Maternal and Child Health Journal

, Volume 15, Issue 7, pp 985-992

First online:

Maternal Smoking During Pregnancy and Childhood Obesity: Results from the CESAR Study

  • Krisztian GorogAffiliated withLondon School of Hygiene & Tropical Medicine
  • , Sam PattendenAffiliated withLondon School of Hygiene & Tropical Medicine Email author 
  • , Temenuga AntovaAffiliated withDepartment of Environmental Health, National Centre of Public Health Protection
  • , Emilia NiciuAffiliated withInstitute of Public Health Bucharest
  • , Peter RudnaiAffiliated withNational Institute of Environmental Health, “Jozsef Fodor” National Center for Public Health
  • , Salome ScholtensAffiliated withInstitute For Risk Assessment Sciences, Universiteit Utrecht
  • , Anna SplichalovaAffiliated withRegional Institute of Hygiene
  • , Katarina SlotovaAffiliated withState Health Institute
  • , Zoltán VokóAffiliated withDepartment of Preventive Medicine, Faculty of Public Health Medical & Health Science Center, University of Debrecen
    • , Renata ZlotkowskaAffiliated withDepartment of Epidemiology, Institute of Occupational Medicine and Environmental Health
    • , Danny HouthuijsAffiliated withNational Institute of Public Health and Environmental Protection (RIVM)

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Childhood obesity is a worldwide public health concern. Recent studies from high income countries have demonstrated associations between maternal smoking during pregnancy and children’s excess body weight. We examine associations between maternal smoking during pregnancy and children’s overweight or obesity, in six countries in the less affluent Central/Eastern European region. Questionnaire data were analysed, for 8,926 singleton children aged 9–12 years. Country-specific odds ratios for effects of maternal smoking during pregnancy on being overweight, and on obesity, were estimated using logistic regression. Heterogeneity between country-specific results, and mean effects (allowing for heterogeneity) were estimated. Positive associations between maternal smoking and overweight were seen in all countries but Romania. While not individually statistically significant, the mean odds ratio was 1.26 (95% CI 1.03–1.55), with no evidence of between-country heterogeneity. Obese children were few (2.7%), and associations between obesity and maternal smoking during pregnancy were more heterogeneous, with odds ratios ranging from 0.71 (0.32–1.57) in Poland to 5.49 (2.11–14.30) in Slovakia. Between-country heterogeneity was strongly related to average persons-per-room, a possible socioeconomic indicator, with stronger associations where households were less crowded. Estimates of dose–response relationships tended to be small and non-significant, even when pooled. Our results provide evidence of a link between maternal smoking in pregnancy and childhood overweight. Associations with obesity, though strong in some countries, were less consistent. Maternal smoking may confer an addition to a child’s potential for obesity, which is more likely to be realised in affluent conditions.


Smoking Pregnancy Body mass index Child Obesity Overweight Affluence