Maternal Smoking During Pregnancy and Negative Health Outcomes in the Offspring

Maternal smoking during pregnancy (MSDP) represents a direct prenatal exposure of the unborn child to all the constituents of tobacco smoke. MSDP is strongly associated with negative pregnancy and birth outcomes such as intrauterine growth retardation, low birth weight, preterm birth, congenital malformations, still birth, increased perinatal mortality, and several obstetrical disorders.1 The 2014 Surgeon General’s Report1 examines for the first time the association of MSDP with childhood neurobehavioral disorders in the offspring and concludes that evidence is suggestive, but not sufficient, to infer a causal relationship with disruptive behavioral disorders. The report does not mention the potential association between MSDP and cardiovascular outcomes (ie, heart rate and blood pressure) in the offspring. A previous Surgeon General’s Report2 has examined the association between prenatal tobacco use and later lung function, and found that the evidence is sufficient to infer a causal relationship between MSDP and persistent adverse effects on lung function in children. However, an important challenge in estimating the magnitude of any association between MSDP and offspring health outcomes is adjusting for the large number of potential confounders such as familial, psychosocial factors, preexisting health disorders in the mother and father and controlling for smoking before and after pregnancy.