The effect of cigarette smoke from the mother on bronchial responsiveness and severity of symptoms in children with asthma

The effect of parental smoking was assessed in 94 consecutively observed children, aged 7 to 17 years, who had a history of asthmatic wheezing. The 24 children whose mothers smoked, when they were compared with children whose mothers did not smoke, had 47% more symptoms, a 13% lower mean FEV1 percent, a 23% lower mean FEF25-75%, and fourfold greater responsiveness to aerosolized histamine. A dose response was evident. There was a highly significant correlation between the results of the tests and the number of cigarettes the mother smoked while she was in the house. The differences between the children of smoking and nonsmoking mothers were greater in older than in younger subjects. The smoking habits of the father were not correlated with the severity of the child's asthma.     

Asthma medication use in pregnancy and fetal growth

BACKGROUND: Given the high prevalence of asthma in pregnancy, it is important to understand the relationship between asthma medications and fetal growth in the context of appropriate treatment. OBJECTIVE: This study examines the effect of inhaled corticosteroids, systemic corticosteroids, and beta(2)-agonists on fetal growth in 654 infants born to women with asthma compared with 303 infants born to controls without asthma. METHODS: Subjects for this prospective study were enrolled throughout North America between 1998 and 2003 and followed up by the Organization of Teratology Information Services. Incidence of small for gestational age (SGA) infants and mean birth size measures were compared among groups. RESULTS: Mean birth weight of full-term infants born to mothers who used systemic corticosteroids (3373 g) was lower than in the beta(2)-agonist group (3552 g) and controls without asthma (3540 g; P < .05) after adjustment for other risk factors. However, no differences in the incidence of SGA for weight were observed among groups. Adjusted mean birth length was slightly shorter in the systemic steroid group compared with controls (P=.02). Incidence of SGA for length and head circumference and mean head circumference did not vary among groups (P>.05). CONCLUSION: The treatment of asthma with systemic corticosteroids resulted in a deficit of about 200 g in birth weight compared with controls and exclusive beta(2)-agonist users and no increased incidence of SGA. These results suggest that asthma management with beta(2)-agonists and/or inhaled corticosteroids during pregnancy does not impair fetal growth, whereas systemic corticosteroids have a minimal effect which should be weighed against the necessity to control severe asthma.     

Reduction in birth weight associated with smoking among young and older-age women

This study examined the combined effects of maternal smoking and maternal age on birth weight. A sample of 1,851 white, full-term infants (37 to 42 weeks) born to primiparous mothers ranging in age from 18 to 41 years was derived from the database of the Child Health and Development Studies (CHDS), available through the National Technical Information Service (NTIS) of the U.S. Department of Commerce. The mothers were classified into three age groups—young, middle-aged, and older-aged—corresponding respectively to values below the 15th, between the 15th and 85th, and at or above the 85th percentile of age. Analyses of the data show that the reduction in birth weight associated with maternal smoking when compared with nonsmoking averaged 181 gm for the young group (18 to 20 years), 162 gm for the middle-aged group (21 to 29 years), and 154 gm for the older-aged group (30 to 41 years). These differences are independent of total income. Hence it appears that the birth weight–reducing effect of smoking is not enhanced among women of older reproductive ages (30 to 41 years). Furthermore, the reduction in birth weight is dose responsive. That is, the greater the number of cigarettes smoked per day, the lower is the resulting mean birth weight and the higher is the proportion of low-birth-weight infants.     

