Effect of the exposure to maternal smoking during pregnancy and childhood on the body mass index until adolescence

Muraro, Ana Paula; Gonçalves-Silva, Regina Maria Veras; Ferreira, Márcia Gonçalves; Silva, Gulnar Azevedo e; Sichieri, Rosely

doi:10.1590/S0034-8910.2015049005423

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Sumário

Original Articles • Rev. Saúde Pública 49 • 2015 • https://doi.org/10.1590/S0034-8910.2015049005423 copy

Effect of the exposure to maternal smoking during pregnancy and childhood on the body mass index until adolescence

Efeito do tabagismo materno durante gestação e infância sobre o índice de massa corporal até a adolescência

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

Investigate the effect of exposure to smoking during pregnancy and early childhood on changes in the body mass index (BMI) from birth to adolescence.

METHODS

A population-based cohort of children (0-5 years old) from Cuiabá, Midwest Brazil, was assessed in 1999-2000 (n = 2,405). Between 2009 and 2011, the cohort was re-evaluated. Information about birth weight was obtained from medical records, and exposure to smoking during pregnancy and childhood was assessed at the first interview. Linear mixed effects models were used to estimate the association between exposure to maternal smoking during pregnancy and preschool age, and the body mass index of children at birth, childhood and adolescence.

RESULTS

Only 11.3% of the mothers reported smoking during pregnancy, but most of them (78.2%) also smoked during early childhood. Among mothers who smoked only during pregnancy (n = 59), 97.7% had smoked only in the first trimester. The changes in body mass index at birth and in childhood were similar for children exposed and those not exposed to maternal smoking. However, from childhood to adolescence the rate of change in the body mass index was higher among those exposed only during pregnancy than among those who were not exposed.

CONCLUSIONS

Exposure to smoking only during pregnancy, especially in the first trimester, seems to affect changes in the body mass index until adolescence, supporting guidelines that recommend women of childbearing age to stop smoking.

Pregnant Women; Smoking, adverse effects; Child Development; Body Mass Index; Cohort Studies

Variable	n	%	BMI-for-age z-score 0 to 5 years old		p	BMI-for-age z-score 10 to 17 years old		p
Variable	n	%	Mean	95%CI	p	Mean	95%CI	p
Sex					0.92			0.15
Male	1,224	50.9	0.14	0.08;0.21		0.19	0.09;0.22
Female	1,181	49.1	0.15	0.09;0.22		0.28	0.20;0.36
Birth weight (g)					< 0.01			< 0.01
≥ 4,000	143	6.9	0.56	0.39;0.73		0.47	0.26;0.69
3,000-3,999	1,619	67.6	0.22	0.17;0.28		0.30	0.23;0.38
2,500-2,999	483	20.1	-0.05	-0.14;0.03		0.01	-0.12;0.15
< 2,500	160	6.4	-0.37	-0.59;-0.15		-0.00	-0.26;0.25
Length-for-age at birth (z-score)^a					< 0.01			0.01
< -2 z-score	270	11.3	0.17	0.12;0.22		0.26	0.20;0.32
≥ -2 z-score	2,124	88.7	-0.06	-0.21;0.08		0.03	-0.15;0.22
BMI-for-age (z-score) - preschool age								< 0.01
Thinness (< -2 z-score)	69	2.8				-0.44	-0.88;0.00
Adequate (≥ -2 to ≤ 1 z-score)	1,857	77.2				0.08	0.02;0.15
Overweight (> 1 to ≤ 2 z-score)	371	15.4				0.72	0.58;0.86
Obesity (> 2 z-score)	108	0.45				1.40	1.13;1.67
Height-for-age (z-score) - preschool age					0.21			0.11
< -2 z-score	2,258	93.9	0.13	0.09;0.18		0.32	-0.04;0.60
≥ -2 z-score	146	6.1	0.31	0.04;0.60		0.14	0.09;0.18
Economic class^b					< 0.01			< 0.01
A (high-income)	86	3.6	0.34	0.11;0.58		0.79	0.48;1.11
B	289	12.0	0.12	-0.02;0.26		0.44	0.25;0.62
C	1,019	42.4	0.25	0.18;0.32		0.26	0.17;0.35
D	807	33.5	0.04	-0.03;0.12		0.17	0.07;0.28
E (low-income)	204	8.5	0.02	-0.12;0.16		-0.17	-0.35;0.02
Maternal schooling (years)^c					0.22			< 0.01
≥ 12	206	8.6	0.17	0.03;0.31		0.60	0.40;0.81
9 to 11	638	26.5	0.16	0.06;0.25		0.30	0.19;0.41
5 to 8	1,363	56.7	0.16	0.10;0.22		0.15	0.07;0.23
0 to 4	177	7.4	-0.02	-0.18;0.14		0.18	-0.05;0.41
Breastfeeding					< 0.01			< 0.01
Any	1,945	80.9	0.17	0.14;0.20		0.26	0.22;0.30
Never	460	19.1	0.05	-0.01;0.11		0.13	0.04;0.21
Maternal smoking during pregnancy and at childhood					0.75			0.13
During both periods	212	8.9	0.14	-0.03;0.31		0.11	-0.07;0.29
Only during pregnancy	59	2.5	0.18	-0.14;0.50		0.70	0.19;1.22
Only during childhood	76	3.1	0.29	0.03;0.55		0.27	-0.02;0.56
No smoking	2,042	85.5	0.15	0.10;0.19		0.24	0.17;0.30
Paternal smoking at childhood^c					0.03			0.49
Yes	501	25.6	0.25	0.14;0.35		0.21	0.07;0.34
No	1,456	76.8	0.12	0.07;0.18		0.28	0.20;0.35

Variable	Coefficient	Standard error	p
Rate of change of body mass index
Childhood	0.18	0.003	< 0.01
Adolescence	0.15	0.004	< 0.01
BMI at birth (intercept) according maternal smoking during pregnancy and childhood
During both periods	0.03	0.019	0.09
Only during pregnancy	-0.07	0.036	0.03
Only during childhood	0.01	0.029	0.60
No smoking	–	–	–
Rate of change of BMI between preschool age and adolescence according maternal smoking during pregnancy and childhood
During both periods	-0.03	0.017	0.09
Only during pregnancy	0.07	0.033	0.03
Only during childhood	-0.01	0.03	0.72
No smoking	–	–	–

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E-mail: revsp@usp.br

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[1] Correspondence: Ana Paula Muraro. Instituto de Saúde Coletiva. Universidade Federal de Mato Grosso. Av. Fernando Corrêa da Costa, 2367 Bloco CCBS III Boa Esperança. 78060-900 Cuiabá, MT, Brasil. E-mail:muraroap@gmail.com