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Prenatal smoking and drinking are associated with altered newborn autonomic functions

Abstract

Background

Prenatal smoking and drinking are associated with sudden infant death syndrome and neurodevelopmental disorders. Infants with these outcomes also have altered autonomic nervous system (ANS) regulation. We examined the effects of prenatal smoking and drinking on newborn ANS function.

Methods

Pregnant women were enrolled in Northern Plains, USA (NP) and Cape Town (CT), South Africa. Daily drinking and weekly smoking data were collected prenatally. Physiological measures were obtained during sleep 12–96 h post-delivery.

Results

In all, 2913 infants from NP and 4072 from CT were included. In active sleep, newborns of mothers who smoked throughout pregnancy, compared to non-smokers, had higher breathing rates (2.2 breaths/min; 95% CI: 0.95, 3.49). Quit-early smoking was associated with reductions in beat-to-beat heart rate variability (HRV) in active (−0.08 s) and quiet sleep (−0.11 s) in CT. In girls, moderate-high continuous smoking was associated with increased systolic (3.0 mmHg, CI: 0.70, 5.24) and diastolic blood pressure (2.9 mmHg, CI: 0.72, 5.02). In quiet sleep, low-continuous drinking was associated with slower heart rate (−4.5 beat/min). In boys, low-continuous drinking was associated with a reduced ratio of low-to-high frequency HRV (−0.11, CI: −0.21, −0.02).

Conclusions

These findings highlight potential ANS pathways through which prenatal drinking and smoking may contribute to neurodevelopment outcomes.

Impact

  • In this prospective cohort study of 6985 mother–infant dyads prenatal drinking and smoking were associated with multiple ANS parameters.

  • Smoking was associated with increased neonatal breathing rates among all infants, and heart rate variability (HRV) and blood pressure (BP) among girls.

  • Drinking was associated with reductions in HR and BP among all newborns, and reductions in the ratio of low to-high frequency HRV among boys.

  • These findings suggest that prenatal smoking and drinking alter newborn ANS which may presage future neurodevelopmental disorders.

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Fig. 1
Fig. 2: Marginal means in each exposure categories, stratified by study site and infant sex.

References

  1. Handmaker, N. S. et al. Impact of alcohol exposure after pregnancy recognition on ultrasonographic fetal growth measures. Alcohol. Clin. Exp. Res. 30, 892–898 (2006).

    CAS  Article  PubMed  Google Scholar 

  2. Scheffers-van Schayck, T., Tuithof, M., Otten, R., Engels, R. & Kleinjan, M. Smoking behavior of women before, during, and after pregnancy: indicators of smoking, quitting, and relapse. Eur. Addict. Res. 25, 132–144 (2019).

    Article  PubMed  Google Scholar 

  3. Popova, S., Lange, S., Probst, C., Gmel, G. & Rehm, J. Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. Lancet Glob. Health 5, e290–e299 (2017).

    Article  PubMed  Google Scholar 

  4. Lange, S., Probst, C., Rehm, J. & Popova, S. National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysis. Lancet Glob. Health 6, e769–e776 (2018).

    Article  PubMed  Google Scholar 

  5. Elliott, A. J. et al. Concurrent prenatal drinking and smoking increases risk for SIDS: safe passage study report. EClinicalMedicine 19, 100247 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hamulka, J., Zielinska, M. A. & Chadzynska, K. The combined effects of alcohol and tobacco use during pregnancy on birth outcomes. Rocz. Panstw. Zakl. Hig. 69, 45–54 (2018).

    PubMed  Google Scholar 

  7. Kesmodel, U., Wisborg, K., Olsen, S. F., Henriksen, T. B. & Secher, N. J. Moderate alcohol intake during pregnancy and the risk of stillbirth and death in the first year of life. Am. J. Epidemiol. 155, 305–312 (2002).

    Article  PubMed  Google Scholar 

  8. Fifer, W. P., Fingers, S. T., Youngman, M., Gomez-Gribben, E. & Myers, M. M. Effects of alcohol and smoking during pregnancy on infant autonomic control. Dev. Psychobiol. 51, 234–242 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lucchini, M. et al. Effects of Prenatal Exposure to Alcohol and Smoking on Fetal Heart Rate and Movement Regulation. Front Physiol. 12, 594605 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Shuffrey, L. C. et al. Association between prenatal exposure to alcohol and tobacco and neonatal brain activity: results from the safe passage study. JAMA Netw. Open 3, e204714 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  11. Flak, A. L. et al. The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: a meta-analysis. Alcohol Clin. Exp. Res. 38, 214–226 (2014).

