Tabaquismo materno durante el embarazo e índice de masa corporal y sobrepeso en los hijos: una revisión sistemática y metaanálisis

Magalhães, Elma Izze da Silva; Sousa, Bruno Andrade de; Lima, Natália Peixoto; Horta, Bernardo Lessa

doi:10.1590/0102-311X00176118

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REVIEW • Cad. Saúde Pública 35 (12) • 2019 • https://doi.org/10.1590/0102-311X00176118 linkcopiar

Tabaquismo materno durante el embarazo e índice de masa corporal y sobrepeso en los hijos: una revisión sistemática y metaanálisis

Autoría SCIMAGO INSTITUTIONS RANKINGS

El objetivo del presente estudio fue llevar a cabo una revisión sistemática y metaanálisis para evaluar la evidencia de asociación del tabaquismo materno durante el embarazo con el índice de masa corporal de los hijos durante la infancia, adolescencia y etapa adulta. Se buscó información en las siguientes bases de datos: MEDLINE, Web of Science y LILACS. También se analizaron listas de referencia. Se incluyeron estudios originales, realizados con humanos, que evaluaron la asociación del tabaquismo materno durante el embarazo con el índice de masa corporal (IMC) en los hijos, así como el sobrepeso en la infancia, adolescencia y etapa adulta, publicado el 1 de mayo de 2018. Se realizó un metaanálisis para estimar el tamaño de los efectos combinados. La revisión sistemática incluyó 64 estudios, donde 37 evaluaron la asociación del tabaquismo materno durante el embarazo con el sobrepeso, 13 con el IMC, y 14 evaluaron ambos resultados. De estos 64 estudios, se obtuvieron 95 medidas de efecto que se incluyeron en el metaanálisis. Verificamos que la calidad de las evidencias en los diferentes estudios, respecto tabaquismo materno durante el embarazo y el sobrepeso, así como el IMC en los hijos, era moderada y baja, respectivamente. La mayor parte de los estudios (44 estudios) estaba clasificada como de riesgo moderado de sesgo. La heterogeneidad entre los estudios incluidos fue alta y, en los análisis agrupados de efectos aleatorios, el tabaquismo materno durante el embarazo incrementó la probabilidad de descendencia con sobrepeso (OR: 1,43; IC95%: 1,35; 1,52) y la diferencia media del IMC (β: 0,31; IC95%: 0,23; 0,39). En conclusión, los hijos de las madres que fumaron durante el embarazo tienen una mayor probabilidad de sobrepeso, así como una diferencia media del IMC, y estas asociaciones persisten en la etapa adulta.

Palabras-clave:
Fumar; Embarazo; Sobrepeso; Índice de Masa Corporal; Metaanálisis

