Review
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Maternal smoking during pregnancy on the child.
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Infant low birth weight.
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Short-interval to subsequent pregnancy (defined as less than two years).
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Childhood A&E attendances and inpatient admissions.
Methods
Search strategy
Inclusion and exclusion criteria
Assessment of studies
Quality assessment
Data analysis
Results
Maternal smoking and child outcomes
Health
Study | Aim | Methods | Outcome measure | Findings | Notes | Quality assessment |
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Blair et al., 1996 [26] | To investigate the effect of exposure to tobacco smoke on the sudden infant death syndrome | Two year population based case-control study Participants: 195 babies who died and 780 matched controls | SIDS | A dose response was associated with exposure to tobacco smoke. Maternal smoking during pregnancy was significantly related to SIDS (OR = 2.10 [95% CI:1.24-3.54]) in the multivariate analysis. After adjustment, paternal smoking had an additional independent effect (OR = 2.50 [95% CI: 1.48- 4.22]) | Adjusted for a good amount of covariates. | Moderate |
Fertig, 2010 [52] | To examine the importance of selection on the effect of prenatal smoking by using three British cohorts | Data from 3 UK birth cohort studies used providing a large data set of 45,400 participants. | Birth weight | The effect of prenatal smoking in 2000 on low birth weight is over 50% greater than in 1958 and is approximately double with respect to the probability of a low birth weight birth conditional on gestation. Selection could explain as much as 50% of the current association between prenatal smoking and the probability of low birth weight birth. | Adjusted for a good amount of covariates. | Strong |
Golding et al., 1990 [14] | Association between child cancer and factors during pregnancy, labour and delivery and other maternal aspects. | Case-control study of 132 children. Development of childhood cancer was recorded. | Child cancer | Childhood cancer was associated with antenatal smoking (OR = 2.69 [95%CI:1.05-6.89]). Logistic regression showed independent relationship between childhood cancer and maternal smoking (OR = 2.5 [95% CI:1.20-5.08]) | Some covariates accounted for. | Moderate |
Hawkins et al., 2009 [18] | Association between risk factors (including birth weight and smoking during pregnancy) obesity. | Prospective cohort study using data from the Millennium Cohort Study (n = 13,188) | Childhood obesity | Early childhood obesity was associated with maternal smoking during pregnancy (1-9 cigarettes daily: OR = 1.34 [1.17-1.54] fully adjusted; 10-19 cigarettes: OR = 1.49 [1.26-1.75] fully adjusted). | Adjusted for a good amount of covariates. | Strong |
Henderson et al., 2001 [13] | Association between smoking during pregnancy, environmental tobacco smoke (ETS) exposure and wheezing illness of infants of 6 months old | Longitudinal cohort studies from the UK and Czech Republic (n = 14,269). | Wheeze | In the UK, infant wheeze was significantly associated with maternal smoking during pregnancy OR = 1.30 [95% CI: 1.09-1.56] adjusted). | Adjusted for a good amount of covariates. | Moderate |
Koshy et al., 2011 [19] | Association between children’s weight and height and cigarette smoke exposure during mothers’ pregnancy | Use 2 UK cross-sectional surveys from 1998 and 2006 (n = 3038) | Childhood obesity | Smoking during pregnancy was associated with an increase in the likelihood of obesity in children (OR = 1.61[95% CI: 1.19–2.18]) | Some covariates included. | Moderate |
Larsson & Montgomery (2011) [28] | To assess the association between smoking during pregnancy and poorer motor competence among offspring | Longitudinal study of 13,207 families in GB followed up to age 11. | Hand control and coordination assessed using known measures. | After adjustment, heavy smoking during pregnancy was significantly associated with poorer performance in PUM (picking up matches) task for the non-dominant hand in both boys (Coeff = 1.474 [95% CI: 0.47-2.48 p = .004] and girls (Coeff = 1.203 [95% CI: 0.15-2.26 p = .026]). It also negatively affected boys’ performance in CD (copying design test score) (Coeff = −0.185 [95% CI:-0.32 - -0.05 p = .006]). | Good covariates | Moderate |