    Article  PubMed  Google Scholar 

  12. Julvez, J. et al. Maternal smoking habits and cognitive development of children at age 4 years in a population-based birth cohort. Int. J. Epidemiol. 36, 825–832 (2007).

    Article  PubMed  Google Scholar 

  13. Manzo-Avalos, S. & Saavedra-Molina, A. Cellular and mitochondrial effects of alcohol consumption. Int. J. Environ. Res. Public Health 7, 4281–4304 (2010).

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. Brocardo, P. S., Gil-Mohapel, J. & Christie, B. R. The role of oxidative stress in fetal alcohol spectrum disorders. Brain Res. Rev. 67, 209–225 (2011).

    CAS  Article  PubMed  Google Scholar 

  15. Jarmasz, J. S., Basalah, D. A., Chudley, A. E. & Del Bigio, M. R. Human brain abnormalities associated with prenatal alcohol exposure and fetal alcohol spectrum disorder. J. Neuropathol. Exp. Neurol. 76, 813–833 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cohen, G. et al. Perinatal exposure to nicotine causes deficits associated with a loss of nicotinic receptor function. Proc. Natl Acad. Sci. USA 102, 3817–3821 (2005).

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. Philips, E. M. et al. Changes in parental smoking during pregnancy and risks of adverse birth outcomes and childhood overweight in Europe and North America: an individual participant data meta-analysis of 229,000 singleton births. PLoS Med. 17, e1003182–e1003182 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mamluk, L. et al. Evidence of detrimental effects of prenatal alcohol exposure on offspring birthweight and neurodevelopment from a systematic review of quasi-experimental studies. Int. J. Epidemiol. 49, 1972–1995 (2020).

    Article  PubMed Central  Google Scholar 

  19. Musser, E. D. et al. Emotion regulation via the autonomic nervous system in children with attention-deficit/hyperactivity disorder (ADHD). J. Abnorm. Child Psychol. 39, 841–852 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  20. Grzadzinski, R. et al. Pre-Symptomatic Intervention for Autism Spectrum Disorder (Asd): Defining a Research Agenda. J. Neurodevelopmental Disord. 13, 49 (2021).

    Article  Google Scholar 

  21. Duncan, J. R. et al. The effect of maternal smoking and drinking during pregnancy upon (3)H-nicotine receptor brainstem binding in infants dying of the sudden infant death syndrome: initial observations in a high risk population. Brain Pathol. 18, 21–31 (2008).

    Article  PubMed  Google Scholar 

  22. Kinney, H. C., Richerson, G. B., Dymecki, S. M., Darnall, R. A. & Nattie, E. E. The brainstem and serotonin in the sudden infant death syndrome. Annu Rev. Pathol. 4, 517–550 (2009).

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  23. Vivekanandarajah, A. et al. Nicotinic receptors in the brainstem ascending arousal system in sids with analysis of pre-natal exposures to maternal smoking and alcohol in high-risk populations of the safe passage study. Front. Neurol. 12, 636668–636668 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  24. Schechtman, V. L. et al. Dynamic analysis of cardiac R-R intervals in normal infants and in infants who subsequently succumbed to the sudden infant death syndrome. Pediatr. Res. 31, 606–612 (1992).

    CAS  Article  PubMed  Google Scholar 

  25. Schechtman, V. L. et al. Heart rate variation in normal infants and victims of the sudden infant death syndrome. Early Hum. Dev. 19, 167–181 (1989).

    CAS  Article  PubMed  Google Scholar 

  26. Schechtman, V. L., Harper, R. M., Wilson, A. J. & Southall, D. P. Sleep apnea in infants who succumb to the sudden infant death syndrome. Pediatrics 87, 841–846 (1991).

    CAS  Article  PubMed  Google Scholar 

  27. Kluge, K. A. et al. Spectral analysis assessment of respiratory sinus arrhythmia in normal infants and infants who subsequently died of sudden infant death syndrome. Pediatr. Res. 24, 677–682 (1988).

    CAS  Article  PubMed  Google Scholar 

  28. Kahn, A. et al. Sleep and cardiorespiratory characteristics of infant victims of sudden death: a prospective case-control study. Sleep 15, 287–292 (1992).

    CAS  Article  PubMed  Google Scholar 

  29. Kahn, A. et al. Sudden infant deaths: from epidemiology to physiology. Forensic Sci. Int. 130, S8–S20 (2002).

    Article  PubMed  Google Scholar 

  30. Sahni, R., Fifer, W. P. & Myers, M. M. Identifying infants at risk for sudden infant death syndrome. Curr. Opin. Pediatr. 19, 145–149 (2007).

