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Original research
Association between active tobacco use during pregnancy and infant respiratory health: a systematic review and meta-analysis
  1. Ediane De Queiroz Andrade1,2,
  2. Carla Rebeca Da Silva Sena1,2,
  3. Adam Collison1,2,
  4. Vanessa E Murphy1,2,
  5. Gillian Sandra Gould2,
  6. Billie Bonevski2,
  7. Joerg Mattes1,2,3
  1. 1GrowUpWell Priority Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
  2. 2School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
  3. 3Department of Paediatric Respiratory & Sleep Medicine, John Hunter Children’s Hospital, Newcastle, New South Wales, Australia
  1. Correspondence to Dr Ediane De Queiroz Andrade; ediane.dequeirozandrade{at}; Dr Joerg Mattes; joerg.mattes{at}


Objective To evaluate what is known about active tobacco use during pregnancy and the association with infant respiratory health.

Design Systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data sources MEDLINE, EMBASE, Cochrane, CINAHL, and Maternity and Infant Care were searched thoroughly until June 2020.

Eligibility criteria for selecting studies We included case–control and cohort studies estimating the association between active tobacco use during pregnancy and infant respiratory health (wheezing and apnoea) and lung function parameters in the first 12 months of life.

Data extraction and synthesis Extraction and risk of bias assessment were conducted by two independent reviewers. The odds ratio, relative risk and mean differences were pooled with a 95% CI using the generic inverse variance method. Heterogeneity was assessed and expressed by percentage using I2.

Results We identified 4423 abstracts, and 21 publications met the eligibility criteria. Pooled OR showed an increase in wheezing episodes in infants born to mothers who were active tobacco users during pregnancy (OR 1.50, 95% CI 1.27 to 1.77, p<0.01). Mixed results were found on lung function parameters, and a meta-analysis including two studies with comparable methodology showed a trend towards reduced maximum flow rate at functional residual capacity of −34.59 mL/s (95% CI −72.81 to 3.63, p=0.08) in 1-month-old infants born to women who smoked during pregnancy. A higher risk of apnoea was described for infants born to mothers who used smokeless tobacco during pregnancy, while the results in infants born to women who actively smoked tobacco during pregnancy were non-conclusive.

Conclusion Infants born to mothers who actively smoked during pregnancy are at higher odds of having wheeze and may have lower lung function. Smokeless tobacco use in pregnancy may increase the risk of apnoea in infancy.

PROSPERO registration number CRD42018083936.

  • epidemiology
  • paediatrics
  • paediatric thoracic medicine
  • respiratory infections
  • respiratory physiology

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  • Contributors EDQA wrote the protocol. EDQA and CRDSS individually performed the abstract extraction and critiqued the literature. AC, VEM, GSG, BB and JM provided insight on the epidemiological aspects of the review and helped draft the manuscript. EDQA, CRDSS, AC, VEM, GSG, BB and JM advised on the background and revised the manuscript. EDQA and JM wrote the first drafts of the manuscript. All authors approved the final version and took responsibility for its content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional review board approval was not necessary because all data were retrieved from public databases.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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