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Maternal smoking in pregnancy increases fracture risk in preschool-aged offspring
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Mothers who smoke during pregnancy — even those who report quitting smoking by 8 weeks’ gestation — are more likely to have children who sustain a fracture before age 7 years when compared with mothers who report not smoking during pregnancy, according to findings from researchers in Finland.
Roope Parviainen, MSc, MB, of the PEDEGO Research Group at the University of Oulu, Finland, and colleagues analyzed data from 6,718 children (3,363 girls) and their mothers from a comprehensive birth cohort of all women living in two northern provinces of Finland. Mothers provided information on smoking habits via questionnaires at baseline and when children were aged 7 years. Mothers were classified as smokers or nonsmokers; a mother was determined to be a smoker if she reported smoking at any time during the pregnancy. Information on fractures in offspring was obtained from the National Hospital Discharge Register. Primary outcome was the number of childhood bone fractures before age 7 years. Researchers used Poisson regression analysis to examine the association between maternal smoking during pregnancy and risk for fracture in offspring.
Within the cohort of children, 86 offspring (1.3%) sustained 88 hospital-treated fractures before age 7 years; boys sustained more fractures vs. girls (1.7% vs. 0.9%). Mean age at time of fracture was 4.1 years; 22 fractures were sustained at the lower limb; 62 fractures were sustained at the upper limb.
Among mothers, 12.2% reported smoking during the first or second trimester of pregnancy. Of those, 91.8% reported quitting during pregnancy, with a mean smoking cessation time of 8 weeks’ gestation, according to the researchers.
They found that maternal smoking during pregnancy was associated with a 1.85-fold increased risk in childhood fracture in offspring before age 7 years when compared with mothers who did not report smoking during pregnancy (95% CI, 1.07-3.03). Results persisted after adjustment for male sex, childhood rheumatic disease, asthma, low socioeconomic status, offspring BMI and advanced maternal age (incidence RR = 1.83; 95% CI, 1.06-3.02).
“In the present study, the mothers stopped smoking at the eighth week of pregnancy, on average, but nevertheless, the fracture risk of the child was found to be elevated compared with that in those subjects whose mothers did not smoke while pregnant,” the researchers wrote. “Therefore, it seems likely that smoking has an independent effect on the developing fetus during early pregnancy.” – by Regina Schaffer
Disclosure: One researcher reports receiving personal fees from Bioretec Ltd. and MSD Ltd.
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