    Article  PubMed  Google Scholar 

  31. Myers, M. M., Burtchen, N., Retamar, M. O., Lucchini, M. & Fifer, W. P. In SIDS Sudden Infant and Early Childhood Death: The Past, the Present and the Future (eds. Duncan, J. R. & Byard, R. W.) (Adelaide (AU): University of Adelaide Press, 2018).

  32. Horne, R. S. C. Cardiovascular autonomic dysfunction in sudden infant death syndrome. Clin. Auton. Res 28, 535–543 (2018).

    Article  PubMed  Google Scholar 

  33. Zeskind, P. S. & Gingras, J. L. Maternal cigarette-smoking during pregnancy disrupts rhythms in fetal heart rate. J. Pediatr. Psychol. 31, 5–14 (2005).

    Article  PubMed  Google Scholar 

  34. Pini, N., Lucchini, M., Fifer, W. P., Myers, M. M. & Signorini, M. G. In 2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). 5874–5877.

  35. Dukes, K. A. et al. The safe passage study: design, methods, recruitment, and follow-up approach. Paediatr. Perinat. Epidemiol. 28, 455–465 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  36. Dukes, K. et al. A modified timeline followback assessment to capture alcohol exposure in pregnant women: application in the safe passage study. Alcohol 62, 17–27 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  37. Sania, A. et al. The K nearest neighbor algorithm for imputation of missing longitudinal prenatal alcohol data. Research Square (2021).

  38. Pini, N. et al. Cluster analysis of alcohol consumption during pregnancy in the safe passage study. Annu Int Conf. IEEE Eng. Med Biol. Soc. 2019, 1338–1341 (2019).

    PubMed  Google Scholar 

  39. Myers, M. M. et al. Cardiorespiratory physiology in the safe passage study: protocol, methods and normative values in unexposed infants. Acta Paediatr. 106, 1260–1272 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  40. Isler, J. R., Thai, T., Myers, M. M. & Fifer, W. P. An automated method for coding sleep states in human infants based on respiratory rate variability. Dev. Psychobiol. 58, 1108–1115 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  41. Harper, R. M., Schechtman, V. L. & Kluge, K. A. Machine classification of infant sleep state using cardiorespiratory measures. Electroencephalogr. Clin. Neurophysiol. 67, 379–387 (1987).

    CAS  Article  PubMed  Google Scholar 

  42. Malik, M. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 93, 1043–1065 (1996). B. J. a. C. J.

    Article  Google Scholar 

  43. Blakesley, R. E. et al. Comparisons of methods for multiple hypothesis testing in neuropsychological research. Neuropsychology 23, 255–264 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  44. Greenland, S. Analysis goals, error-cost sensitivity, and analysis hacking: Essential considerations in hypothesis testing and multiple comparisons. Paediatr Perinat Epidemiol. 35, 8–23 (2021).

  45. Rothman, K. J. No adjustments are needed for multiple comparisons. Epidemiology 1, 43–46 (1990).

    CAS  Article  PubMed  Google Scholar 

  46. Kahn, A. et al. Prenatal exposure to cigarettes in infants with obstructive sleep apneas. Pediatrics 93, 778–783 (1994).

    CAS  Article  PubMed  Google Scholar 

  47. Coddou, C., Bravo, E. & Eugenin, J. Alterations in cholinergic sensitivity of respiratory neurons induced by pre-natal nicotine: a mechanism for respiratory dysfunction in neonatal mice. Philos. Trans. R. Soc. Lond. B Biol. Sci. 364, 2527–2535 (2009).

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  48. Milner, A. D., Rao, H. & Greenough, A. The effects of antenatal smoking on lung function and respiratory symptoms in infants and children. Early Hum. Dev. 83, 707–711 (2007).

    CAS  Article  PubMed  Google Scholar 

  49. Beratis, N. G., Panagoulias, D. & Varvarigou, A. Increased blood pressure in neonates and infants whose mothers smoked during pregnancy. J. Pediatr. 128, 806–812 (1996).

    CAS  Article  PubMed  Google Scholar 

  50. Browne, C. A., Colditz, P. B. & Dunster, K. R. Infant autonomic function is altered by maternal smoking during pregnancy. Early Hum. Dev. 59, 209–218 (2000).

