CAN THO UNIVERSITY

SCHOOL OF FOREIGN LANGUAGES

DEPARTMENT OF ENGLISH LANGUAGE AND CULTURE

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THE EFFECTS OF MATERNAL

SMOKING

Can Tho, 2019

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Introduction
Tobacco smoking is a globally growing public health problem. It reduces the life
expectancy among smokers. Cigarette smoking is clearly linked to the most
common causes of death in the elderly and contributes to the morbidity and
disability associated with many chronic neurological, cardiovascular, and
pulmonary illnesses. Cigarette smoke not only affects smokers but also
contributes to the health problems of nonsmokers. Maternal smoking during
pregnancy is a strong risk factor for low birth weight (LBW). It also increases
the occurrence of preterm birth, although this effect is more attributable to fetal
growth than to preterm delivery.
Summaries
Huang, S.H., Weng, K.P., Huang, S.M., Liou, H.H., Wang, C.C., Ou, S.F., Lin,
C.C., Chien, K.J., Lin, C.C., & Wu, M.T., (2017). The effects of maternal
smoking exposure during pregnancy on postnatal outcome: A sectional study.
Journal of the Chinese Medical Association, 80, 796-802.
This study evaluate the possible association between maternal smoking during
pregnancy and offspring outcomes of birth weight, pre-term birth, remediation,
low scholastic achievement, regular smoking, attention deficit hyperactivity
disorder and conduct problems while controlling for similar behaviors in parents.
Using telephone interviews, data were collected, in 2001 and 2004, as a part of
two United States offspring of twins projects. Fathers, who were twins
participating in the Vietnam Era Twin Registry, their female spouse and their
offspring were interviewed - information on 1,342 unique pregnancies in mothers
with a history of regular smoking was utilized for these analyses. The association
between maternal smoking during pregnancy and birth weight, pre-term birth,
remediation, low scholastic achievement, regular smoking, attention deficit
hyperactivity disorder and conduct disorder while controlling for similar
behaviors in parents, was examined using regression. Maternal smoking during
pregnancy was associated with decreased birth weight, low scholastic
achievement, regular smoking and attention deficit hyperactivity disorder.

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However, the association between maternal smoking during pregnancy and
offspring attention deficit hyperactivity disorder was explained by maternal
attention deficit hyperactivity disorder. Maternal smoking during pregnancy was
also associated with earlier age of offspring initiation of smoking and onset of
regular smoking.
Balte, P., Karmaus, W., Roberts, G., Kurukulaaratchy, R., Mitchell, F., & Arshad,
H., (2016). Relationship between birth weight, maternal smoking during
pregnancy and childhood and adolescent lung function: A path analysis.
Respiratory Medicine, 121, 13-20.
In this study, Balte, P., et al performed a cohort study to investigate the
association of the amount of parental smoking during different pregnancy stages
with birth weight and the incidence of preterm delivery. They found that
maternal smoking decreased birth weight. Compared with the nonsmoking
groups, all the maternal smoking groups had higher incidences of LBW, small for
gestational age (SGA), and preterm birth infants, especially when the mothers
smoked >20 cigarettes per day. The association of paternal smoking with LBW,
SGA, and preterm birth infants was insignificant. They concluded that maternal
smoking is responsible for increased incidences of LBW and preterm delivery of
babies and, therefore, pregnant women should be advised to stop or decrease
smoking to reduce neonate morbidities. However, several important limitations
of the study must be comprehended so that it can be placed into the proper
context. These findings are partially in accordance with previous reports that
both maternal and paternal smoking is associated with lower birth weight. This
study does not specifically report the results of an intervention trial, and there is
no strong evidence to support that smoking cessation/reduction could decrease
neonatal morbidities in this study.
Surprisingly, the association of paternal smoking with LBW, SGA, and preterm
birth infants was insignificant in this study. Although the effects of paternal
smoking on SGA and LBW of their offspring remain unclear, many studies
showed that both maternal and paternal smoking are associated with lower birth
weight, with maternal smoking having a greater effect. Common to retrospective

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studies, a weakness of this study is the potential for recall bias in the self-
reported data on tobacco smoke exposures. Finally, this cohort study only reports
short-term outcome after birth. Restricted intrauterine growth has a long-term
effect on later growth and development in children. Newer studies clearly
showed that prenatal maternal smoking is associated with respiratory and ear
infections, sudden infant death syndrome, behavioral problems, and
neurocognitive deficits. Further study regarding long-term outcomes is
warranted.

