Neonatology pp 709-716 | Cite as

Infants of Smoking Mothers

  • Roberto Paludetto
  • Letizia CapassoEmail author
  • Francesco Raimondi
Reference work entry


Maternal smoking during pregnancy represents a serious health hazard for the fetus and the neonate; its consequences may persist well into later life. Environmental tobacco smoke is also a threat to pre- and postnatal life. Although tobacco smoke contains thousands of compounds whose effects have not been fully studied, most of its detrimental effects are presumed to be mediated by nicotine. Cotinine, a nicotine metabolite, is used as a biomarker of tobacco exposure, and it has allowed an objective measure of smoke-related adverse events spanning from preterm birth, intrauterine growth retardation, and low birth weight to congenital malformations. Deficient cardiovascular and respiratory functions have also been linked to intrauterine and neonatal exposure to tobacco smoke such as an increased risk of metabolic syndrome in adulthood. Nicotine’s complex interaction with fetal and neonatal neurotransmitters induces behavioral alterations in the newborn period and may help to explain the higher incidence of SIDS and ADHD described in offspring of smoking mothers.


  1. Bahmanyar S, Montgomery SM, Weiss RJ et al (2008) Maternal smoking during pregnancy, other prenatal and perinatal factors and the risk of Legg-Calvè-Perthes disease. Pediatrics 122:e459–e464CrossRefGoogle Scholar
  2. Banderali G, Martelli A, Landi M et al (2015) Short and long term health effects of parental tobacco smoking during pregnancy and lactation: a descriptive review. J Transl Med 13:327CrossRefGoogle Scholar
  3. Been JV, Mackay DF, Millett C et al (2015) Impact of smoke-free legislation on perinatal and infant mortality: a national quasi-experimental study. Sci Rep 5:13020CrossRefGoogle Scholar
  4. Blanchard ES, Chardon K, Leke´ A (2010) In utero exposure to smoking and peripheral chemoreceptor function in preterm neonates. Pediatrics 125(3):e592–e599CrossRefGoogle Scholar
  5. Blatt K, Moore E, Chen A et al (2015) Association of reported trimester-specific smoking cessation with fetal growth restriction. Obstet Gynecol 125(6):1452–1459CrossRefGoogle Scholar
  6. Bruin JE, Gerstein HC, Holloway AC (2010) Long-term consequences of fetal and neonatal nicotine exposure: a critical review. Toxicol Sci 116(2):364–374CrossRefGoogle Scholar
  7. Chang AB, Wilson SJ, Masters IB et al (2003) Altered arousal response in infants exposed to cigarette smoke. Arch Dis Child 88:30–33CrossRefGoogle Scholar
  8. Chamberlain C, O’Mara-Eves A, Oliver S et al (2013) Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev 10:CD001055Google Scholar
  9. Cnattingius S, Akre O, Lambe M et al (2006) Will adverse pregnancy outcome influence the risk of continued smoking in the next pregnancy? Am J Obstet Gynecol 195:1680–1686CrossRefGoogle Scholar
  10. Coleman T (2008) Reducing harm from tobacco smoke exposure during pregnancy. Birth Defects Res 84:73–79CrossRefGoogle Scholar
  11. Cunningham J, Dockery DW, Speizer FE (1994) Maternal smoking during pregnancy as a predictor of lung function in children. Am J Epidemiol 139:1139–1152CrossRefGoogle Scholar
  12. Cunningham J, Dockery DW, Speizer FE (1995) Racial differences between maternal smoking during pregnancy and lung function in children. Am J Respir Crit Care Med 152:565–569CrossRefGoogle Scholar
  13. de Chazeron I, Llorca PM, Ughetto S et al (2007) Occult exposure to environmental tobacco smoke exposure. Tob Control 16:64–65CrossRefGoogle Scholar
  14. Fang F, Luo Z-C, Dejemli A et al (2015) Maternal smoking and metabolic health biomarkers in newborns. PLoS One 10(11):e0143660CrossRefGoogle Scholar
  15. Franco P, Grosswasser J, Hassid S (1999) Prenatal exposure to cigarette smoking is associated with a decrease in arousal in infants. J Pediatr 135:34–38CrossRefGoogle Scholar
  16. Fried PA, O’Connell CM (1987) A comparison of the effects of prenatal exposure to tobacco, alcohol, cannabis and caffeine on birth size and subsequent growth. Neurotoxicol Teratol 9:79–85CrossRefGoogle Scholar
  17. Geerts CC, Grobbee DE, van der Ent CK et al (2007) Tobacco smoke exposure of pregnant mothers and blood pressure in their newborns. Hypertension 50:572–578CrossRefGoogle Scholar
  18. Gunnerbeck A, Edstedt Bonamy AK, Wikstrom AK et al (2014) Maternal snuff use and smoking and the risk of oral cleft malformations – a population-based cohort study. PLoS ONE 9(1):e84715CrossRefGoogle Scholar
  19. Hanharan JP, Tager IB, Segal MR et al (1992) The effect of maternal smoking during pregnancy on early infant lung function. Am Rev Respir Dis 145:1129–1135CrossRefGoogle Scholar
  20. Harrod CS, Reynolds RM, Chasan-Taber L et al (2012) Maternal smoking during pregnancy and offspring trajectories of height and adiposity: comparing maternal and paternal associations. Int J Epidemiol 41:722–732CrossRefGoogle Scholar
  21. Harrod CS, Reynolds RM, Chasan-Taber L et al (2014) Quantity and timing of maternal prenatal smoking on neonatal body composition: the healthy start study. J Pediatr 165:707–712CrossRefGoogle Scholar