Maternal smoking and alcohol consumption during pregnancy as risk factors for sudden infant death

A population based case control study was conducted to examine alcohol consumption and maternal smoking during pregnancy and the risk of SIDS in an Irish population. Each SIDS case (n = 287) was compared with control infants (n = 832) matched for date and place of birth for infants born from 1994 to 2001. Conditional logistic regression was used to investigate differences between Cases and Controls establishing Odds Ratio's (OR) and 95% Confidence Intervals (CI). Mothers who smoked were 3 times more likely to have a SIDS Case, and a dose response effect was apparent, with mothers smoking 1-10 cigarettes/day OR 2.93 (CI 1.50-5.71), and those smoking > 10 cigarettes/day OR 4.36 (CI 2.50-7.61). More Case mothers consumed alcohol during pregnancy than Control mothers and, within drinkers, the amount of alcohol consumed was also greater (p < 0.05). A dose response with frequency of drinking was apparent. The adjusted odds ratio for those consuming alcohol in all three trimesters was 3.59 (CI:1.40-9.20). Both of these risk factors are modifiable and need to be incorporated into antenatal education from a SIDS point of view.     

Does tobacco smoke prevent atopic disorders? A study of two generations of Swedish residents

BACKGROUND: Earlier studies have given conflicting results regarding the effect of exposure to tobacco smoke on atopic sensibilization. METHODS: A cross-sectional study of present and former smoking habits in relation to atopic disorders from data on 6909 young and middle-aged adults (16-49 years) and their 4472 children (3-15 years) from the Swedish Survey of Living Conditions in 1996-97. RESULTS: The prevalence of allergic asthma and allergic rhino-conjunctivitis decreased, in a dose-response manner (P = 0.03 and P = 0.004, respectively), with increasing exposure to tobacco smoke in the adult study population. This pattern was little changed when potential confounders (sex, age, education, domicile, country of birth) were entered into a multivariate analysis: the adjusted odds ratio (OR) for allergic rhino-conjunctivitis was 0.5 (0.4-0.7) for those who smoked at least 20 cigarettes a day and OR 0.7 (0.6-0.9) for those smoking 10-19 cigarettes, compared with those who reported that they never had smoked Former smokers had a tendency for a slightly lower risk: OR 0.9 (0.8-1.0). In a multivariate analysis, children of mothers who smoked at least 15 cigarettes a day tended to have lower odds for suffering from allergic rhino-conjunctivitis, allergic asthma, atopic eczema and food allergy, compared to children of mothers who had never smoked (ORs 0.6-0.7). Children of fathers who had smoked at least 15 cigarettes a day had a similar tendency (ORs 0.7-0.9). CONCLUSIONS: This study demonstrates an association between current exposure to tobacco smoke and a low risk for atopic disorders in smokers themselves and a similar tendency in their children. There is a need for further studies with a prospective design to certify the causal direction of this association. Smoking habits and atopic disorder in parents should not be considered independent variables in epidemiological studies of the connection between exposure to tobacco smoke and atopy in children.     

Parental bad habits breed bad behaviors in youth: Exposure to gestational smoke and child impulsivity

In utero exposure to cigarette smoke has been shown to have an adverse effect on healthy brain development in childhood. In the present study, we examine whether fetal exposure to mild and heavy smoking is associated with lower levels of impulsivity and cognitive control at age 10. Using a sample of 2120 children from the Québec Longitudinal Study of Child Development, we examine the association between gestational cigarette smoke exposure and fourth grade teacher reports of impulsivity and classroom engagement which represent behavioral indicators of executive functions. When compared to children of non-smokers, children of mothers who reported smoking heavily during pregnancy (10 or more cigarettes per day) were rated by their fourth grade teachers as displaying higher levels of impulsive behavior, scoring.112 standard deviation units higher than children of non-smokers. Children of mothers who smoked heavily were also less engaged in the classroom, scoring.057 standard deviation units lower than children of women who did not smoke. These analyses were adjusted for many potentially confounding child and family variables. Exposure to perinatal nicotine may compromise subsequent brain development. In particular, fetal nicotine may be associated with impairment in areas recruited for the effortful control of behavior in later childhood, a time when task-orientation and industriousness are imperative for academic success.     