Mine, T., Tanaka, T., Nakasone, T., Itokazu, T., Yamagata, Z., & Nishiwaki, Y.,
(2016). Maternal smoking during pregnancy and rapid weight gain from birth to
early infancy. Journal of Epidemiology, 27, 112-116.

In this study, we discuss the effects of maternal and paternal smoking on the
offspring during the different stages of pregnancy. Low birth weight (LBW) is
associated with increased morbidities and mortalities in neonates. Preterm
birth also leads to several complications, such as respiratory distress, feeding
intolerance, or below-normal neurodevelopment compared with term infants.
Many factors contribute to LBW and preterm birth, and one of the important
factors is prenatal exposure to smoking, such as maternal smoking and passive
smoke exposure. Maternal active smoking during pregnancy induces birth-
weight decrease and significantly increases the risk of LBW. Reduced birth
weight was found to be adversely correlated with the extent of maternal smoking
during pregnancy. Chiolero et al revealed that maternal smoking of ≥10
cigarettes/day is significantly associated with LBW, small for gestational
age (SGA), and preterm birth. However, smoking 1-9 cigarettes/day was
associated with LBW and SGA, but not preterm birth. Paternal smoking is also
an important risk factor for LBW of the offspring. Horta et al revealed that
women whose partners smoked were 1.3 times more likely to have a growth-
retarded child than women with nonsmoking partners. Although the interaction
between paternal and maternal smoking is still not evident, birth weight of
infants was found to be further reduced if both parents smoked.
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Sirvinskiene, G., Zemaitiene, N., Jusiene, R., Smigelskas, K., Veryga, A., &
Markuniene, E., (2016). Smoking during pregnancy in association with maternal
emotional well-being. Medicina, 52, 132-138.

This study assesses the effects of maternal smoking during pregnancy on child
neurodevelopment between ages 3 to 24 months. The study evaluates the
smoking effects both pooled and stratified by socioeconomic status (SES), which
is a significant predictor of smoking participation and intensity. The paper
contributes significantly to understanding the impacts of smoking as a major
maternal risk behavior on early child neurodevelopment as a form of human
capital. Previous studies of smoking effects during pregnancy on early life
neurodevelopment are limited by fairly small sample sizes and descriptive
statistical methods that do not account for unobserved confounders that may
correlate with both smoking and child neurodevelopment. Another limitation in
several studies is relying on maternal report of child developmental measures,
which may be biased. Further, previous studies of prenatal smoking effects on
child neurodevelopment in populations from less developed countries such as in
South America are rare. Such studies are essential given the comparable, and in
certain countries, higher prenatal smoking rates compared to developed
countries.

It is generally well accepted that prenatal factors such as maternal smoking,

nutrition, and body size influence fetal adaptive responses and subsequently have
significant impacts on the risk of disease throughout life. One of the mechanisms
by which smoking during pregnancy is thought to affect child neurodevelopment
is by restricting fetal access to oxygen-rich blood, leading to fetal
neurodevelopment impairments. This is thought to occur through impacting
uterine blood flow and the level of carboxyhemoglobin (hemoglobin with carbon
monoxide) in both the infant’s and mother’s blood. In addition, toxins introduced
into the mother’s body via smoking readily cross the placenta during gestation
and are absorbed easily by the developing fetus. Some of the early detrimental

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smoking effects may involve changes in brain activation that affect children’s
ability to appropriately respond to stimuli.

Conclusion

Maternal smoking is responsible for increased incidences of LBW and preterm

delivery of babies, and therefore, smoking cessation/reduction should be advised
to pregnant women to reduce morbidities in their neonates. Further studies are
needed to clarify the correlation of fetal health with passive smoking, including
exposure to environmental tobacco smoke and to other smokers in the family.
Given the importance of early child health in general and neurodevelopment
specifically for future human capital and that neurodevelopment may be
considered an early form of human capital, identifying the effects of maternal
risk behaviors during pregnancy, such as smoking, on early child
neurodevelopment becomes essential for identifying ways to improve not only
neurodevelopment but also human capital throughout life. Therefore, studying
the effects of prenatal smoking on neurodevelopment has direct implications for
identifying early determinants of human capital that can be addressed by
interventions very early in life, including during pregnancy. Identifying these
effects may allow for developing such interventions that can have positive
multiplicative lifetime effects on health and human capital. Prenatal interventions
that improve early child neurodevelopment are likely to be cost-effective and
result in large social returns due to the self-producing effects of child
developmental skills over time and their complementarity effects with
investments later in life. In other words, early child development has direct
positive (self-producing) effects on development later in life and may also
enhance the effects of later investments. For example, children who have
acquired more skills earlier in life may benefit more from later investments
compared to those who have acquired fewer skills.