Association between active tobacco use during pregnancy and infant respiratory health: a systematic review and meta-analysis

Abstract

ObjectiveTo evaluate what is known about active tobacco use during pregnancy and the association with infant respiratory health.DesignSystematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesMEDLINE, EMBASE, Cochrane, CINAHL, and Maternity and Infant Care were searched thoroughly until June 2020.Eligibility criteria for selecting studiesWe 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 synthesisExtraction 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.ResultsWe 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.ConclusionInfants 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 numberCRD42018083936.

Prenatal and Perinatal Environmental Influences Shaping the Neonatal Immune System: A Focus on Asthma and Allergy Origins

“…Maternal smoking during gestation is associated with increased risk in the offspring of respiratory infections [ 43 ], wheezing [ 44 , 45 , 46 ], asthma [ 47 , 48 ], and impaired lung function in childhood and later in life [ 49 , 50 ]. Secondhand tobacco smoke during pregnancy could also influence risk of asthma [ 51 ].…”

Smokeless Tobacco and Its Ill-Effects: Recent Literature Update

“…A systematic review of 21 studies concluded that SLT user probably increases the chances of poor outcome in pregnancy. 32 Studies have also shown that prenatal Snus (SLT) exposure is associated with higher systolic pressure and altered heart rate variability at 6 years of child's age. Another Australian study found that SLT (pituri) use is associated with possible complication like elevated glucose concentration which may lead to gestational diabetes.…”

The First 1000 Days: Impact of Prenatal Tobacco Smoke Exposure on Hospitalization Due to Preschool Wheezing

“…Maternal smoking increases the risk of obstetric complications, preterm birth, low birth weight and poor intrauterine growth, infant death (Sudden Infant Death Syndrome), neurodevelopmental and behavioral problems and possibly childhood cancer [1,3]. Regarding the lung, it is generally accepted that there is reduced and disturbed intra-uterine lung growth and as a consequence an increased incidence of acute lower airway infections (0-3 years), persisting reduced lung function and increased incidence of wheeze (0-5 years) [1,3,4].…”