Abstract
Background
 Nicotine consumption during pregnancy and advanced maternal age are well known independent risk factors for poor pregnancy outcome and therefore serious public health problems.
 Objectives
 Considering the ongoing trend of delaying childbirth in our society, this study investigates potential additive effects of nicotine consumption during pregnancy and advanced maternal age on foetal growth.
 Sample and Methods
 In a medical record-based study, we analysed the impact of maternal age and smoking behaviour before and during pregnancy on newborn size among 4142 singleton births that took place in Vienna, Austria between 1990 and 1995.
 Results
 Birth weight (H=82.176, p<0.001), birth length (H=91.525, p<0.001) and head circumference (H=42.097, p<0.001) differed significantly according to maternal smoking behaviour. For birth weight, the adjusted mean differences between smokers and non-smokers increased from 101.8g for the < 18-year-old mothers to 254.8g for >35 year olds, with the respective values for birth length being 0.6 cm to 0.7cm, for head circumference from 0.3 cm to 0.6 cm.
 Conclusion
 Increasing maternal age amplified the negative effects of smoking during pregnancy on newborn parameters. Our findings identify older smoking mothers as a high-risk group which should be of special interest for public health systems.
Highlights
For more than four decades, most highincome countries have been confronted with a remarkable demographic change in childbearing patterns
Considering the ongoing trend of delaying childbirth in our society, this study investigates potential additive effects of nicotine consumption during pregnancy and advanced maternal age on foetal growth
Our findings identify older smoking mothers as a high-risk group which should be of special interest for public health systems
Summary
For more than four decades, most highincome countries have been confronted with a remarkable demographic change in childbearing patterns. Today advanced maternal age is defined as 40 years and, the term “very advanced maternal age” is applied to women who are at least 45 years old (Kahveci et al 2018) This trend of postponing motherhood, poses certain risks. It is a well-established fact that delaying childbirth beyond the age of 35 or 40 years is associated with reduced fertility, and with several adverse obstetric outcomes. There is a clear effect of maternal age on foetal development and birth outcomes (Cleary-Goldman et al 2005; Briggs et al 2007; Salem Yaniv et al 2011). Nicotine consumption during pregnancy and advanced maternal age are well known independent risk factors for poor pregnancy outcome and serious public health problems
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