Little et al. 2004 [27] | Association between smoking and orofacial clefts | Case-control study of 438 children from England and Scotland. | Orofacial clefts | Maternal smoking during pregnancy had a positive association with cleft lip with or without cleft palate (CL+/-P)(OR = 1.9 [95% CI:1.1-3.1] adjusted), and cleft palate (CP) (OR = 2.3 [95% CI:1.3-4.1] adjusted). A dose-response was observed for both CL+/-P (p value = 0.012) and CP (p value = 0.004). Passive smoking of mothers also had weak effect. | Adjusted for a good amount of covariates. | Moderate |
Pang et al. 2003 [53] | Association between parental preconceptional smoking and maternal smoking in pregnancy, and risk of developing cancer in childhood | UK based case control study using children diagnosed with malignancy or CNS tumour under 15 years (n = 3838) and matched controls (n = 7629). | Childhood cancer | Significant monotonic decreasing trends in risk were found in relation to the amount of cigarettes smoked by the mother during pregnancy for all child cancers, leukaemia, lymphoma, CNS tumours and other solid tumours (p < 0.001, p = 0.03, p = 0.01 and P = 0.03 respectively), with ORs statistically significantly below 1 among heavy smokers. For primitive neuroectodermal tumours the OR was 0.55 (P = 0.01). | Some covariates included. | Strong |
Power et al. 2010 [20] | Association between maternal smoking during pregnancy and risk factors for CVD | Prospective UK cohort study following members up to age 45 years (n = 8815). | Risk factors of CVD in adulthood | Maternal smoking during pregnancy was associated with an increased likelihood of obesity in adult offspring classified by BMI (OR = 1.40 [95% CI: 1.25–1.56]) and high waist circumference (OR = 1.32 [95% CI: 1.19–1.47]) | Adjusted for a good amount of covariates. | Strong |
Power et al. 2003 [22] | To investigate growth trajectories and predictive factors for those with low birth weight and high adult BMI | Birth cohort study followed up to age 33. Full data available for 7017 participants. | Adulthood obesity | Maternal smoking during pregnancy was associated with an increased likelihood of obesity in adult offspring classified by BMI for both males (OR = 1.79 [95% CI: 1.37-2.29] and females (OR = 2.27 [95% CI: 1.79-2.86]). | Some covariates adjusted for. | Strong |
Power and Jefferies 2002 [21] | Association between maternal smoking during pregnancy and obesity risk through childhood to age 33 | Prospective GB cohort study of 5839 born in 1958. Assessed obesity status (BMI) at age 33. | Adulthood obesity | Maternal smoking during pregnancy was associated with an increased likelihood of obesity in adult offspring classified by BMI for both males (OR = 1.56 [95% CI: 1.22-2.00] and females (OR = 1.41 [95% CI: 1.12-1.79]. | Good range of covariates. | Strong |
Ramadas et al. 2007 [15] | 1. Association between the IL1RN gene polymorphisms with asthma; and 2. association between the gene (IL1RN)-environment (smoke exposure) interactions and asthma | UK based prospective cohort study. Outcome measure: Asthma, airway obstruction and BHR | Asthma | The rs2234678 genotype GG was significantly associated with repeated measurements of asthma in children of mothers who smoked during pregnancy (ETS-2 group: OR 4.43, CI 1.62–12.1, p = 0.0037) but not in children without maternal smoking exposure during pregnancy (ETS-0 or ETS-1). This suggests that exposure to maternal smoking may be more detrimental to some children than others. | Some covariates adjusted for. | Moderate |
