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Fetal exposure to maternal active and secondhand smoking with offspring early-life growth in the Healthy Start study



Previous studies have modeled the association between fetal exposure to tobacco smoke and body mass index (BMI) growth trajectories, but not the timing of catch-up growth. Research on fetal exposure to maternal secondhand smoking is limited.


To explore the associations between fetal exposure to maternal active and secondhand smoking with body composition at birth and BMI growth trajectories through age 3 years.


We followed 630 mother-child pairs enrolled in the Healthy Start cohort through age 3 years. Maternal urinary cotinine was measured at ~ 27 weeks gestation. Neonatal body composition was measured using air displacement plethysmography. Child weight and length/height were abstracted from medical records. Linear regression models examined the association between cotinine categories (no exposure, secondhand smoke, active smoking) with weight, fat mass, fat-free mass, and percent fat mass at birth. A mixed-effects regression model estimated the association between cotinine categories and BMI.


Compared to unexposed offspring, birth weight was significantly lower among offspring born to active smokers (−343-g; 95% CI: −473, −213), but not among offspring of women exposed to secondhand smoke (−47-g; 95% CI: −130, 36). There was no significant difference in the rate of BMI growth over time between offspring of active and secondhand smokers (p = 0.58). Therefore, our final model included a single growth rate parameter for the combined exposure groups of active and secondhand smokers. The rate of BMI growth for the combined exposed group was significantly more rapid (0.27 kg/m2 per year; 95% CI: 0.05, 0.69; p < 0.01) than the unexposed.


Offspring prenatally exposed to maternal active or secondhand smoking experience rapid and similar BMI growth in the first three years of life. Given the long-term consequences of rapid weight gain in early childhood, it is important to encourage pregnant women to quit smoking and limit their exposure to secondhand smoke.

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We gratefully acknowledge the contributions of Stephen Brindley for performing the laboratory analysis of cotinine.


This work was supported by the National Institutes of Health (R01DK076648, UG3OD023248, R01ES02293403, R01GM121081, K99ES028711) .

Author information

The authors’ responsibilities were as follows: BFM, APS, SM, JLA, and DD designed the work of this study. CSH, WBA, BMR, and DHG contributed to the data acquisition and interpretation. SM, JLA, and DD supervised. BFM, BMR, and DHG performed the statistical analyses. BFM wrote the manuscript. APS, SM, CSH, WBA, JLA, BMR, DHG, and DD provided critical revisions to the manuscript. All authors read and approved the final manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Correspondence to Dana Dabelea.

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