Study (Year)	Origin	Study design	Gender	Sample (N)	Age group (years)	Outcome
Toschke et al. ¹⁹ (2002)	Germany	Cross-sectional	All	8,765	< 10	Overweight and obesity
von Kries et al. ²⁰ (2002)	Germany	Cross-sectional	All	6,483	< 10	Overweight and obesity
Bergmann et al. ²¹ (2003)	Germany	Cohort	All	918	< 10	Overweight and obesity
Toschke et al. ²² (2003)	Germany	Cross-sectional	All	4,974	< 10	Overweight and obesity
Widerøe et al. ²³ (2003)	Norway and Sweden	Cohort	All	482	< 10	Overweight or obesity
Oken et al. ⁶⁵ (2005)	United States	Cohort	All	746	< 10	Overweight or obesity and BMI (Z score)
Reilly et al. ²⁴ (2005)	United Kingdom	Cohort	All	7,758	< 10	Obesity
Chen et al. ⁶⁶ (2006)	United States	Cohort	All	Male: 6,298; Female: 6,362;	< 10	Overweight or obesity and BMI (kg/m²)
Dubois & Girard ²⁵ (2006)	Canada	Cohort	All	1,450	< 10	Overweight or obesity
Leary et al. ⁵⁶ (2006)	England	Cohort	All	5,689	< 10	BMI (SD units)
Macías Gelabert et al. ²⁶ (2007)	Cuba	Case-control	All	172	< 10	Obesity
Goldani et al. ⁵⁷ (2007)	Brazil	Cohort	Male	1,189	10-19	BMI (kg/m²)
Mizutani et al. ²⁷ (2007)	Japan	Cohort	All	1,417	< 10	Overweight and obesity
Salsberry & Reagan ²⁸ (2007)	United States	Cohort	All	3,368	10-19	Overweight or obesity
Tomé et al. ²⁹ (2007)	Brazil	Cohort	All	2,797	< 10	Overweight or obesity
Koupil & Toivanen ⁶⁷ (2008)	Sweden	Cohort	Male	1,103	10-19	Overweight or obesity and BMI (kg/m²)
Moschonis et al. ³⁰ (2008)	Greece	Cohort	All	1,667	< 10	Overweight or risk of overweight
Sharma et al. ³¹ (2008)	United States	Cohort	All	NHW: 82,361; NHB: 31,704; H: 34,378; AIAN: 2,228; API: 4,740	< 10	Obesity
von Kries et al. ³² (2008)	Germany	Cross-sectional	All	5,899	< 10	Overweight and obesity
Fasting et al. ⁶⁸ (2009)	Norway	Cohort	All	711	< 10	Overweight or obesity and BMI (kg/m²)
Hawkins et al. ³³ (2009)	United Kingdom	Cohort	All	13,188	< 10	Overweight or obesity
Hesketh et al. ⁵⁸ (2009)	Australia	Cohort	All	1,373	10-19	BMI (Z score)
Braun et al. ⁶⁹ (2010)	United States	Cohort	All	356	< 10	Overweight or obesity and BMI (kg/m²)
Iliadou et al. ⁷⁰ (2010)	Sweden	Cohort	Male	124,203	≥ 20	Overweight or obesity and BMI (kg/m²)
Koshy et al. ³⁴ (2010)	United Kingdom	Cross-sectional	All	3,038	< 10	Overweight and obesity
Kuhle et al. ³⁵ (2010)	Canada	Cross-sectional	All	3,426	10-19	Overweight or obesity
Mangrio et al. ³⁶ (2010)	Sweden	Cross-sectional	All	9,009	< 10	Overweight and obesity
Pirkola et al. ³⁷ (2010)	Finland	Cohort	All	4,168	10-19	Overweight or obesity
Power et al. ⁸ (2010)	United Kingdom	Cohort	All	8,815	≥ 20	Obesity and BMI (kg/m²)
Seach et al. ³⁸ (2010)	Australia	Cohort	All	307	10-19	Overweight or obesity
Beyerlein et al. ⁴ (2011)	Germany	Cross-sectional	All	12,383	10-19	BMI (SD score)
Gorog et al. ³⁹ (2011)	Bulgaria, Czech Republic, Hungary, Poland, Romania and Slovakia	Cross-sectional	All	8,926	10-19	Overweight and obesity