Sadeghnejad et al. 2008 [16] | To investigate whether there is a combined effect of interleukin-I3 gene polymorphisms and tobacco smoke on persistent childhood wheezing and asthma | UK based cohort study followed up to age 10 (n = 791) Outcomes were wheezing and persistent childhood asthma | Wheezing and asthma | Maternal smoking during pregnancy was associated with early onset persistent wheeze (OR = 2.93, p < 0.0001). However, the effect of maternal smoking during pregnancy was stronger in children with certain genetic features (OR = 5.58 and OR =1.29, respectively; p for interaction = 0.014). When analyzing asthma instead of wheezing, the interaction was statistically significant (p = 0.03) for persistent asthma. Children with a CCG/CCG haplotype pair had an OR of 5.57 (95% CI 2.13 to 14.63, p = 0.0005) for ETS-2 on persistent asthma. For subjects with haplotype pairs other than CCG/CCG, the OR was 1.32 (95% CI 0.57 to 3.04, p = 0.587). | Some covariates adjusted for. | Moderate |
Severson et al. 1993 [54] | Association between parental smoking and alcohol consumption and childhood AML. | Case control study in the US and Canada. | Childhood cancer (Acute Myeloid Leukemia (AML)) | No statistically significant associations were found for maternal cigarette smoking when exposures were restricted to the month immediately preceding pregnancy; the first, second, or third trimester of pregnancy; or during the time the mother was nursing the index child. | Some covariates adjusted for. | Moderate |
Sorahan et al. 1995 [55] | Association between any childhood cancer and consumption of alcohol and tobacco. | Case-control study in England and Wales. | Childhood cancer | There was no association between maternal smoking and childhood cancer (P = 0.602). | Only class, maternal and paternal age controlled for. | Moderate |
Sorahan and Lancashire 2004 [56] | Relation between parental cigarette smoking and hepatoblastoma | Case-control study in UK. 43 cases of hepatoblastoma and 5777 controls | Childhood cancer | Positive associations were found between hepatoblastoma risks and both maternal and paternal smoking. The largest relative risk is shown in the fuller model for both parents being smokers (RR = 2.69, P < 0.05, 95% CI 1.18–6.13). | Good range of covariates. | Moderate |
Strachan et al. 1996 [17] | The relationship between incidence of wheezing illness from birth to age 33 and perinatal, medical, social, environmental, and lifestyle factors | Prospective longitudinal study across the UK. 18,559 participants followed to age 33 | Asthma and wheeze | Maternal smoking during pregnancy was associated with increased incidence of childhood wheezing (OR = 1.72 [95% CI: 1.11-2.67]), when compared to cohort members whose mother never smoked. Birth order, birth weight and birth weight for gestation were not significant independent risk factors. | Good range of covariates. | Strong |
Thomas et al. 2007 [23] | To explore how prenatal exposures known to be associated with low birth weight effect glucose metabolism in midlife. | UK cohort study of 7518 cohort members born in 1958. | Adult metabolism (diabetes) | No association was found between maternal smoking and blood glucose levels in offspring after accounting for birth weight for gestational age (BGA) and adult adiposity. | Some covariates adjusted for. | Strong |
Toschke et al. 2007 [24] | To look at the association between maternal smoking and type 2 diabetes. | GB prospective cohort study. 5214 cohort members from NCDS and 6069 from BCS70. | Diabetes | No association between diabetes and postnatal maternal smoking was observed. | Good range of covariates | Moderate |
Toschke et al. 2003 [25] | Association between smoking in pregnancy and appetite control in offspring | GB prospective cohort study 10,557 cohort members born 1958 | Appetite control | An association was found between maternal smoking during pregnancy and offspring appetite control in adulthood (OR = 1.22 [95% CI: 1.01-1.48]). | Some covariates adjusted for. | Moderate |
Cognitive development and educational attainment
Study | Aim | Methods | Outcome measure | Findings | Notes | Quality assessment |
