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Pediatrics

Maternal smoking during pregnancy and offspring overweight: is there a dose–response relationship? An individual patient data meta-analysis

International Journal of Obesity volume 42, pages 1249–1264 (2018)Cite this article

Subjects

Abstract

Background/objectives

A number of meta-analyses suggest an association between any maternal smoking in pregnancy and offspring overweight obesity. Whether there is a dose–response relationship across number of cigarettes and whether this differs by sex remains unclear.

Subject/methods

Studies reporting number of cigarettes smoked during pregnancy and offspring BMI published up to May 2015 were searched. An individual patient data meta-analysis of association between the number of cigarettes smoked during pregnancy and offspring overweight (defined according to the International Obesity Task Force reference) was computed using a generalized additive mixed model with non-linear effects and adjustment for confounders (maternal weight status, breastfeeding, and maternal education) and stratification for sex.

Results

Of 26 identified studies, 16 authors provided data on a total of 238,340 mother–child-pairs. A linear positive association was observed between the number of cigarettes smoked and offspring overweight for up to 15 cigarettes per day with an OR increase per cigarette of 1.03, 95% CI = [1.02–1.03]. The OR flattened with higher cigarette use. Associations were similar in males and females. Sensitivity analyses supported these results.

Conclusions

A linear dose–response relationship of maternal smoking was observed in the range of 1–15 cigarettes per day equally in boys and girls with no further risk increase for doses above 15 cigarettes.

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Acknowledgements

We want to thank the funders of the individual studies: the UK Medical Research Council and the Wellcome Trust (Grant ref: 102215/2/13/2) and the University of Bristol, the Danish National Research Foundation, Pharmacy Foundation, the March of Dimes Birth Defects Foundation, the Augustinus Foundation, and the Health Foundation, the US NICHD (contracts no. 1-HD-4-2803 and no. 1-HD-1-3127, R01 HD HD034568), the NHMRC, the CNPq (Portuguese acronym for the National Research Council—grant 523474/96-2) and FAPESP (Portuguese acronym for the São Paulo State Research Council—grant 00/0908-7). We would like to thank the participating families of all studies for the use of data. For the ASPAC study, we want to thank the midwives for their help in recruiting families, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists, and nurses. This work was supported by the Deutschen Forschungsgesellschaft (German Research Foundation, DFG) [KR 1926/9-1, KU1443/4-1]. Dr. Gilman’s contribution was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

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Authors and Affiliations

  1. Division of Epidemiology, Institute of Social Paediatrics and Adolescents Medicine, Ludwig-Maximilians-University Munich, Munich, Germany

    Lucia Albers, Christina Sobotzki & Rüdiger von Kries

  2. German Diabetes Center, Institute of Biometrics and Epidemiology, Düsseldorf, 40225, Germany

    Oliver Kuß

  3. Department of Clinical Epidemiology (formerly Institute of Preventive Medicine), Bispebjerg and Frederiksberg Hospitals, The Capital Region, Denmark

    Teresa Ajslev, Camilla Schmidt Morgen & Thorkild IA Sørensen

  4. Departamento de Saúde Pública, Universidade Federal do Maranhão, São Luís, MA, Brazil

    Rosangela FL Batista & Antônio AM da Silva

  5. Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil

    Heloisa Bettiol & Viviane C Cardoso

  6. Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK

    Bernard Brabin & Gibby Koshy

  7. Department of Community Child Health,Royal Liverpool Children’s Hospital, NHS Trust Alder Hey, Liverpool, UK

    Bernard Brabin

  8. Emma Kinderziekenhuis, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

    Bernard Brabin

  9. Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA

    Stephen L Buka

  10. Adelaide Medical School, The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia

    Vicki L Clifton & Luke E Grzeskowiak

  11. Child Health, University of Aberdeen, Aberdeen, UK

    Graham Devereux & Stephen Turner

  12. Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA

    Stephen E Gilman

  13. Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA

    Stephen E Gilman

  14. Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA

    Stephen E Gilman

  15. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Stephen E Gilman

  16. Institute of Occupational, Social, and Environmental Medicine, University Hospital, Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Occupational, Social, and Environmental Medicine, University Hospital, Neuherberg, Germany

    Joachim Heinrich

  17. Forschergruppe Diabetes der Technischen Universität München, Munich, Germany

    Sandra Hummel

  18. Institut für Diabetesforschung der Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Munich, Germany

    Sandra Hummel

  19. Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway

    Geir W Jacobsen

  20. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia

    Graeme Jones

  21. Obesity Prevention Program, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA

    Emily Oken & Sheryl L Rifas-Shiman

  22. Rotman Research Institute and Departments of Psychology and Psychiatry, University of Toronto, Toronto, Canada

    Tomas Paus

  23. Hospital for Sick Children and Departments of Physiology and Nutritional Sciences, University of Toronto, Toronto, Canada

    Zdenka Pausova

  24. Centers for Disease Control and Prevention, Atlanta, USA

    Andrea J Sharma

  25. Novo Nordisk Foundation Centre for Basic Metabolic Research, and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Thorkild IA Sørensen

  26. Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany

    Elisabeth Thiering

  27. Department of Laboratory Medicine, Children and Women’s Health, Norwegian University of Science and Technology, Trondheim, Norway

    Torstein Vik

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Corresponding author

Correspondence to Lucia Albers.

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Albers, L., Sobotzki, C., Kuß, O. et al. Maternal smoking during pregnancy and offspring overweight: is there a dose–response relationship? An individual patient data meta-analysis. Int J Obes 42, 1249–1264 (2018). https://doi.org/10.1038/s41366-018-0050-0

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  • DOI: https://doi.org/10.1038/s41366-018-0050-0

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