Maternal and Child Health Journal

, Volume 15, Issue 7, pp 985–992 | Cite as

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

  • Krisztian Gorog
  • Sam PattendenEmail author
  • Temenuga Antova
  • Emilia Niciu
  • Peter Rudnai
  • Salome Scholtens
  • Anna Splichalova
  • Katarina Slotova
  • Zoltán Vokó
  • Renata Zlotkowska
  • Danny Houthuijs


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 


Acknowledgments & Ethical Approval.

The Central European Study on Air pollution and Respiratory health (CESAR) was funded by the Commission of the European Communities (CEC): Directorate General XII, Science Research and Development in the framework of the Cooperation with Third Countries and International Organisations research and technological development programme (contract number IC15-CT98-0320), and Directorate General I, External Economic Relations, in the framework of the financial and technical assistance provided to General and Eastern Europe under the Phare Multi-Country Environment programme (contract number 94-0472). Ethical approval for the study was obtained in all participating countries. We would also like to acknowledge the participation of children, parents, teachers and technicians who made this study possible.

Conflict of Interest Statement

All authors declare that the answer to the questions on your competing interest form are all ‘No’ and therefore have nothing to declare.


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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Krisztian Gorog
    • 1
  • Sam Pattenden
    • 1
    Email author
  • Temenuga Antova
    • 2
  • Emilia Niciu
    • 3
  • Peter Rudnai
    • 4
  • Salome Scholtens
    • 5
  • Anna Splichalova
    • 6
  • Katarina Slotova
    • 7
  • Zoltán Vokó
    • 8
  • Renata Zlotkowska
    • 9
  • Danny Houthuijs
    • 10
  1. 1.London School of Hygiene & Tropical MedicineLondonUK
  2. 2.Department of Environmental HealthNational Centre of Public Health ProtectionSofiaBulgaria
  3. 3.Institute of Public Health BucharestBucharestRomania
  4. 4.National Institute of Environmental Health“Jozsef Fodor” National Center for Public HealthBudapestHungary
  5. 5.Institute For Risk Assessment SciencesUniversiteit UtrechtUtrechtThe Netherlands
  6. 6.Regional Institute of HygieneOstravaCzech Republic
  7. 7.State Health InstituteBanska BystricaSlovak Republic
  8. 8.Department of Preventive Medicine, Faculty of Public Health Medical & Health Science CenterUniversity of DebrecenDebrecenHungary
  9. 9.Department of EpidemiologyInstitute of Occupational Medicine and Environmental HealthSosnowiecPoland
  10. 10.National Institute of Public Health and Environmental Protection (RIVM)BilthovenThe Netherlands

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