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Brion et al., (2010) [30] | To assess the association between maternal prenatal smoking and child psychological problems. | Prospective cohort study in 3 health districts in England and Brazil. N = 6735 in England, 509 children in Brazil | Behavioural outcomes measured by Strengths and Difficulties Questionnaire (England) or Child Behaviour Checklist (Brazil) around age 4 | In the UK cohort maternal smoking was significantly associated with hyperactivity/attention problems (OR = 1.17 [95% CI 1.04-1.31]), and peer social problems (OR = 1.24 [95% CI 1.1-1.4]). Smoking was also associated with conduct/externalizing problems (OR = 1.24 [95% CI:1.07-1.46]) | Adjusted for good range of covariates included paternal smoking | Strong |
Collins et al., (2007) [29] | To assess the association between prenatal tobacco exposure and child academic achievement. | Longitudinal analysis of 6390 mother-child pairs across the UK. | Adolescent offspring academic achievement measured through pass/fail on O-level (GCSE equivalent) and A-level at ages 16 and 18 respectively. | Prenatal exposure had no significant effects on test failure in adolescence. | Some covariates accounted for | Moderate |
Hutchinson et al., (2010) [31] | Associations between maternal smoking in pregnancy and child behaviour. | Prospective cohort study of 13,778 families across the UK (MCS) followed from birth | Children’s conduct and hyperactivity/inattention problems measured by the SDQ at age 3 years. | After adjustment, for boys, mothers’ persistent smoking in pregnancy was significantly associated with conduct problems (OR = 1.44 [95% CI: 1.01-2.06] for light smoker; OR = 1.80 [95% CI: 1.28-2.54] for heavy smoker) and hyperactivity-inattention problem (OR = 1.56 [95% CI: 1.12-2.15] for light smoker; OR = 1.62 [95% CI: 1.13-2.33] for heavy smoker). | Good range of covariates | Strong |
Maughan et al., (2004) [32] | To explore the association between prenatal smoking and early childhood behaviour | Longitudinal study of 1116 families in England and Wales. | Children’s conduct problems at age 5 and 7 years were assessed using the CBCL measures. | No significant association between maternal smoking and child behaviour. | Some covariates | Moderate |
Problem behaviour and criminal activity
Study | Aim | Methods | Outcome measure | Findings | Notes | Quality assessment |
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Hay et al., (2010) [33] | To examine the links between exposure to maternal depression in pregnancy and antisocial outcomes in children. | Longitudinal study of 120 families in Britain. Families were followed until the child was around 16 years. | Incidence of arrests and DSM diagnoses. | Antenatal exposure to cigarette smoking did not predict antisocial outcomes for children. | Adjusted for a wide range of covariates | Moderate |
Macleod et al., (2008) [57] | To estimate the prevalence of alcohol and tobacco use among children | Birth cohort study in England (n = 6895, 3410 male) | Measured self-reported use of tobacco and alcohol at age 10. | After adjusting for potential covariates no significant association was found between maternal smoking and child tobacco and alcohol use. | Good range of covariates. 10 years old likely too young for outcome measure | Moderate |
Murray et al., (2010) [34] | To identify early predictors of conduct problems and crime | Large UK cohort study (n = 16,401) followed up to age 34 years | Child conduct problems at age 10 measured using parent-rated Rutter A2 scale. Convictions were self-reported at ages 30 and 34 years. | In fully adjusted models, maternal smoking during pregnancy was significantly associated with conduct problems at age 10 (partial OR = 1.8 [95% CI: 1.3-2.5] for girls; Partial OR = 1.7 [95% CI: 1.4-2.2] for boys) and convictions in adulthood (partial OR = 1.8 [95% CI: 1.2-2.7] for girls; partial OR = 1.4 [95% CI: 1.1-1.7] for boys). | Adjusted for a wide range of covariates | Strong |
Low infant birth weight and child outcomes
Health
Study | Aim | Methods | Outcome measure | Results | Notes | Quality assessment |
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Annesi-Maesano et al., 2001 [38] | To explore how in utero and perinatal factors and health outcomes affect the development and severity of asthma in childhood | Prospective cohort study. 4065 children and 2583 mothers. Mean age among cohort mothers was 31.0 ± 3.3 years. | Childhood asthma | Low birth weight (< 2.5 kg) was associated with child asthma (OR = 1.57 [95% CI: 1.10- 2.25]) | Good range of covariates | Strong |
