Abstract
BackgroundDespite considerable global efforts to reduce growth faltering in early childhood, rates of stunting remain high in many regions of the world. Current interventions primarily target nutrition-specific risk factors, but these have proven insufficient. The objective of this study was to synthesize the evidence on the relationship between active tobacco use during pregnancy and growth outcomes in children under five years of age.MethodsIn this systematic review and meta-analysis, six online databases were searched to identify studies published from January 1, 1980, through October 31, 2016, examining the association between active tobacco use during pregnancy and small-for-gestational age (SGA), length/height, and/or head circumference. Ecological studies were not included. A meta-analysis was conducted, and subgroup analyses were carried out to explore the effect of tobacco dosage.ResultsAmong 13,189 studies identified, 210 were eligible for inclusion in the systematic review, and 124 in the meta-analysis. Active tobacco use during pregnancy was associated with significantly higher rates of SGA (pooled adjusted odds ratio [AORs] = 1.95; 95% confidence interval [CI]: 1.76, 2.16), shorter length (pooled weighted mean difference [WMD] = 0.43; 95% CI: 0.41, 0.44), and smaller head circumference (pooled WMD = 0.27; 95% CI: 0.25, 0.29) at birth. In addition, a dose-response effect was evident for all growth outcomes.ConclusionTobacco use during pregnancy may represent a major preventable cause of impaired child growth and development.
Highlights
Despite considerable global efforts to reduce growth faltering in early childhood, rates of stunting remain high in many regions of the world
No systematic review has been conducted to characterize the association between tobacco use during pregnancy and linear growth faltering using these indicators. To explore this potential nutrition-sensitive risk factor, we considered it important and timely to review and synthesize the current literature on the relationship between tobacco use during pregnancy and gestational growth outcomes that likely lead to linear growth faltering
We report small-for-gestational age (SGA) results as pooled adjusted odds ratios (AORs) with 95% confidence intervals (CIs), and length/ height and head circumference results, as pooled weighted mean differences (WMDs) with a 95% Confidence interval (CI)
Summary
Despite considerable global efforts to reduce growth faltering in early childhood, rates of stunting remain high in many regions of the world. Chronic undernutrition and the resultant growth faltering affect approximately 23% of children under five years of age [1]. The prevalence of stunting, the most common indicator for growth faltering and defined as height-for-age z-score (HAZ) two or more standard deviations below the median of the reference population, is highest in Asia and Africa, where it is estimated to affect 87 million and 59 million children under five years of age, In 2013, The Lancet series on Maternal and Child Nutrition highlighted that beyond a package of ten proven nutrition-specific interventions, the factors contributing to stunting have still not been comprehensively characterized [4]. The first 1000 days of life, from conception through age two years, present a critical developmental period, in which most linear growth faltering occurs [3, 5]. In addition to factors associated with the mother’s characteristics and underlying health conditions, there are several external modifiable exposures that may have an important impact on the developing fetus during pregnancy
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