Maternal and Child Health Journal

, Volume 15, Issue 7, pp 985–992

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


  • Krisztian Gorog
    • London School of Hygiene & Tropical Medicine
    • London School of Hygiene & Tropical Medicine
  • Temenuga Antova
    • Department of Environmental HealthNational Centre of Public Health Protection
  • Emilia Niciu
    • Institute of Public Health Bucharest
  • Peter Rudnai
    • National Institute of Environmental Health“Jozsef Fodor” National Center for Public Health
  • Salome Scholtens
    • Institute For Risk Assessment SciencesUniversiteit Utrecht
  • Anna Splichalova
    • Regional Institute of Hygiene
  • Katarina Slotova
    • State Health Institute
  • Zoltán Vokó
    • Department of Preventive Medicine, Faculty of Public Health Medical & Health Science CenterUniversity of Debrecen
  • Renata Zlotkowska
    • Department of EpidemiologyInstitute of Occupational Medicine and Environmental Health
  • Danny Houthuijs
    • National Institute of Public Health and Environmental Protection (RIVM)

DOI: 10.1007/s10995-009-0543-5

Cite this article as:
Gorog, K., Pattenden, S., Antova, T. et al. Matern Child Health J (2011) 15: 985. doi:10.1007/s10995-009-0543-5


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.


SmokingPregnancyBody mass indexChildObesityOverweightAffluence

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© Springer Science+Business Media, LLC 2009