Davies et al. 2004 [45] | Association between birth weight and adult total cholesterol concentration (TC) | Cross-sectional 1994-1996 18,286 men and 7557 women. British Telecom employees The mean age is 38.9 for men and 36 for women | Adult cholesterol | After adjustment, in men a − 0.09 mmol/L reduction in TC was observed per 1 kg increase in birth weight (95% CI, − 0.11 to − 0.06 mmol/L; P < 0.001); in women, a − 0.006 mmol/L reduction in TC was observed per 1 kg increase in birth weight (95% CI, − 0.04 to 0.03; P = 0.8). | Birth weight and TC association may be dependent on sex. Adjusted for a good amount of covariates | Moderate |
Gale and Martyn 2004 [39] | Association between birth weight and risk of psychological distress and depression | Prospective cohort study 5187 participants included for the 16-year follow-up; 8292 for the 26-year follow-up | Adult depression | Low birth weight < =2.5 kg was associated with depression in women at age 26 (OR = 1.3 [95% CI:0.9-1.8]) and men at age 26 years (OR = 1.6 [95% CI:1.1-2.3]). | Adjusted for a good amount of covariates | Strong |
Law et al. 1993 [40] | Association between low birth weight and high blood pressure | Longitudinal study 1895 children (0-10 years) and 1231 men and women aged 59-71 years. | Childhood and adult blood pressure | Every kg of birth weight increase was associated with 2.8 mmHg (95% CI: 1.4-4.1) decrease in blood pressure at the age of 4, 4.0 mmHg (95% CI: 1.5-6.5) decrease at the age of 64, and 5.2 mmHg (95% CI: 1.8-8.6) decrease for the age of 64 to 71 | Blood pressure as a proxy of hypertension | Strong |
Moore 2005 [46] | To identify the incidence and characteristics of preventable childhood deaths. | Retrospective survey 34 childhood preventable deaths. City of Wolverhampton, UK Mother’s age < 20 years (33%) | Childhood death | Preventable deaths were associated with low (2933 g) birth weight (p < 0.001). | Weak | |
Orfei et al. 2008 [58] | Association between adult lung function and birth weight, postnatal growth and early air-pollution exposure | Data drawn from 2 UK cohort studies (n = 3262 and 9377). Lung function (forced expiratory volume in 1 s (FEV1), and forced vital capacity (FVC)). The 1946 cohort was assessed for lung function at age 43 years; the 1958 cohort was assessed at age 44-45 years. | Lung function | When the two cohorts were pooled and mutually adjusted, 1 SD increase in birth weight was associated with 30.4 ml increase in FEV1 (95% CI: 16.1-44.8) and 26.9 ml increase in FVC (95% CI: 8.0-46.0). | Adjusted for a good amount of covariates. | Strong |
Pearce et al. 2012 [41] | Direct and indirect associations between foetal, infancy and adult risk factors and fibrinogen levels | Prospective study 394 singleton study members Newcastle upon Tyne, UK | Adult fibrinogen level (a risk factor for CVD) | No significant association was found between standardised birth weight and adult plasma fibrinogen levels (Beta-coefficient = − 0.03, 95% CI: − 0.01-0.001, p = 0.34, unadjusted) | Moderate | |
Riordan et al. 2006 [42] | The association between perinatal circumstances and subsequent young adult suicide | Birth cohort study 1,061,830 participants birth between 1 Jan 1969 - 31 Dec 1986 | Adult suicide | Individuals of low birth weight (< 2500 g), when compared with the reference group (3250–3749 g) were at higher risk of suicide (HR = 1.35, 95% CI 1.05–1.72) and at higher risk of death from other causes (HR = 1.41, 95% CI 1.24–1.61). | Strong | |
Robertson and Harrild 2010 [43] | Association between maternal and neonatal risk factors and type 1 diabetes in children under 15 years old | 361 case children and 1083 controls 1972-2005 Scottish Study | Childhood diabetes | The risk of development childhood type 1 diabetes was not associated with birth weight (OR 0.66 CI95% 0.34 to 1.28; p = 0.22 adjusted). | Moderate | |
