

confidence: 99%

Birth outcomes and early growth patterns associated with age at adiposity rebound: the Ma’anshan birth cohort (MABC) study

Zhou,

Teng,

Zhang

et al. 2023

BMC Public Health

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ObjectiveEarly onset of adiposity rebound (AR) is considered an early indicator of obesity risk. Our objective was to investigate the association of birth outcomes and early physical growth patterns with early AR in children.MethodsStudy subjects (n = 2705) were enrolled from the Ma’anshan birth cohort (MABC). The body mass index (BMI), head circumference, waist circumference, and body fat were collected. Rapid weight gain (RWG) was defined by the change in weight standard-deviation score in the first two years of life. Group-based trajectory modeling (GBTM) was used to determine children’s physical growth trajectories. The age of AR was fitted using fractional polynomial function models.ResultsChildren with very high BMI trajectories (RR = 2.83; 95% CI 2.33 to 1.40), rising BMI trajectories (RR = 3.15; 95% CI 2.66 to 3.72), high waist circumference trajectories (RR = 4.17; 95% CI 3.43 to 5.06), and high body fat trajectories (RR = 3.01; 95% CI 2.62 to 3.46) before 72 months of age were at a greater risk of experiencing early AR. Low birth weight (LBW) (RR = 1.86; 95% CI 1.28 to 2.51), preterm birth (PTB) (RR = 1.50; 95% CI 1.17 to 1.93), and small for gestational age (SGA) (RR = 1.37; 95% CI 1.14 to 1.64) associated with increased risk of early AR. Moreover, infants experiencing RWG (RR = 1.59; 95% CI 1.40 to 1.83), low BMI trajectories (RR = 1.27; 95% CI 1.06 to 1.53) and rising BMI trajectories (RR = 1.50; 95% CI 1.22 to 1.84) in the first two years were at higher risk of developing early AR subsequently. Compared to the group with non-early AR, the BMI of children with early AR tended to be lower first (from birth to 6 months of age) and then higher (from 18 to 72 months of age).ConclusionsChildren with overall high BMI, high waist circumference, and high body fat before 72 months of age are more likely to experience early AR, but infants with low BMI trajectories, rising BMI trajectories and infants experiencing RWG in the first two years of life similarly increase the risk of early AR. These results can help to understand the early factors and processes that lead to metabolic risks.

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Maternal smoking status during pregnancy and low birth weight in offspring: systematic review and meta-analysis of 55 cohort studies published from 1986 to 2020

Abstract: Ethical approval Not needed. Conflicts of InterestWe declare that we have no conflicts of interest. Data availability statementStudies used for meta-analysis are listed in Supplementary eTable 2.

Cited by 48 publications

References 74 publications

Objective measures of smoking and caffeine intake and the risk of adverse pregnancy outcomes

Objective measures of smoking and caffeine intake and the risk of adverse pregnancy outcomes

Maternal Iodine Status and Birth Outcomes: A Systematic Literature Review and Meta-Analysis

Birth outcomes and early growth patterns associated with age at adiposity rebound: the Ma’anshan birth cohort (MABC) study

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