    CAS  Article  PubMed  Google Scholar 

  51. Eckberg, D. L. Sympathovagal balance: a critical appraisal. Circulation 96, 3224–3232 (1997).

    CAS  Article  PubMed  Google Scholar 

  52. Sheinkopf, S. J. et al. Developmental trajectories of autonomic functioning in autism from birth to early childhood. Biol. Psychol. 142, 13–18 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  53. Nordenstam, F. et al. Prenatal exposure to snus alters heart rate variability in the infant. Nicotine Tob. Res. 19, 797–803 (2017).

    CAS  Article  PubMed  Google Scholar 

  54. Franco, P., Chabanski, S., Szliwowski, H., Dramaix, M. & Kahn, A. Influence of Maternal smoking on autonomic nervous system in healthy infants. Pediatr. Res. 47, 215–220 (2000).

    CAS  Article  PubMed  Google Scholar 

  55. Moscovis, S. M., Hall, S. T., Burns, C. J., Scott, R. J. & Blackwell, C. C. The male excess in sudden infant deaths. Innate Immun. 20, 24–29 (2014).

    CAS  Article  PubMed  Google Scholar 

  56. Boychuk, C. R., Fuller, D. D. & Hayward, L. F. Sex differences in heart rate variability during sleep following prenatal nicotine exposure in rat pups. Behav Brain Res. 219, 82–91 (2011).

    CAS  Article  PubMed  Google Scholar 

  57. Zhang, Z. et al. Parental smoking and blood pressure in children and adolescents: a national cross-sectional study in China. BMC Pediatrics 19, 116 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  58. Geerts, C. C. et al. Tobacco smoke exposure of pregnant mothers and blood pressure in their newborns. 50, 572–578 (2007).

  59. Bakker, R., Steegers, E. A., Mackenbach, J. P., Hofman, A. & Jaddoe, V. W. Maternal smoking and blood pressure in different trimesters of pregnancy: the generation R study. J. Hypertens. 28, 2210–2218 (2010).

    CAS  Article  PubMed  Google Scholar 

  60. Lewandowska, M. & Więckowska, B. The influence of various smoking categories on the risk of gestational hypertension and pre-eclampsia. J. Clin. Med 9, 1743 (2020).

    CAS  Article  PubMed Central  Google Scholar 

  61. Killen, J. D., Fortmann, S. P., Schatzberg, A., Hayward, C. & Varady, A. Onset of major depression during treatment for nicotine dependence. Addictive Behav. 28, 461–470 (2003).

    Article  Google Scholar 

  62. Jesse, S. et al. Alcohol withdrawal syndrome: mechanisms, manifestations, and management. Acta Neurol. Scand. 135, 4–16 (2017).

    CAS  Article  PubMed  Google Scholar 

  63. Graham, H. & Owen, L. Are there socioeconomic differentials in under-reporting of smoking in pregnancy? Tob. Control 12, 434–434 (2003).

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  64. Rukmani, M. R., Seshadri, S. P., Thennarasu, K., Raju, T. R. & Sathyaprabha, T. N. Heart rate variability in children with attention-deficit/hyperactivity disorder: a pilot study. Ann. Neurosci. 23, 81–88 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  65. Lucchini, M., Fifer, W. P., Sahni, R. & Signorini, M. G. Novel heart rate parameters for the assessment of autonomic nervous system function in premature infants. Physiol. Meas. 37, 1436–1446 (2016).

    CAS  Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors gratefully acknowledge the cooperation of the study participants, PASS investigators, the PASS Steering Committee Chairman Gary D.V. Hankins, MD, and members of the National Institute of Child Health and Human Development advisory safety monitoring board: Elizabeth Thom, Ph.D. (Chair); Reverend Phillip Cato, Ph.D.; James W. Collins Jr, MD, MPH; Terry Dwyer, MD, MPH; George Macones, MD; Philip A. May, Ph.D.; Jeff Murray, MD; Richard M. Pauli, MD, Ph.D.; Raymond W. Redline, MD; and Michael Varner, MD. Furthermore, the following individuals made significant contributions to the research and warrant recognition: DCAC: Idania Ramirez, MPH; Jamie Collins, MA; Laura Spurchise, MPH; DBPC: Richard A. Belliveau, BA; Kristin McMillan, BA; Megan Minter, MS; PAC: Johnston T. Grier, BA; Emilia F. Vignola, BA; Joseph J. Violaris, BA. All contributors were compensated by one or more of the listed funding sources.