Disproportionate fetal growth and raised IgE concentration in adult life

Summary. A follow-up study was carried out to determine whether either impaired or disproportionate fetal growth are associated with a raised total serum IgE concentration in men and women aged 50 years. The serum IgE concentration was measured in 146 men and 134 women born in Preston (Lancashire, UK) between 1935 and 1943, whose size at birth had been measured in detail.
Sixty-two subjects were found to have an IgE concentration above 80 IU/ml. Compared with subjects with a normal IgE on average they had a 0.30 inch larger head circumference at birth ( P -0.004) and weighed 5.6 ounces more at birth (^P= 0.04). People with a raised and with a normal IgE were of similar crown-heel length at birth, indicating that in utero those with a raised IgE had had disproportionate growth of the head in relation to the trunk and limbs. The prevalence of a raised IgE rose from 14% in subjects whose head circumference at birth was 13 inches or less to 37% in those whose head circumference was more than 14 inches. This association was independent of gestational age at birth and of the mother's pelvic size and parity. It was also independent of adult physique, social class and smoking, and was similar in men and women. In multiple logistic regression analyses odds ratios of a raised IgE rose progressively to more than 4 as head circumference at birth increased from 13 inches or less to more than 14 inches.
One possibility is that these associations reflect the long-term effects of sustaining fetal brain growth at the expense of the trunk, in particular the thymus. This may be a consequence of fetal under-nutrition in late gestation.     

Comparison of head circumference in an Israeli child population with United States and British standards

The head circumference (HC) growth pattern of infants from 1 to 24 months of age was studied in a Jerusalem community. The means of HC of the study population are smaller for each age and sex group than those of the National Center of Health Statistics, USA reference population, London children and the Nellhaus standard. The regression of HC on length explains about 20% of the variance. In an analysis of variance controlling for social class, birth order and length, the differences by region of origin of the mother were not significant. The smaller HC of the study population is probably due to these children being shorter and lighter than the above-mentioned western populations. Malnutrition as a factor for small HC was excluded.     

Twins: measures of birth size at different gestational ages

Means, standard deviations, and empirical centile values are given for birth weight, length and head circumference for twins born at gestational ages 31+ to 42+ weeks. The data are compared with recent results for singletons, and the twins show a deficit that becomes greater as gestational age increases. Although weight may be slightly more affected than the other two measures, the relative growth suppression for twins is quite similar in all three dimensions. Comparatively, the average size of twins born at 33+ weeks gestational age is equal to the 36th centile for singletons; but at 40+ weeks gestational age, the average size for twins is below the 5th centile for singletons.     

The effects of in-utero tobacco-toxin exposure on the respiratory system in children

PURPOSE OF REVIEW: Promotion of cigarettes to children and women has resulted in unacceptably high rates of smoking during pregnancy in most developed countries and the potential to greatly increase smoking by mothers in developing countries. The risks of smoking during pregnancy to mothers and unborn children are well known and include growth retardation, respiratory diseases and sudden infant death syndrome. Determining the effects of exposure on the fetus depends upon accurate assessment of maternal smoking, both active and involuntary, and this can be done using self-reports and a variety of biomarkers in the mother and/or newborn. RECENT FINDINGS: The evidence is clear that most of the excess respiratory morbidity in children born to smoking mothers is due to in-utero exposure and that deficits in lung function measured soon after birth persist in children and adults. Recent studies have also indicated that some children are genetically predisposed to adverse outcomes in response to in-utero exposure. SUMMARY: Although many women attempt to quit during pregnancy and effective interventions are available, ultimately the respiratory health of future generations will depend upon effective public health and tobacco control measures designed to prevent smoking uptake by youth and in particular girls and young women.     

Mixed‐longitudinal growth of breastfeeding children in Moroto District,Uganda (Karamoja subregion). A loss of biological resiliency?

