• Elise M Philips, Susana Santos, Leonardo Trasande, Juan J Aurrekoetxea, Henrique Barros, Andrea von Berg, Anna Bergström, Philippa K Bird, Sonia Brescianini, Carol Ní Chaoimh, Marie-Aline Charles, Leda Chatzi, Cécile Chevrier, George P Chrousos, Nathalie Costet, Rachel Criswell, Sarah Crozier, Merete Eggesbø, Maria Pia Fantini, Sara Farchi, Francesco Forastiere, van Gelder Marleen M H J MMHJ 0000-0003-4853-4434 Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Ce, Vagelis Georgiu, Keith M Godfrey, Davide Gori, Wojciech Hanke, Barbara Heude, Daniel Hryhorczuk, Carmen Iñiguez, Hazel Inskip, Anne M Karvonen, Louise C Kenny, Inger Kull, Debbie A Lawlor, Irina Lehmann, Per Magnus, Yannis Manios, Erik Melén, Monique Mommers, Camilla S Morgen, George Moschonis, Deirdre Murray, Ellen A Nohr, Anne-Marie Nybo Andersen, Emily Oken, Adriëtte J J M Oostvogels, Eleni Papadopoulou, Juha Pekkanen, Costanza Pizzi, Kinga Polanska, Daniela Porta, Lorenzo Richiardi, Sheryl L Rifas-Shiman, Nel Roeleveld, Franca Rusconi, Ana C Santos, Sørensen Thorkild I A TIA 0000-0003-4821-430X Department of Public Health, Section of Epidemiology, Faculty of Health and Medical Sciences, University, Marie Standl, Camilla Stoltenberg, Jordi Sunyer, Elisabeth Thiering, Carel Thijs, Maties Torrent, Vrijkotte Tanja G M TGM 0000-0003-3641-4048 Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterda, John Wright, Oleksandr Zvinchuk, Romy Gaillard, and Jaddoe Vincent W V VWV 0000-0003-2939-0041 The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands. .
• The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands.
• PLoS Med. 2020 Aug 1; 17 (8): e1003182.

BackgroundFetal smoke exposure is a common and key avoidable risk factor for birth complications and seems to influence later risk of overweight. It is unclear whether this increased risk is also present if mothers smoke during the first trimester only or reduce the number of cigarettes during pregnancy, or when only fathers smoke. We aimed to assess the associations of parental smoking during pregnancy, specifically of quitting or reducing smoking and maternal and paternal smoking combined, with preterm birth, small size for gestational age, and childhood overweight.Methods And FindingsWe performed an individual participant data meta-analysis among 229,158 families from 28 pregnancy/birth cohorts from Europe and North America. All 28 cohorts had information on maternal smoking, and 16 also had information on paternal smoking. In total, 22 cohorts were population-based, with birth years ranging from 1991 to 2015. The mothers' median age was 30.0 years, and most mothers were medium or highly educated. We used multilevel binary logistic regression models adjusted for maternal and paternal sociodemographic and lifestyle-related characteristics. Compared with nonsmoking mothers, maternal first trimester smoking only was not associated with adverse birth outcomes but was associated with a higher risk of childhood overweight (odds ratio [OR] 1.17 [95% CI 1.02-1.35], P value = 0.030). Children from mothers who continued smoking during pregnancy had higher risks of preterm birth (OR 1.08 [95% CI 1.02-1.15], P value = 0.012), small size for gestational age (OR 2.15 [95% CI 2.07-2.23], P value < 0.001), and childhood overweight (OR 1.42 [95% CI 1.35-1.48], P value < 0.001). Mothers who reduced the number of cigarettes between the first and third trimester, without quitting, still had a higher risk of small size for gestational age. However, the corresponding risk estimates were smaller than for women who continued the same amount of cigarettes throughout pregnancy (OR 1.89 [95% CI 1.52-2.34] instead of OR 2.20 [95% CI 2.02-2.42] when reducing from 5-9 to ≤4 cigarettes/day; OR 2.79 [95% CI 2.39-3.25] and OR 1.93 [95% CI 1.46-2.57] instead of OR 2.95 [95% CI 2.75-3.15] when reducing from ≥10 to 5-9 and ≤4 cigarettes/day, respectively [P values < 0.001]). Reducing the number of cigarettes during pregnancy did not affect the risks of preterm birth and childhood overweight. Among nonsmoking mothers, paternal smoking was associated with childhood overweight (OR 1.21 [95% CI 1.16-1.27], P value < 0.001) but not with adverse birth outcomes. Limitations of this study include the self-report of parental smoking information and the possibility of residual confounding. As this study only included participants from Europe and North America, results need to be carefully interpreted regarding other populations.ConclusionsWe observed that as compared to nonsmoking during pregnancy, quitting smoking in the first trimester is associated with the same risk of preterm birth and small size for gestational age, but with a higher risk of childhood overweight. Reducing the number of cigarettes, without quitting, has limited beneficial effects. Paternal smoking seems to be associated, independently of maternal smoking, with the risk of childhood overweight. Population strategies should focus on parental smoking prevention before or at the start, rather than during, pregnancy.

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