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Maternal smoking as an independent risk factor for the development of severe retinopathy of prematurity in very preterm infants



Retinopathy of prematurity (ROP) is a severe neonatal complication potentially leading to visual impairment and blindness. Known risk factors include preterm birth, low birth weight and respiratory support. Limited and contradictory data exist on the risk of maternal smoking during pregnancy on the development of ROP. This study aims to investigate smoking as an independent risk factor for the development of severe ROP (≥stage 3).


This is a single centre retrospective case-control study of prospectively collected clinical data of infants born before 32 weeks of gestation between 2001 and 2012 at a tertiary care university hospital. The association between maternal smoking during pregnancy and the development of severe ROP was analyzed by multivariate logistic regression.


In total, n = 751 infants born < 32 weeks of gestation were included in this study. In total, 52.9% (n = 397) were diagnosed with ROP and 10.8% (n = 81) developed ROP ≥ stage 3. In total, 8.4% (n = 63) mothers presented with a history of smoking during pregnancy, which was associated to a higher rate of ROP (OR 2.59, 95% CI 1.10–6.12). Low gestational age, low birth weight and prolonged respiratory support were confirmed as independent risk factors for the development of severe ROP.


To date, this is the largest study evaluating the effect of maternal smoking on the development of ROP. Maternal smoking during pregnancy is identified as an independent risk factor for the development of severe ROP in preterm infants born < 32 weeks of gestation.

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Author information




HH: protocol/project development, data collection or management, data analysis, paper writing/editing. TB: data collection or management, data analysis. JP: paper editing. TS: paper editing. RJK: protocol/project development, data collection or management, data analysis, paper writing/editing. All authors read and approved the final paper.

Corresponding author

Correspondence to Ruben-J. Kuon.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Heidelberg University institutional review board (IRB, S-094/2013). All procedures performed in the study were in accordance with the ethical standards and data safety of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

The institutional ethics committee waived informed consent due to the retrospective nature of the study, and pseudonymization of data

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Hudalla, H., Bruckner, T., Pöschl, J. et al. Maternal smoking as an independent risk factor for the development of severe retinopathy of prematurity in very preterm infants. Eye 35, 799–804 (2021).

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