Matijasevich et al. ⁵⁹ (2011)	Brazil	Cohort	All	1993 cohort: 1,450; 2004 cohort: 3,799	< 10	BMI (Z score)
Raum et al. ⁴⁰ (2011)	Germany	Cross-sectional	All	1,954	< 10	Overweight or obesity
Chen et al. ⁴¹ (2012)	Taiwan	Cross-sectional	All	7,930	10-19	Overweight and obesity
Cupul-Uicab et al. ⁴² (2012)	Norway	Cross-sectional	Female	74,023	≥ 20	Obesity
Gopinath et al. ⁴³ (2012)	Australia	Cross-sectional	All	4,094	10-19	Overweight and/or obesity
Janjua et al. ⁴⁴ (2012)	United States	Cohort	All	740	< 10	Overweight and obesity
Mamun et al. ⁹ (2012)	Australia	Cohort	All	2,038	≥ 20	Overweight, obesity and BMI (kg/m²)
Messiah et al. ⁴⁵ (2012)	United States	Cross-sectional	All	H: 1,416; NHB: 1,090; NHW: 1,138	< 10	Overweight and obesity
Plachta-Danielzik et al. ⁴⁶ (2012)	Germany	Cross-sectional	All	34,240	< 10	Overweight or obesity
Risvas et al. ⁴⁷ (2012)	Greece	Cross-sectional	All	2,093	10-19	Overweight or obesity
Bingham et al. ⁴⁸ (2013)	Portugal	Cross-sectional	All	17,136	< 10	Overweight and/or obesity
Harris et al. ⁴⁹ (2013)	United States	Cohort	Female	35,020	≥ 20	Overweight and obesity
Mattsson et al. ⁵⁰ (2013)	Sweden	Cohort	Female	54,012	≥ 20	Obesity
Pei et al. ⁷¹ (2013)	Germany	Cohort	All	Male: 1,588; Female: 1533	10-19	Overweight or obesity and BMI (Z score)
Shi et al. ⁵¹ (2013)	Canada	Cross-sectional	All	968	< 10	Overweight and obesity
Wang et al. ⁵² (2013)	United States	Cohort	All	1,041	10-19	Overweight or obesity
Yang et al. ⁷² (2013)	Belarus	Cohort	All	13,889	< 10	Overweight or obesity and BMI (kg/m²)
Durmuş et al. ⁷³ (2013)	Netherlands	Cohort	All	5,243	< 10	Overweight, obesity and BMI (kg/m²)
Ehrenthal et al. ⁶⁰ (2013)	United States	Cohort	All	3,302	< 10	BMI (Z score)
Dior et al. ⁶¹ (2014)	Israel	Cohort	All	1,440	≥ 20	BMI (kg/m²)
Florath et al. ⁵ (2014)	Germany	Cohort	All	609	< 10	BMI (kg/m²)
Huang et al. ⁵³ (2014)	United States	Cohort	All	5,156	10-19	Obesity
Moller et al. ⁵⁴ (2014)	Denmark	Cohort	All	32,747	< 10	Overweight or obesity
Riedel et al. ⁶ (2014)	Germany	Cohort	All	Male: 540; Female: 509	10-19	BMI (Z score)
Suzuki et al. ⁷⁴ (2014)	Japan	Cohort	All	Male: 1,134; Female: 1,096	< 10	Overweight or obesity and BMI (kg/m²)
Timmermans et al. ⁷⁵ (2014)	Netherlands	Cohort	All	1,730	< 10	Overweight or obesity and BMI (Z score)
Fairley et al. ⁶² (2015)	United Kingdom	Cohort	All	987	< 10	BMI (Z score)
Grzeskowiak et al. ⁷ (2015)	Australia	Cohort	All	7,658	< 10	BMI (Z score)
Mourtakos et al. ⁵⁵ (2015)	Greece	Cross-sectional	All	5,125	< 10	Obesity
Thurber et al. ⁶³ (2015)	Australia	Cohort	All	682	< 10	BMI (Z score)
Li et al. ⁶⁴ (2016)	Portugal	Cross-sectional	All	Male: 8,798; Female: 8,488	< 10	BMI (kg/m²)
Robinson et al. ⁷⁶ (2016)	Spain	Cohort	All	INMA subcohorts: 1,866; Menorca subcohort: 427	INMA subcohorts: 10; Menorca subcohort: 10-19	Overweight or obesity and BMI (Z score)

