651: Maternal smoking during pregnancy and the risk of pediatric cardiovascular diseases of the offspring: A population-based cohort study with up to 18-years follow up

Abstract

Cigarette smoke is a well-known reproductive toxicant, and maternal cigarette smoke exposure was shown to be associated with maternal cardiovascular morbidity. The understanding of the effect of in utero exposure to cigarette smoke on long-term childhood diseases and specifically cardiovascular morbidity is limited. We aimed to study the long-term effect of cigarette smoking during pregnancy on the risk for childhood cardiovascular morbidity of the offspring. A population based cohort analysis was performed comparing total and different subtypes of cardiovascular related pediatric hospitalizations among offspring of smoking mothers versus offspring of non-smoking mothers. The analysis included all singletons born between the years 1999-2014 at a single tertiary regional medical center. Cardiovascular related morbidities included hospitalizations involving a pre-defined set of ICD-9 codes, as recorded in the hospital computerized files. Infants with congenital malformations, multiple gestations, and all perinatal deaths were excluded from the analysis. A Kaplan-Meier survival curve was used to compare the cumulative cardiovascular morbidity, and a Cox proportional hazards model was constructed to adjust for confounders. The study population included 242,342 newborns which met inclusion criteria; among them 2861 were born to mothers who smoke during pregnancy. Offspring of smoking mothers had significantly higher rates of cardiovascular-related hospitalizations in comparison to offspring of non-smoking mothers (1.3% vs. 0.6%, OR 2.1, 95% CI 1.5-2.9; p<0.001; Kaplan-meier survival curve presented in graph). The association remained significant and independent while adjusting for gestational age, maternal age, hypertension and diabetes (Adjusted HR=2.3, 95% CI 1.6-3.1; p<0.001). Smoking exposure during pregnancy is associated with an increased risk for long-term pediatric cardiovascular morbidity of the offspring. Patients should be informed about the long-term consequences of maternal smoking on offspring health, which may facilitate smoking cessation in this population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)