Abstract
Maternal smoking during pregnancy (SDP) seems associated with reduced birthweight in the offspring. This observation, however, is based on conventional epidemiological analyses, and it might be confounded by unobserved maternal characteristics related to both smoking habits and offspring birth weight. Therefore, we apply a quasi-experimental sibling analysis to revisit previous findings. Using the Swedish Medical Birth Register, we identified 677,922 singletons born between 2002 and 2010 from native Swedish mothers. From this population, we isolated 62,941 siblings from 28,768 mothers with discrepant habits of SDP. We applied conventional and mother-specific multilevel linear regression models to investigate the association between maternal SDP and offspring birthweight. Depending on the mother was light or heavy smoker and the timing of exposition during pregnancy (i.e., first or third trimester), the effect of smoking on birthweight reduction was between 6 and 78 g less marked in the sibling analysis than in the conventional analysis. Sibling analysis showed that continuous smoking reduces birthweight by 162 grams for mothers who were light smokers (1 to 9 cigarettes per day) and 226 g on average for those who were heavy smokers throughout the pregnancy in comparison to non-smoker mothers. Quitting smoking during pregnancy partly counteracted the smoking-related birthweight reduction by 1 to 29 g, and a subsequent smoking relapse during pregnancy reduced birthweight by 77 to 83 g. The sibling analysis provides strong evidence that maternal SDP reduces offspring birthweight, though this reduction was not as great as that observed in the conventional analysis. Our findings support public health interventions aimed to prevent SDP and to persuade those who already smoke to quit and not relapse throughout the pregnancy. Besides, further analyses are needed in order to explain the mechanisms through which smoking reduces birthweight and to identify other maternal characteristics that are common causes of both birthweight reduction and maternal smoking.
Highlights
The relevance of birthweight as an indicator of a newborn’s future health is well established in the literature
As expected, the complete dataset has a larger proportion of first-order newborns because this dataset includes children without siblings born in the study period, and these children are excluded from the sibling sample
We observed that the specific effect of smoking during pregnancy depends on the number of cigarettes smoked per day and the timing of the exposure
Summary
The relevance of birthweight as an indicator of a newborn’s future health is well established in the literature. Birthweight has been linked to neonatal and infant mortality [1,2] and, later in life, to intellectual impairment [3,4,5], and to specific morbidities including obesity, coronary heart diseases, type-2 diabetes, hypertension, metabolic syndrome, among others [6,7,8,9,10]. Low birthweight increases the risk of premature adult mortality [11]. Smoking during pregnancy (SDP) is considered the single most important determinant of decreased birthweight [15,16]. Empirical evidence shows that SDP reduces birthweight by 200 to 377 g [17], depending on daily consumption (larger reduction for heavy smokers) [18] and the trimester in which exposure occurs (larger reduction during the last trimester) [19]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