This study examines the pattern of growth, underlying growth velocity and nutritional status in a sample of thirty breastfeeding Karimojong children, aged from birth to three years. A mixed‐longitudinal structure was adopted for the study, which was carried out between August and December, 2004, in two communities in Moroto District, Uganda. Monthly anthropometric and health examinations were administered to mothers and children during this interval. Children in the study were small at birth but grew relatively rapidly for their first six months. Thereafter they experienced falling off of growth in weight, length, and head circumference. Loss of growth velocity and deterioration in nutritional status after six months was a result of physiologic stress arising from high parasite loads, introduction of inappropriate weaning foods, and psychosocial stress associated with patterns of maternal behavior. Environmental and maternal effects on child growth were exacerbated by widespread armed violence and related subsistence change in these communities. Growth of these children reflects loss of growth plasticity resulting from worsening environmental and social conditions in Moroto in 2004. Am. J. Hum. Biol., 2008. © 2008 Wiley‐Liss, Inc.     

Number of teeth at the age of one year in relation to maternal smoking

The mean number of deciduous teeth at the age of 1 year was investigated in the 10 499 children comprising a birth cohort from 1966 in Northern Finland. The 1563 children whose mothers smoked during pregnancy had on average 0.3 tooth more than the children of the control mothers. Highly significant explanatory variables in a regression analysis on the number of teeth at the age of one were weight at one year, maternal smoking, height at one year and birthweight, whereas gestational age and place of residence on a north-south axis were significant. Differences in cumulative percentages of eruption of the first tooth between the children of smokers and their controls were seen from the age of 4 months, with a maximal difference at 5 months: 30.0% versus 25.6%. The discrepancy was less that 1% by the age of 12 months.     

Head circumference at birth and maternal factors related to cord blood total IgE

BACKGROUND: A recent study reported an association between a large head circumference at birth and adult total IgE. However, no study has yet looked at the relation between head circumference and cord blood IgE. OBJECTIVES: To assess the relationship between child's cord blood total IgE and head circumference at birth taking parental allergy and smoking habits as well as placental calcifications into account. METHODS: Two samples of unselected newborns and their mothers with uncomplicated pregnancies were studied: 235 in study A with data on parental allergy and 99 in study B with data on placental calcifications. RESULTS: In both studies, cord blood IgE was significantly related to large head circumference at birth (0.07 vs 0.15 IU/mL for newborns < 37 cm vs >/= 37 cm, respectively, P = 0. 03 for study A and 0.09 vs 0.28 IU/mL, P = 0.04 for study B). Cord blood IgE was unrelated to parental smoking habits. Maternal IgE significantly increased in mothers exposed to both active and passive smoking during pregnancy compared with other pregnant women. High cord blood IgE were associated with high maternal IgE (r = 0. 38; P < 0.001). Multiple linear regression showed that large head circumference, maternal IgE and clinical manifestations of maternal, but not paternal, allergy were independently related to cord blood IgE (study A). Large head circumference and placental calcifications were independently related to a higher cord blood IgE level (study B). CONCLUSIONS: Besides the role of genetic factors, results on the preferential role of maternal vs paternal allergy and associations to large head circumference and placental calcifications support the hypothesis of the role of environmental factors during pregnancy on the level of cord blood IgE.     

Maternal smoking during pregnancy and sleep problems in 2-month-old infants

Objective

The study aimed to assess possible association between maternal smoking during pregnancy and sleep disturbances in 2-month-old infants.

Subjects and methods

The study comprised 200 apparently healthy infants from community settings selected by chance (88 boys, 112 girls), aged 2 months, who were singletons born in St. Petersburg in 2007. The mothers were asked to complete the questionnaires addressing major infant, maternal and demographic characteristics with particular emphasis on maternal smoking during pregnancy. As a part of the interview, the mothers were requested to describe possible sleep disturbances in their infants, divided into five major sleep domains: bedtime problems, excessive daytime sleepiness, awakenings, regularity and duration of sleep as well as snoring.

Results

Of 200 mothers, 63 (31.5%) smoked during pregnancy. The babies born to smoking mothers more commonly were reported as having bedtime problems [odds ratio (OR)=2.75; 95% confidence interval (CI)=1.15–6.58], and this association remained significant after adjustment was made for major potential confounders. Maternal smoking after delivery did not significantly add to the risk. Babies born to smoking mothers more often had irregular sleep, but this association was markedly influenced by the confounding effect of maternal education. No statistically significant differences were found for total night time sleep duration, the frequency of night time awakenings, excessive night time waking and daytime sleepiness as well as for snoring and noisy breathing during sleep.

