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Maternal smoking status during pregnancy and low birth weight in offspring: systematic review and meta-analysis of 55 cohort studies published from 1986 to 2020

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Abstract

Background

Maternal smoking during pregnancy may be associated with low birth weight (LBW) in offspring and global risk estimates have not been summarized previously. We aimed to systematically explore evidence regarding maternal smoking and the LBW risk in offspring globally and examine possible causes of heterogeneity across relevant studies.

Methods

Comprehensive search of PubMed, Ovid Embase, Ovid Medline (R), and Web of science from inception until October 2021 was carried out. A random-effects meta-analysis was used to estimate the pooled odds ratio (OR) and corresponding 95% confidence interval (CI). Restricted cubic spline analysis with three knots was used to further examine the dose–response relationship.

Results

Literature searches yielded 4940 articles, of which 53 met inclusion criteria (comprising 55 independent studies). Maternal smoking during pregnancy was significantly associated with the risk of LBW in offspring (OR = 1.89, 95% CI = 1.80–1.98). Furthermore, an obvious dose–response relationship between the amount of cigarettes daily smoked in pregnancy and the risk of LBW in offspring was observed. The results of subgroup analyses indicated that the risk of maternal smoking on LBW was larger in more recently conducted studies (P = 0.020) and longer period of active smoking during pregnancy (P = 0.002). No evidence of publication bias was found.

Conclusions

In summary, maternal smoking in pregnancy was significantly associated with a higher risk of LBW in offspring on a global scale. The risk of maternal smoking on infant LBW seems to be increasing over time, and was higher with longer smoking duration throughout pregnancy and more cigarettes smoked daily.

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Data availability statement

Studies used for meta-analysis are listed in Supplementary eTable 2.

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Acknowledgements

We thank all the authors of the studies included in our meta-analysis.

Funding

This study was funded by the by the National Social Science Foundation of China (Grant No. 18ZDA085).

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Authors and Affiliations

  1. Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China

    Hong-Kun Di, Yong Gan, Chao Wang, Yi Zhu, Xin Meng, Wen-Qi Xia, Min-Zhi Xu, Jing Feng, Zhi-Qiang Nie, Jun-An Liu & Zu-Xun Lu

  2. Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China

    Kai Lu

  3. School of Public Health, Zhengzhou University, Zhengzhou, Henan, China

    Qing-Feng Tian & Yan He

  4. Norwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich, NR47TJ, UK

    Fu-Jian Song

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  1. Hong-Kun Di
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Contributions

HKD and YG contributed equally to this work. HKD, YG, and ZXL conceived the study. HKD and YG searched the databases and checked them according to the eligible criteria and exclusion criteria. KL, CW and YZ helped develop search strategies. HKD and KL did the data extraction and quality assessment. HKD and YG analyzed the data. YZ, XM, JAL and FJS gave advice on meta-analysis methodology. H.K.D and Y.G wrote the draft of the paper. HKD, YG, YZ, WQX, XM, MZX, JF, JAL, FJS and ZXL contributed to reviewing or revising the paper. All authors read and approved the final manuscript. ZXL is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Fu-Jian Song or Zu-Xun Lu.

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Di, HK., Gan, Y., Lu, K. et al. Maternal smoking status during pregnancy and low birth weight in offspring: systematic review and meta-analysis of 55 cohort studies published from 1986 to 2020. World J Pediatr 18, 176–185 (2022). https://doi.org/10.1007/s12519-021-00501-5

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