Chest
Volume 141, Issue 4, April 2012, Pages 876-885
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Original Research
Asthma
Fetal Exposure to Maternal and Paternal Smoking and the Risks of Wheezing in Preschool Children

https://doi.org/10.1378/chest.11-0112Get rights and content

Background

Previous studies have suggested that fetal smoke exposure is associated with increased risks of wheezing during childhood. The underlying pathways are unknown. We examined the associations of parental smoking during pregnancy with wheezing in preschool children and whether these associations are explained by postnatal smoke exposure or small for gestational age at birth.

Methods

This study was embedded in a population-based prospective cohort study. Parental smoking was prospectively assessed by questionnaires. Wheezing was reported at 1 to 4 years. Small for gestational age at birth was available from registries. The analyses were based on 4,574 subjects.

Results

Maternal smoking during the first trimester only was not associated with wheezing. Continued maternal smoking in pregnancy was associated with the risk of wheezing at 1 to 4 years (P for trends < .05). The strongest effect estimates were observed for frequent wheezing (four or more episodes of wheezing per year) until age 3 years (OR [95% CI]: age 1,1.64 [1.12-2.40]; age 2, 1.64 [1.01-2.64]; age 3, 2.19 [1.24-3.86]). Among children of nonsmoking mothers, fetal exposure to paternal smoking was not consistently associated with the risks of wheezing. The associations of continued maternal smoking during pregnancy with wheezing symptoms were independent of postnatal smoke exposure or small for gestational age at birth.

Conclusions

Fetal exposure to continued maternal smoking is associated with increased risks of wheezing in preschool children. Further research is needed to explore the effects of paternal smoking. Diminishing maternal smoking before conception or in early pregnancy is likely to have the greatest impact on reducing childhood wheezing.

Section snippets

Design and Setting

This study was embedded in the Generation R Study, a population-based prospective cohort study of pregnant women and their children from fetal life onward in Rotterdam, The Netherlands.19, 20 Assessments during pregnancy, including physical examinations, fetal ultrasound examinations, and administration of questionnaires, were planned in each trimester of pregnancy.20 All children were born between April 2002 and January 2006. Postnatal data about asthma-related phenotypes were collected by

Population for Analysis

In total, 6,969 children and their mothers were included prenatally and fully participated in the postnatal phase of the study (Fig 1). Those without information about parental smoking during pregnancy were excluded from the analyses (n = 936, 13%). Of the remaining 6,033 mothers, those with twin pregnancies (n = 125, 2%) and those with second or third participating infants in the study (n = 382, 6%) were excluded from the present analyses to prevent bias due to correlation. Of the remaining

Main Findings

Continued maternal smoking during pregnancy was associated with an increased risk of wheezing in preschool children. The strongest adverse effects of continued maternal smoking were observed for frequent wheezing, defined as four or more episodes per year. The study did not demonstrate a statistically significant effect of maternal smoking in the first trimester only, but paternal smoking with wheezing in the offspring showed a nonsignificant tendency. The association of continued maternal

Conclusions

The results suggest that continued maternal smoking during pregnancy is associated with wheezing symptoms in preschool children. These associations are independent of paternal smoking, postnatal smoke exposure, and size for gestational age and implies a direct adverse effect of smoke exposure on fetal lung development next to the well-known adverse effects of secondhand smoke exposure on lung morbidity after birth. Further studies focusing on the underlying mechanisms are needed.

Acknowledgments

Author contributions: Drs Duijts and de Jongste had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Duijts: contributed to the study concept and design, data analysis and interpretation, and drafting of the manuscript.

Dr Jaddoe: contributed to the study concept and design, data analysis and interpretation, and drafting of the manuscript.

Mr van der Valk: contributed to the study concept, data

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    Funding/Support: The Generation R Study is made possible by financial support from the Erasmus Medical Center; Erasmus University; The Netherlands Organization for Health Research and Development; The Netherlands Organisation for Scientific Research; the Ministry of Health, Welfare and Sport; and the Ministry of Youth and Families. Funding also was received from a European Respiratory Society/Marie Curie Joint Research Fellowship [MC 1226-2009 to Dr Duijts] under grant agreement RESPIRE, PCOFUND-GA-2008-229571 and from the seventh framework programme, project CHICOS [HEALTH-F2-2009-241504 to Dr Duijts]. Additional grants were received from The Netherlands Organization for Health Research and Development [ZonMw 90700303, 916.10159 to Dr Jaddoe].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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