Prenatal tobacco smoke exposure and neurological impairment at 10 years of age among children born extremely preterm: a prospective cohort

Abstract

Objective To determine the association between prenatal tobacco smoke exposure and neurological impairment at 10 years of age among children born extremely preterm (<28 weeks of gestation). Design The Extremely Low Gestational Age Newborn (ELGAN) Study, a prospective cohort. Setting Ten‐year follow‐up of extremely preterm infants born at 14 US hospitals between 2002 and 2004. Methods Prenatal tobacco smoke exposure was defined as a mother’s report at enrolment of active (i.e. maternal) and passive smoking during pregnancy. Poisson regression with generalized estimating equations was used. Models adjusted for mother’s age, race/ethnicity, education, insurance, pre‐pregnancy body mass index, US region, multiple gestation and infant’s sex; and in sensitivity analysis, gestational age at delivery and clinical subtype of preterm birth, given their classification as intermediate and non‐confounding variables. Main outcomes Neurological impairment at 10 years, epilepsy, cerebral palsy and cognitive impairment. Results Of 1200 ELGAN study survivors, 856 were assessed at 10 years of age with neurological outcomes, of whom 14% (118/856) had active tobacco exposure during pregnancy and 24% (207/852) had passive tobacco exposure. Compared with children who were not exposed prenatally to tobacco, children exposed to active tobacco use during pregnancy had a higher risk of epilepsy (14% versus 5%; adjusted relative risk: 1.68, 95% CI 1.45–1.92). This risk remained after adjustment for gestational age at delivery and clinical subtype of preterm birth. Prenatal tobacco smoke exposure was not associated with other assessed neurological outcomes, including cerebral palsy and multiple measures of cognitive impairment. Conclusions Among children born extremely preterm, prenatal active tobacco smoke exposure was associated with an increased risk of epilepsy at 10 years of life. Tweetable abstract Among infants born before 28 weeks of gestation, prenatal active tobacco smoke exposure was associated with an increased risk of epilepsy at 10 years of life.

Birth weight and head circumference discordance and outcome in preterms: results from the EPIPAGE-2 cohort

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Development and Validation of a Novel Placental DNA Methylation Biomarker of Maternal Smoking during Pregnancy in the ECHO Program

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Association of prenatal modifiable risk factors with attention-deficit hyperactivity disorder outcomes at age 10 and 15 in an extremely low gestational age cohort

“…Prenatal maternal passive and active tobacco smoke exposure was ascertained by maternal interview at the time of participant enrollment ( Venkatesh et al, 2021 ). In this analysis, active maternal smoke exposure during pregnancy was assessed.…”

“…Our group has also previously reported that maternal overweight status or obesity was associated with increased ADHD behaviors at age 10, but the previously reported analysis did not control for family history of ADHD and did not assess the added effect of maternal diabetes ( van der Burg et al, 2017 ). A previous report on the effect of prenatal tobacco exposure on neurological outcomes identified that active, but not passive, smoking was associated with an increased risk of epilepsy ( Venkatesh et al, 2021 ). There was no effect on the risk of cerebral palsy or cognitive impairment.…”