Subgroups	Overweight			BMI
Subgroups	N	Pooled OR (95%CI)	% heterogeneity explained	N	Pooled β (95%CI)	% heterogeneity explained
Age group (years)			0.0			51.8
< 10	41	1.44 (1.33; 1.56)		21	0.23 (0.17; 0.29)
10-19	14	1.43 (1.21; 1.70)		9	0.30 (0.16; 0.44)
≥ 20	6	1.50 (1.42; 1.57)		4	0.64 (0.46; 0.83)
Gender			0.0			0.0
Male	5	1.50 (1.31; 1.73)		5	0.25 (0.10; 0.40)
Female	6	1.46 (1.36; 1.58)		5	0.30 (0.17; 0.42)
All	50	1.45 (1.34; 1.56)		24	0.33 (0.23; 0.43)
Setting			0.5			0.0
Low/Middle income country	9	1.35 (1.12; 1.64)		6	0.24 (0.06; 0.42)
High income country	52	1.45 (1.36; 1.54)		28	0.32 (0.24; 0.41)
Study design			12.8			0.0
Cohort	40	1.37 (1.27; 1.47)		31	0.30 (0.22; 0.39)
Cross-sectional/Case-control	21	1.58 (1.43; 1.73)		3	0.36 (0.27; 0.45)
Sample size (participants)			34.4			0.0
< 800	8	2.33 (1.44; 3.77)		8	0.36 (0.25; 0.47)
800-1,500	11	1.74 (1.48; 2.05)		8	0.32 (0.15; 0.49)
> 1,500	42	1.37 (1.29; 1.43)		18	0.28 (0.18; 0.38)
Assessment of maternal smoking			0.0			0.0
During pregnancy	28	1.40 (1.30; 1.50)		15	0.30 (0.17; 0.42)
At maternity hospital	7	1.36 (1.16; 1.59)		12	0.34 (0.18; 0.50)
In the first year of life	2	1.47 (1.12; 1.93)		3	0.33 (0.14; 0.52)
Older than 1 year	24	1.53 (1.36; 1.72)		4	0.30 (0.14; 0.46)
Source of maternal smoking information			11.2			0.0
Interview/Questionnaire	54	1.41 (1.33; 1.51)		26	0.26 (0.20; 0.33)
Medical record	4	1.55 (1.46; 1.65)		4	0.48 (0.10; 0.86)
Serum/Urinary cotinine	3	2.00 (1.51; 2.64)		4	0.40 (0.14; 0.66)
Adjustment for socioeconomic variables			0.4			0.0
No	12	1.61 (1.37; 1.89)		5	0.20 (0.07; 0.33)
Yes	49	1.40 (1.32; 1.50)		29	0.32 (0.24; 0.41)
Adjustment for demographic variables			23.2			0.0
No	6	2.12 (1.47; 3.06)		4	0.41 (0.07; 0.75)
Yes	55	1.40 (1.32; 1.48)		30	0.30 (0.22; 0.38)
Adjustment for maternal anthropometry			0.0			0.0
No	21	1.46 (1.37; 1.56)		5	0.22 (0.09; 0.36)
Yes	40	1.44 (1.33; 1.56)		29	0.32 (0.23; 0.40)
Adjustment for maternal comorbidities			0.0			0.0
No	57	1.44 (1.36; 1.54)		30	0.33 (0.24; 0.41)
Yes	4	1.34 (1.22; 1.47)		4	0.19 (0.10; 0.32)
Adjustment for birth conditions			11.9			21.7
No	24	1.51 (1.41; 1.61)		20	0.24 (0.14; 0.34)
Yes	37	1.37 (1.26; 1.49)		14	0.43 (0.32; 0.54)
Adjustment for breastfeeding/complementary feeding			4.2			0.0
No	31	1.46 (1.37; 1.56)		19	0.28 (0.16; 0.39)
Yes	30	1.42 (1.29; 1.55)		15	0.34 (0.25; 0.43)
Adjustment for lifestyle variables			0.0			0.0
No	42	1.44 (1.35; 1.53)		22	0.30 (0.20; 0.41)
Yes	19	1.42 (1.24; 1.62)		12	0.33 (0.19; 0.45)
Adjustment for socioeconomic and demographic variables			11.2			0.0
No	17	1.66 (1.44; 1.91)		9	0.29 (0.15; 0.44)
Yes	44	1.38 (1.29; 1.47)		25	0.31 (0.22; 0.40)
Adjustment for socioeconomic, demographic variables and mediators			33.6			0.0
No adjustment for socioeconomic and demographic variables	17	1.66 (1.44; 1.91)		9	0.29 (0.15; 0.44)
Adjustment for socioeconomic and demographic variables without adjust for mediators	9	1.52 (1.44; 1.61)		8	0.33 (0.11; 0.54)
Adjustment for socioeconomic and demographic variables and mediators	35	1.33 (1.23; 1.44)		17	0.30 (0.23; 0.37)
Overall	61	1.43 (1.35; 1.52)		34	0.31 (0.23; 0.39)

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[TFN1] AIAN: American Indian or Alaska Native; API: Asian or Pacific Islander; BMI: body mass index; H: Hispanic; INMA: Infancia y Medio Ambiente; NHB: Non-Hispanic Black; NHW: Non-Hispanic White; SD: standard deviation.