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Effect of maternal smoking on stress physiology in healthy neonates



To assess the impact of maternal smoking during pregnancy (MSDP) on the neonatal hypothalamic–pituitary–adrenal axis.

Study Design:

In a prospective observational study, salivary cortisol and cortisone levels were measured at the fourth day of life during resting conditions and in response to a pain-induced stress event in healthy neonates whose mothers smoked cigarettes during each stage of pregnancy and compared with controls.


Neonates in the control group (n=70) exhibited a physiologic stress response with a significant increase in cortisol (1.3 to 2.1 ng ml−1; P<0.05) and cortisone (11.8 to 17.8 ng ml−1; P<0.05) from baseline levels, whereas in neonates from mothers who smoked (n=33), cortisol (0.9 to 0.8 ng ml−1; P=0.77) and cortisone (11.5 to 13.0; P=0.19) stress response was not significantly different from baseline levels. A two-way analysis of variance confirmed these findings in both groups.


Healthy neonates whose mothers smoked during pregnancy show a blunted stress response on the fourth day of life. Thus, MSDP leads to a dysregulation of the HPA axis with continued effects in neonatal life. This might explain long-term consequences of MSDP such as overweight, diabetes mellitus and modification of blood pressure control mechanisms in adult life.

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Correspondence to C Haslinger.

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Haslinger, C., Bamert, H., Rauh, M. et al. Effect of maternal smoking on stress physiology in healthy neonates. J Perinatol 38, 132–136 (2018).

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