  22. Hook B, Cederblad M, Berg R (2006) Prenatal and postnatal maternal smoking as risk factors for preschool children’s mental health. Acta Paediatr 95:671–677CrossRefGoogle Scholar
  23. Jaddoe VWV, Troe EJWM, Hofman A et al (2008) Active and passive maternal smoking during pregnancy and the risks of low birthweight and preterm birth: the generation R study. Paediatr Perinat Epidemiol 22:162–171CrossRefGoogle Scholar
  24. Kannellopoulos TA, Varvarigou AA, Karatza AA et al (2007) Course of growth during the first 6 years in children exposed in utero to tobacco smoke. Eur J Pediatr 166:685–692CrossRefGoogle Scholar
  25. Kum-Nji P, Meloy L, Herrod HG (2006) Environmental tobacco smoke exposure: prevalence and mechanisms of causation of infections in children. Pediatrics 117:1745–1753CrossRefGoogle Scholar
  26. Leary SD, Smith GD, Rogers IS et al (2006) Smoking during pregnancy and offspring fat and lean mass in childhood. Obesity 14:2284–2293CrossRefGoogle Scholar
  27. Lie RT, Wilcox AJ, Taylor J et al (2008) Maternal smoking and oral clefts: the role of detoxification pathway genes. Epidemiology 19:606–615CrossRefGoogle Scholar
  28. Machaalani R, Waters KA (2008) Neuronal cell death in the sudden infant death syndrome brainstem and association with risk factors. Brain 131:218–228CrossRefGoogle Scholar
  29. Malik S, Cleves MA, Honein MA et al (2008) Maternal smoking and congenital heart defects. Pediatrics 121:e810–e815CrossRefGoogle Scholar
  30. Mansi G, Raimondi F, Pichini S et al (2002) Neonatal urinary cotinine correlates with behavioural alterations in newborns prenatally exposed to tobacco smoke. Pediatr Res 61:257–261CrossRefGoogle Scholar
  31. Maritz GS, Harding R (2011) Life-long programming implications of exposure to tobacco smoking and nicotine before and soon after birth: evidence for altered lung development. Int J Environ Res Public Health 8:875–898CrossRefGoogle Scholar
  32. Novakovic B, Ryan J, Pereira N et al (2014) Postnatal stability, tissue, and timing specific effects of AHRR methylation change in response to maternal smoking in pregnancy. Epigenetics 9(3):377–386CrossRefGoogle Scholar
  33. Oken E, Levitan EB, Gillman MW (2008) Maternal smoking during pregnancy and child overweight: systematic review and meta analysis. Int J Obes 32:201–210CrossRefGoogle Scholar
  34. Pauly JR, Slotkin TA (2008) Maternal tobacco smoking, nicotine replacement and behavioural development. Acta Paediatr 97:1331–1337CrossRefGoogle Scholar
  35. Pellegrini M, Marchei E, Rossi S et al (2007) Liquid chromatography/electrospray ionization tandem mass spectrometry assay for determination of nicotine and metabolites, caffeine and arecoline in breast milk. Rapid Commun Mass Spectrom 21:2693–2703CrossRefGoogle Scholar
  36. Pirini F, Guida E, Lawson F, Mancinelli A, Guerrero-Preston R (2015) Nuclear and mitochondrial DNA alterations in newborns with prenatal exposure to cigarette smoke. Int J Environ Res Public Health 12:1135–1155CrossRefGoogle Scholar
  37. Puig C, Garcia-Algar O, Monleon T et al (2008) A longitudinal study of environmental tobacco smoke exposure in children: parental self reports versus age dependent biomarkers. BMC Public Health 8:47–55CrossRefGoogle Scholar
  38. Schmitz M, Demarolin D, Laufer Silva T et al (2006) Smoking during pregnancy and attention-deficit/hyperactivity disorder, predominantly inattentive type: a case-control study. J Am Acad Child Adolesc Psychiatry 45:1338–1345CrossRefGoogle Scholar
  39. Shaw GM, Carmichael SM, Vollset SE et al (2009) Mid-pregnancy cotinine and risks of orofacial clefts and neural tube defects. J Pediatr 154:17–19CrossRefGoogle Scholar
  40. Simons E, To T, Moineddin R et al (2014) Maternal second-hand smoke exposure in pregnancy is associated with childhood asthma development. J Allergy Clin Immunol Pract 2(2):201–207CrossRefGoogle Scholar
  41. Stroud LR, Paster RL, Papandonatos GD et al (2009) Maternal smoking during pregnancy and newborn neurobehavior: effects at 10 to 27 days. J Pediatr 154:10–16CrossRefGoogle Scholar
  42. Sullivan PM, Dervan LA, Reiger S et al (2015) Risk of congenital heart defects in the offspring of smoking mothers: a population based study. J Pediatr 166(4):978–984CrossRefGoogle Scholar
  43. Wang C, Salam MT, Islam T et al (2008) Effects of in utero and childhood tobacco smoke exposure and beta-2 adrenergic receptor genotype on childhood asthma and wheezing. Pediatrics 122:e107–e114CrossRefGoogle Scholar
  44. Ward C, Lewis S, Coleman T (2007) Prevalence of maternal smoking and environmental tobacco smoke exposure during pregnancy and impact on birth weight: retrospective study using Millennium Cohort. BMC Public Health 7:81Google Scholar
  45. World Health Organization (2007) The tobacco atlas

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Roberto Paludetto
    • 1
  • Letizia Capasso
    • 1
    Email author
  • Francesco Raimondi
    • 1
  1. 1.Division of Neonatology, Department of Translational Medical SciencesUniversità “Federico II” di NapoliNaplesItaly

Personalised recommendations