Chest
Original ResearchAsthmaFetal Exposure to Maternal and Paternal Smoking and the Risks of Wheezing in Preschool Children
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
References (37)
- et al.
The maternal and fetal physiologic effects of nicotine
Semin Perinatol
(1996) - et al.
In utero and childhood exposure to parental tobacco smoke, and allergies in schoolchildren
Respir Med
(2007) - et al.
Dose-response of birth weight to various measures of maternal smoking during pregnancy
J Clin Epidemiol
(1988) The Global Burden of Disease 2004 Update
(2004)- et al.
The global burden of asthma: executive summary of the GINA Dissemination Committee report
Allergy
(2004) Prenatal factors and the development of asthma
Curr Opin Pediatr
(2008)- et al.
Environmental tobacco smoke (ETS) and respiratory health in children
Eur J Pediatr
(2009) - et al.
Parental smoking and children's respiratory health: independent effects of prenatal and postnatal exposure
Tob Control
(2006) - et al.
Maternal nicotine exposure during gestation and lactation interferes with alveolar development in the neonatal lung
Reprod Fertil Dev
(1998) - et al.
Fetal lung hypoplasia associated with maternal smoking: a morphometric analysis
Pediatr Res
(1985)
The effects of smoking on the developing lung: insights from a biologic model for lung development, homeostasis, and repair
Lung
Cigarette smoking and fetal breathing movements
Br J Obstet Gynaecol
Wheeze associated with prenatal tobacco smoke exposure: a prospective, longitudinal study
Arch Dis Child
Effects of pre- and postnatal exposure to parental smoking on early childhood respiratory health
Am J Epidemiol
Maternal smoking during pregnancy increases the risk of recurrent wheezing during the first years of life (BAMSE)
Respir Res
Wheezing, asthma, hayfever, and atopic eczema in childhood following exposure to tobacco smoke in fetal life
Clin Exp Allergy
Effects of early onset asthma and in utero exposure to maternal smoking on childhood lung function
Am J Respir Crit Care Med
Influence of parental smoking on respiratory symptoms during the first decade of life: the Tucson Children's Respiratory Study
Am J Epidemiol
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2021, Allergology InternationalCitation Excerpt :In a prospective birth cohort study, maternal smoking throughout pregnancy was a significant risk factor for wheeze in children, although there were no associations between maternal smoking in the first trimester only or in the second and/or third trimesters and the development of wheeze compared with no maternal smoking during pregnancy.21 Another population-based prospective cohort study in the Netherlands showed no association between maternal smoking during the first trimester and wheeze in preschool children.22,23 Contrary to these studies, the present study showed that even if mothers quit smoking early in pregnancy, there were significantly increased risks of wheeze and asthma in the offspring.
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2021, Encyclopedia of Respiratory Medicine, Second EditionPrenatal and early life exposure to particulate matter, environmental tobacco smoke and respiratory symptoms in Mexican children
2021, Environmental ResearchCitation Excerpt :Similarly to air pollution, environmental tobacco smoke (ETS) exposure starting in utero has been independently associated with greater risk of respiratory symptoms in childhood (Vardavas et al., 2016)., and might increase the susceptibility for the adverse effects of air pollution (Duijts et al., 2012; Rabinovitch et al., 2011). In the Generation R study in the Netherlands, exposure to higher levels of PM10 and NO2 during the first three years of life was associated with increased risk of wheezing during the same time period only among children who were exposed to tobacco smoke during fetal and infant life (Sonnenschein-van der Voort et al., 2012).
Prevalence and risk factors for wheezing in infants in the region of Pamplona, Spain
2016, Allergologia et ImmunopathologiaCitation Excerpt :Garcia-Marcos et al.21 found that infant eczema was a risk factor for pneumonia in infants, which suggests a role between eczema and the development of other risk factors which lead to wheezing. We found that smoking mother, as well as smoking during pregnancy, were risk factors for wheezing ever and recurrent wheezing, findings which have been previously described in many studies.23–25 Although a Spanish study found that paternal smoking was not associated with wheezing,26 we found it as risk factor for recurrent wheezing.
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].
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