Smith et al. 2007 [44] | The relation between complications in a first livebirth (such as preeclampsia, preterm birth, or intrauterine growth restriction) and the risk of unexplained stillbirth. | retrospective cohort study 133,163 women having a second birth Scotland | Subsequent pregnancy outcomes | Small for gestational age birth weight (smallest 10% for sex and gestation) shows an increase in the risk of stillbirth in the second pregnancy (HR 2.32 CI 95% 1.82, 2.96 p < 0.001) | Risk of explained and unexplained stillbirth in the second pregnancy | Strong |
Cognitive development and educational attainment
Study | Aim | Outcome measure | Methods | Results | Notes | Quality assessment |
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Strauss 2000 [47] | To determine the long-term functional outcome of Small for Gestational Age (SGA) (2436 g) infants | Educational and employment attainment | Prospective cohort study 14,189 full-term cohort infants | Teachers were less likely to rate SGA children in the top 15th percentile of the class at 16 years (13% vs 20%, P < 0.01) and more likely to recommend special education (4.9% vs 2.3%, p < 0.01). Adults (26 years) born SGA were less likely to have professional or managerial jobs (8.7% vs 16.4%, p < 0.01) and reported significantly lower levels of weekly income. | Strong | |
Mackay et al. 2013 [48] | Association between gestation and birth weight and each cause of special educational need | Causes of special educational needs | Retrospective cohort study 407,503 school children aged between 4 and 19 years | Low birth weight was associated with sensory (OR 2.85, 95% CI 2.04–3.99), physical or motor problems (OR 2.47, 95% CI 1.82–3.37), and intellectual impairments (OR 2.67, 95% CI 2.41–2.96). | No details about weight in grams | Moderate |
Bartley et al., 1994 [59] | Association between birth weight and socioeconomic disadvantage during childhood, adolescence, and early adulthood up to 23 years old | Socio-economic disadvantage | Longitudinal analysis 4321 participants have data on birth weight and financial problems; 3370 have data on birth weight, housing conditions and social class. 1958-1981 (when cohort members were followed up at 23 years old) | Birth weight under 2721 g (6 lb) experienced the combined disadvantage of lower social class and overcrowding in the household (P = 0 01, 0 01, and 0 13 at ages 7, 1 1, and 16 years, respectively). Lower social class without household amenities or sharing them (P = 0.008, 0.002, and 0.18 at ages 7, 11, and 16 years, respectively). Strong association (P < 0 001), with cohort members of low birth weight being more likely to experience housing inadequacy. | Statistical analyses were unadjusted | Moderate |
O’Brien et al. 2004 [60] | To investigate the neurodevelopmental progress in a cohort of preterm (median 1282 g) survivors by comparing the results of detailed assessment at 8 and 14 years. | Disability and educational outcomes | Longitudinal 151 (out of 224 eligible infants) were available for the assessment at 14-15 years. | In preterm was an increase in the proportion of subjects with disability from 11% at 8 to 22% at 14–15 years of age. Full scale IQ decreased from 104 to 95 from childhood to adolescence, and more adolescents (24%) were requiring extra educational provision than they had at the age of 8 years (15%). | Without control group | Weak |
Short-duration to second pregnancy
Study | Aim | Methods | Outcome measure | Findings | Notes | Quality assessment |
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Smith et al., (2003) [49] | To determine whether a short interval between pregnancies is an independent risk factor for adverse obstetric outcome. | Retrospective cohort study conducted in Scotland, UK. 89,194 women were included | Outcomes were measured for the second child: Intrauterine growth restriction, extremely preterm birth, moderately preterm birth and perinatal death. | A short inter-pregnancy interval (< 6 months) was an independent risk factor for extremely preterm birth (adjusted odds ratio 2.2, 1.4 to 3.6), moderately preterm birth (1.6, 1.3 to 2.0), and neonatal death unrelated to congenital abnormality (3.6, 1.2 to 10.7). | Good range of covariates accounted for in statistical analysis | Moderate |