Effects of maternal smoking on body size and proportions at birth: a register-based cohort study of 1.4 million births

Abstract

ObjectivesThe aim of our work was to analyse the effect of maternal smoking on body size and body proportions of newborns when the mother had smoked only during the first trimester, in comparison with continued smoking after the first trimester. Furthermore, we have evaluated how growth restriction associated with maternal smoking contributes to changes in body proportions.DesignRegister-based cohort studySettingMaternal Exposure (MATEX) cohort identified from the Finnish Medical Birth Register.ParticipantsSingleton births without congenital anomalies and missing data (1.38 million) from 1 January 1991 to 31 December 2016.MethodsLogistic regression was used to quantify the effect of maternal smoking, stratified by the maternal smoking status.Outcome measuresBody proportions indicated by low brain-to-body ratio (defined as <10th percentile); high ponderal index and high head-to-length ratio (defined as >90th percentile); small body size for gestational age at birth (defined as weight, length or head circumference <10th percentile) and preterm birth (<37 weeks) and low birth weight (2500 g).ResultsContinued smoking after the first trimester was associated with high ponderal index (OR 1.26, 95% CI 1.23 to 1.28), low brain-to-body ratio (1.11, 1.07–1.15) and high head-to-length ratio (1.22, 1.19–1.26), corresponding with absolute risks of 22%, 10% and 19%, respectively). The effects were slightly lower when smoking had been quit during the first trimester. Similar effects were seen for the body size variables and low birth weight. Preterm birth was not associated with smoking only during first trimester.ConclusionsMaternal smoking, independent of smoking duration during pregnancy, was associated with abnormal body proportions resulting from larger reduction of length and head circumference in comparison to weight. The effects of having quit smoking during the first trimester and having continued smoking after the first trimester were similar, suggesting the importance of early pregnancy as a sensitive exposure window.