Conclusion

Maternal smoking during pregnancy should be considered as a risk factor for infant bedtime problems, emerging as early as 2 months of age.     

Maternal smoking during pregnancy and conduct problems in high-risk youth: a developmental framework

Smoking during pregnancy is associated with adverse consequences for children. Most recently, it has been established as a risk factor for developmental psychopathology, specifically Conduct Disorder (CD). Although this association has been shown to be robust, developmental pathways from exposure to CD have not been established. We examined how prenatal exposure to cigarettes interacts with child and family factors to increase risk of CD symptoms in a longitudinal study of 10-year-old urban, African-American youth (N = 77). The effects of prenatal exposure at school age were moderated by child sex. Boys whose mothers smoked during pregnancy were significantly more likely to develop CD symptoms, but exposure did not increase risk in girls. A similar trend was found during infancy: prenatal smoking was associated with low sociability/negative emotionality only for boys. The effects of smoking during pregnancy were also moderated by the quality of the early caregiving environment. Exposed boys whose mothers were unresponsive during infancy were at increased risk of CD symptoms, but exposed boys with early responsive mothers were not. Prospective studies, with developmentally based measures of behavior across time, are critical for further elucidating pathways from prenatal exposure to cigarettes to the development of clinical disorder. The identification of a potentially modifiable, prenatal risk factor for early onset developmental psychopathology has important implications for prevention.     

Birth weight in offspring of mothers with polycystic ovarian syndrome

BACKGROUND: A relationship between reduced fetal growth and the polycystic ovary syndrome (PCOS) has been proposed in girls with PCOS. However, the birth weight in the offspring of PCOS mothers has not been systematically investigated. The aim of this study was to establish the birth weight of newborns of mothers with PCOS and to compare it with a control group of newborns of normal women matched by age and weight at the beginning of pregnancy. METHODS: The birth weight of 47 infants born from singleton pregnancies in women with well-documented PCOS was compared with 180 infants born from singleton pregnancies in healthy controls. RESULTS: The prevalence of small for gestational age (SGA) infants was significantly higher in the PCOS group compared to the control group (12. 8% versus 2.8%, respectively, P<0.02). Moreover, SGA infants born to PCOS mothers were smaller than those born to control mothers (P<0.05). The prevalence of large for gestational age infants (LGA) was similar in both groups, but birth length of LGA newborns was greater in PCOS women than controls (P<0.05). CONCLUSIONS: PCOS mothers showed a significantly higher prevalence of SGA newborns which cannot be completely attributed to pregnancy complications, and seems to be more related to the PCOS condition of the mother.     

Italian standards for crown-heel length and head circumference at birth

Cross-sectional standards for crown-heel length and head circumference at birth are presented, based on 16336 reference neonates born in six towns in North, Central and South Italy, between 1973 and 1981, and included in a multicentre survey of perinatal preventive medicine. Single liveborn infants, with no congenital anomalies, of mothers with no risk factor for pregnancy, such as diabetes, hypertension, vaginal bleeding, previous stillbirths or abortions, were considered as the reference group. These were treated as a sample drawn from one reference population, regardless of birthplace. Large differences in social and environmental conditions typical of the six towns appeared to exert negligible effects on the reference neonates' dimensions. Unlike intrauterine growth charts published previously in Italy, these standards apply to any Italian neonate born between 32 and 43 weeks of gestation. Cross-sectional standards derived from anthropometric measurements of infants having different gestational ages should be regarded mainly as a tool for assessing size and proportion of neonates, rather than as growth charts for monitoring fetal development. This latter task should be fulfilled by longitudinal growth charts: to date, intrauterine ultrasonography has not provided data sufficient to replace cross-sectional standards.     

