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Parental Smoking Linked With Vascular Damage in Offspring

  • Authors: News Author: Laurie Barclay, MD
    CME Author: Désirée Lie, MD, MSEd
  • CME Released: 1/4/2012
  • Valid for credit through: 1/4/2013
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Target Audience and Goal Statement

This article is intended for primary care clinicians, obstetricians, and other specialists who care for pregnant women.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  1. Describe the association between maternal smoking during pregnancy and vascular damage in the offspring at age 5 years.
  2. Describe the association between the number of cigarettes smoked during pregnancy, paternal smoking, and vascular damage in the offspring at age 5 years.


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  • Laurie Barclay, MD

    Freelance writer and reviewer, Medscape, LLC


    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.


  • Brande Nicole Martin, MA

    CME Clinical Editor, Medscape, LLC


    Disclosure: Brande Nicole Martin, MA, has disclosed no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer, Medscape, LLC


    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

CME Reviewer

  • Sarah Fleischman

    CME Program Manager, Medscape, LLC


    Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

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Parental Smoking Linked With Vascular Damage in Offspring

Authors: News Author: Laurie Barclay, MD CME Author: Désirée Lie, MD, MSEdFaculty and Disclosures

CME Released: 1/4/2012

Valid for credit through: 1/4/2013


Clinical Context

According to the current study by Geerts and colleagues, the effect of maternal smoking during pregnancy on the vasculature of offspring is largely unknown. Autopsy studies have demonstrated that smoking during early age promotes development of plaques and fatty streaks in aortas as precursors of atherosclerosis. Passive exposure to cigarette smoking during childhood has been linked to vascular damage in young adult offspring.

This study of offspring of women who smoked vs women who did not smoke during pregnancy examines its effect on arterial properties in their 5-year-old offspring.

Study Synopsis and Perspective

Parental smoking during pregnancy may cause vascular damage when the children reach 5 years of age, according to the results of a birth cohort study published online December 26 and in the January 2012 print issue of Pediatrics.

"Smoking during pregnancy has been related to thicker carotid intima media thickness in young adults, and this was also shown in neonates," write Caroline C. Geerts, MD, from the Julius Center for Health Sciences and Primary Care and University Medical Center Utrecht in the Netherlands and colleagues. "The relation between smoke exposure in early life, the prenatal period in particular, and the vascular development of young children is largely unknown."

To evaluate the association between parental smoking during pregnancy and subsequent vascular characteristics in their children, the investigators used data from the birth cohort enrolled in the Wheezing Illnesses Study Leidsche Rijn (WHISTLER)-Cardio study. At 5 years of age, 259 participants underwent ultrasonographic measurement of carotid artery intima-media thickness (CIMT) and arterial wall distensibility. Parental smoking data were also updated.

After adjustment for the child's age and sex, maternal age, and breast-feeding, children of mothers who had smoked throughout pregnancy had more vascular damage than children of mothers who did not smoke during pregnancy. CIMT was 18.8 μm thicker in the former group (95% confidence interval [CI], 1.1 - 36.5; P = .04), and distensibility was 15% lower (95% CI, −0.3 to −0.02; P = .02).

Children of mothers who smoked after pregnancy, but not during pregnancy, did not have these adverse effects on CIMT and distensibility. If both parents smoked during pregnancy, the associations were even stronger than with only maternal smoking: CIMT was 27.7 μm thicker (95% CI, 0.2 - 55.3), and distensibility was 21% lower (95% CI, −0.4 to −0.03).

"This study is the first to show that the effect of smoking during pregnancy on the vasculature of children is (still) visible at the age of 5 years," the study authors write. "Pregnancy appears to be the critical period for this damage to occur."

Limitations of this study include slightly different profiles in participants than in nonparticipants, lack of cotinine measurements at birth, and reliance on parental self-report of smoking.

"In view of the early origins of cardiovascular disease, preventive measures against smoking should be specifically directed at the gestational period," the study authors conclude.

The Netherlands Organization for Health Research and Development supported the WHISTLER birth cohort. The University Medical Center Utrecht supported WHISTLER-Cardio. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online December 26, 2011. Abstract

Study Highlights

  • The WHISTLER-Cardio cohort is an ongoing, large prospective birth cohort initiated in 2001 in a single city with infants recruited at age 2 weeks.
  • All children who had reached 5 years old were invited to participate in this study for vascular measurements and parental questionnaires.
  • At the 4-week neonatal visit, parents completed a questionnaire about prenatal, perinatal, and postnatal factors, and further information was derived from a linked health database.
  • During this visit, mothers filled in a questionnaire asking specifically about smoking during pregnancy.
  • The questionnaire asked about smoking in the first and second halves of pregnancy and number of cigarettes smoked daily.
  • Smoking during pregnancy was defined as smoking a minimum of 1 cigarette a day during the entire pregnancy.
  • Data on nonsmoking women and early quitters were pooled into a single group.
  • At the 5-year follow-up visit, both parents completed questionnaires about smoking, including type of tobacco, number of cigarettes smoked daily, and the child's exposure to smoking.
  • Passive exposure to smoking in the first 5 years was examined as a confounder for exposure during pregnancy.
  • Vascular conditions of the right common carotid artery were studied ultrasonographically with use of high-resolution echo-tracking technology.
  • CIMT was measured.
  • During the ultrasound study, blood pressure was recorded, and properties of the carotid artery including distensibility and elastic modulus were assessed.
  • CIMT and distension measurements were completed in 97.7% and 89.8% of children, respectively. A total of 259 children with complete data on maternal smoking exposure and these measurements were included in the analysis.
  • At birth, the offspring of smoking mothers were lighter (3447 vs 3493 g) and shorter than those of nonsmoking mothers.
  • Other characteristics were similar.
  • At the first neonatal visit, weight was similar as was length, with 58.6% of offspring of nonsmoking mothers vs 26.7% of those of smoking mothers being breast-fed.
  • Maternal smoking during pregnancy was associated with fathers smoking during pregnancy.
  • The number of cigarettes smoked by women with and without smoking fathers was similar.
  • After controlling for exposure during infancy, the children exposed to maternal smoking had increased CIMT vs children without such exposure during (CIMT thickness, 18.8 µm thicker).
  • Maternal smoking explained 0.57 SD of CIMT in this study.
  • The children of mothers who smoked also had 15% lower arterial distensibility.
  • There was a trend toward increasing CIMT and decreasing distensibility with the greater number of cigarettes smoked by the mother during pregnancy.
  • Paternal smoking during pregnancy did not affect these outcomes unless the mother also smoked, in which case paternal smoking had an added effect.
  • The authors concluded that parental smoking during pregnancy had structural and functional effects on the arterial vascular wall of young children.

Clinical Implications

  • Maternal smoking during pregnancy is associated with higher CIMT and lower arterial distensibility in the offspring at age 5 years.
  • Parental smoking during pregnancy is associated with greater vascular damage in the offspring, but paternal smoking alone during pregnancy appears not to be associated with vascular damage in the offspring.

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