The following institutions and researchers comprise the PASS Network (additional network members other than authors listed): Data Coordinating and Analysis Center (DCAC): Director: Kimberly Dukes, Ph.D.; Codirector: Lisa M. Sullivan, PhD; Biostatistics: Tara Tripp, MA; Project Management and Regulatory Affairs: Julie M. Petersen, BA; Rebecca A. Young, MPH; Data Management and Information Technology: Travis Baker, BS; Derek Petersen, BS; Gregory Toland, MS. Developmental Biology and Pathology Center (DBPC): Director: Hannah C. Kinney, MD; Assistant Director: Robin L. Haynes, Ph.D.; Coinvestigators: David S. Paterson, Ph.D.; Kevin G. Broadbelt, PhD; Kyriacos Markianos, Ph.D.; Ingrid A. Holm, MD; Theonia Boyd, MD; Drucilla Roberts, MD; Richard G. Goldstein, MD; Hanno Stein, Ph.D.; Technicians: Claire Maggiotto, BS; Catherine Hassett, BS. Comprehensive Clinical Site Northern Plains: Coinvestigators: Donald Habbe, MD; H. Eugene Hoyme, MD; William Massello III, MD; Bradley Randall, MD; Mary Ann Sens, MD, Ph.D.; Catherine Stoos, MD, Peter Van Eerden, MD; Project Management: Whitney Adler, BA; Elizabeth Berg, RN; Jessica Gromer, RN; Bethany Norton, MA; Liz Swenson, RN; Deb Tobacco, MA. Comprehensive Clinical Site South Africa: Project Management: Erna Carstens, RN; Mandy Potter, RN; Lucy Brink, MSc; Sylvia Abrahams, RN; Allison Borchardt, RN; Noorjahan Bosman, RN; Ciska Botha, BSocSc; Lehana Breytenbach, RN; Lucille Burger, RN; Carina Carstens, BCur (Nursing); Erna Carstens, RN; Weslin Charles, Hons BA (Psychology); Milly de Jager, RN; Carlie du Plessis, RN; Sandra Felix, RN; Nicola James (Nel), MCur (Nursing); Ronnie Jurgens, RN; Belda Klukowski, RN; Mugeleigh Lakay, MCur (Nursing); Samacia Maloy, RN; Marilyn Mentor, RN; Petra Opperman, RN; Berenice Pillay, RN; Mandy Potter, RN; Earl Prinsloo, BA Hons (Sociology); Sonja Schell, RN; Marisa van der Spuy, BCur (Nursing); Mariëtta Warwick, RN. Physiology Assessment Center (PAC): Project Management: Daianna Rodriguez, BA; Albany Perez, BA; Data Processing: Margaret C. Shair, BA; Tracy Thai, BA. National Institutes of Health: Project Scientists: Marian Willinger, PhD (National Institute of Child Health and Human Development); Dale Herald, Ph.D. (National Institute on Alcohol Abuse and Alcoholism); Howard J. Hoffman, Ph.D. (National Institute on Deafness and Other Communication Disorders); Chuan-Ming Li, MD, Ph.D. (National Institute on Deafness and Other Communication Disorders); Program Officers: Bill Dunty, Ph.D. (National Institute on Alcohol Abuse and Alcoholism); Tonse Raju, MD, DCH (National Institute of Child Health and Human Development); Gordon B. Hughes, MD (National Institute on Deafness and Other Communication Disorders).

Funding

This research was supported by grants UH3OD023279, U01HD055154, U01HD045935, U01HD055155, and U01AA016501, issued by the Office of the Director, National Institutes of Health of the National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Institute on Deafness and Other Communication Disorders. Ayesha Sania is supported by UH3OD023279-05S1, re-entry supplement from Office of the Director, NIH, and Office of Research on Women Health (ORWH). The opinions expressed in this paper are those of the authors and do not necessarily represent the official views of the National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Development, the National Institute on Alcohol Abuse and Alcoholism, or the National Institute on Deafness and Other Communication Disorders.

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A.S. conceptualized and conducted statistical analysis, drafted the initial manuscript, and reviewed and revised the manuscript. M.M.M. was a principal investigator of the study; he conceptualized and designed the study, supervised data collection and data processing, drafted the manuscript, reviewed, and revised it. A.J.E., W.P.F., and H.J.O. were principal investigators of the study, they acquired funding, contributed to data analyses and interpretation of the results, and writing of the manuscript. N.P. M.L., and L.C.S. contributed to the interpretation of results and drafting the manuscript. J.D.N., J.B., and J.A. participated in study supervision, data collection and processing, drafting and critical revision of the manuscript. S.R. participated in data analysis and drafting of the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Ayesha Sania.

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Sania, A., Myers, M.M., Pini, N. et al. Prenatal smoking and drinking are associated with altered newborn autonomic functions. Pediatr Res (2022). https://doi.org/10.1038/s41390-022-02060-5

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