Perinatal factors and atopic disease in childhood

Background Recent work has suggested possible linkages between perinatal factors and notably, head circumference and risks of subsequent atopic illness. Objective To examine the linkages between perinatal factors and risks of atopic conditions in a birth cohort of New Zealand children studied to the age of 16. Methods Measures of atopic illness including asthma, eczema, and other allergies were assessed prospectively during the course of a 16 year longitudinal study of a birth cohort of 1265 New Zealand children. In the initial stage of this research, measures of perinatal variables including birthweight, gestational age, head circumference and length at birth were obtained from hospital record data. Results Children with head circumference at birth of 37 cm or greater had (unadjusted) odds of asthma that were 1.8 (P < 0.01) to 3.0 (P < 0.0001) times higher than the odds for children of lesser head circumference. However, risks of asthma were not related to other perinatal measures including birthweight, gestational age or length or ratios of these measures. There were no consistent associations between perinatal measures and other measures of childhood atopy including eczema, allergic rhinitis and other allergies. The associations between head circumference and asthma risks persisted when due allowance was made for potentially confounding social and perinatal factors. Conclusions It is concluded that large head circumference at birth may be associated with increased risks for the development of asthma. Possible explanations for the linkages between head circumference and asthma risks are considered.     

Growth charts for cri-du-chat syndrome: an international collaborative study

Low birth weight and slow growth are frequently observed in the patients with cri-du-chat syndrome. To provide a growth reference standard for children with cri-du-chat syndrome, syndrome-specific growth charts have been developed from a combination of cross-sectional and longitudinal measurements on 374 patients from North America, Italy, Australia, and the British Isles. The data were obtained from pediatric records, parent reporting, and personal examinations at national 5p- parent support group meetings in the U.S., Italy, U.K., and Australia. The growth curves include height and weight measurements for patients ages 0 to 18 years and head circumference measurements for patients ages 0 to 15 years. Birth weight was above the 5th percentile of general population in 50% of cases: mean weight 2.8 kg +/- 1.85 SD for males and 2.6 kg +/- 1.51 SD for females. Growth curve medians were usually at or below the 5th centile of reference populations throughout life. The median head circumference falls below the 2nd centile, and this change increases with age. The charts show that compared with the standard population, most children with cri-du-chat syndrome are small at birth and as they grow most, but not all, have significant microcephaly and compromised weight for age, and to a lesser extent, compromised height for age. Am. J. Med. Genet. 94:153-162, 2000.     

The importance of head growth patterns in predicting the cognitive abilities and literacy skills of small-for-gestational-age children

This study evaluated the effects of head growth compromise beginning in utero and continuing, in some cases, through the first 9 months of life on the cognitive and literacy skills of school-age small-for-gestational-age (SGA) children. Seventy-one SGA children, aged 7 to 9 years (gestational ages, 24-41 weeks) and 16 full-term appropriate-for-gestational-age control children of comparable socioeconomic backgrounds and age at testing completed tests assessing intelligence, receptive language, working memory, problem solving, visual-motor integration, phonological awareness, reading, and spelling. SGA children were subdivided into head-growth pattern groups based on their head circumference at birth and at 9 months postterm. Analyses showed that SGA children with poor prenatal and postnatal head growth had the worst outcomes, followed by those with prenatal brain compromise, but good postnatal head growth. SGA children with preserved head growth in utero as well as good head growth after birth demonstrated the best outcomes, although spelling skills were deficient relative to full-term peers. The Verbal and Full Scale IQ ratings of the SGA children who had experienced brain compromise in utero declined significantly from 5 to 8 years of age. We conclude that mild intrauterine growth retardation (IUGR) has a minimal effect on the development of cognitive or academic abilities, providing that brain growth in utero is not affected. IUGR that slows brain growth in utero impairs the acquisition of some cognitive and academic abilities, even when followed by good catch-up head growth after birth, whereas poor brain growth in utero followed by little or no catch-up head growth results in widespread impairments. Findings highlight the limits to brain plasticity and emphasize the importance of optimal prenatal and postnatal brain growth.