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Míguez MC, Pereira B. Effects of active and/or passive smoking during pregnancy and the postpartum period. An Pediatr (Barc) 2021; 95:222-232. [PMID: 34556446 DOI: 10.1016/j.anpede.2020.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 07/28/2020] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Tobacco smoking may cause adverse effects during pregnancy and postpartum. The aim of this study was to evaluate several repercussions of active and/or passive smoking by the mother at home, during pregnancy, at delivery, as well as for the newborn baby and breastfeeding, including the effect of quitting smoking in the first trimester of pregnancy. METHODS A prospective longitudinal study was carried out with a sample of 800 pregnant women. Four evaluations were made: first and third trimester of pregnancy, and 2 and 6/8 months postpartum. Sociodemographic, obstetric, health and tobacco consumption details were collected, with biochemical tests being performed to confirm the self-reported abstinence. RESULTS Being an active and passive smoker predicted suffering complications in pregnancy (OR 2.50; 95% CI; 1.42-4.35) and delivery (OR 3.10; 95% CI; 1.75-5.51), and also tended not to breastfeed (OR 2.44; 95% CI; 1.35-4.42). Being an active smoker predicted complications at childbirth (OR 5.58; 95% CI; 2.64-7.77), for the baby (OR 3.77; 95% CI; 1.53-9.36) and not breastfeeding at 2 (OR 25.73; 95% CI; 11.95-55.40), and 6/8 months postpartum (OR 6.61; 95% CI; 3.21-13.58). Being a passive smoker reduces the intend to breastfeed (OR 1.81; 95% CI; 1.11-2.95), and the practice of breastfeeding at 2 months postpartum (OR 1.94; 95% CI; 1.11-3.37). Women who quit smoking are less likely to suffer complications in pregnancy and childbirth, and are more likely to attend antenatal and breastfeeding classes, and to have babies with higher birth weight. CONCLUSIONS Active and passive tobacco consumption has significant implications during pregnancy and postpartum period. Smoking cessation at the beginning of pregnancy reverses much of these effects.
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Affiliation(s)
- M Carmen Míguez
- Departamento de Psicología Clínica y Psicobiología, Facultad de Psicología, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| | - Beatriz Pereira
- Departamento de Psicología Clínica y Psicobiología, Facultad de Psicología, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Yu P, Jiang Y, Zhou L, Li K, Xu Y, Meng F, Zhou Y. Association between pregnancy intention and smoking or alcohol consumption in the preconception and pregnancy periods: A systematic review and meta-analysis. J Clin Nurs 2021; 31:1113-1124. [PMID: 34459054 DOI: 10.1111/jocn.16024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 12/16/2022]
Abstract
AIMS To investigate the association between pregnancy intention and smoking or alcohol consumption in preconception and pregnancy periods. BACKGROUND Suboptimal lifestyle such as smoking and alcohol consumption can lead to devastating outcomes on the maternal and foetus. Pregnancy intention exerts a significant effect on promoting healthy lifestyle behaviours. However, no reliable evidences confirmed pregnancy intention was associated with smoking and alcohol consumption before and during pregnancy. DESIGN Systematic review and meta-analysis. METHODS We performed a comprehensive search from databases including PubMed, Cochrane, Web of Science, IEEE Xplore, MEDLINE, ProQuest and Scopus from the inception of these databases up to November, 2020. All eligible studies exploring the association between pregnancy intention and smoking or alcohol consumption were included. The fixed- or random effect pooled measure was used to estimate the odds ratio (OR) or risk ratio (RR) and 95% CI. In addition, the PRISMA checklist was used in this meta-analysis. RESULTS A total of 23 studies were included in this systematic review and meta-analysis. During pregnancy, the findings suggested that women with unplanned pregnancy were 68% more likely to consume cigarettes (OR = 1.68, 95% CI = 1.44-1.95) and 44% more likely to consume alcohol (OR = 1.44, 95% CI = 1.15-1.81) than those women with planned pregnancy. Meanwhile, during preconception, women with unplanned pregnancy were 30% more likely to consume cigarettes (OR = 1.30, 95% CI = 1.10-1.53) and 20% more likely to consume alcohol (OR = 1.20, 95% CI = 1.01-1.42) than those women with planned pregnancy. CONCLUSION The findings suggested that women with unplanned pregnancy were more likely to follow unhealthy behaviours such as smoking and alcohol consumption before and during pregnancy. Health professionals should consider the women's desire for pregnancy to decrease preconception and pregnancy smoking or alcohol consumption in future studies. RELEVANCE OF CLINICAL PRACTICE Pregnancy intention is the key determinant of smoking and alcohol consumption during preconception and pregnancy periods. Offering effective contraception in primary healthcare setting could prevent unplanned pregnancy. Meanwhile, popularising minimal alcohol consumption and comprehensive smoke-free legislation would be beneficial to improve reproductive outcomes.
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Affiliation(s)
- Pengli Yu
- School of Nursing, Qingdao University, Qingdao, China
| | - Yunxia Jiang
- School of Nursing, Qingdao University, Qingdao, China
| | - Lixue Zhou
- School of Nursing, Qingdao University, Qingdao, China
| | - Kuinan Li
- School of Nursing, Qingdao University, Qingdao, China
| | - Yanhong Xu
- School of Nursing, Qingdao University, Qingdao, China
| | - Fei Meng
- School of Nursing, Qingdao University, Qingdao, China
| | - Yunping Zhou
- School of Nursing, Qingdao University, Qingdao, China
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Míguez MC, Pereira B. [Effects of active and/or passive smoking during pregnancy and the postpartum period]. An Pediatr (Barc) 2020; 95:S1695-4033(20)30288-5. [PMID: 33041241 DOI: 10.1016/j.anpedi.2020.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/11/2020] [Accepted: 07/28/2020] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Tobacco smoking may cause adverse effects during pregnancy and postpartum. The aim of this study was to evaluate several repercussions of active and/or passive smoking by the mother at home, during pregnancy, at delivery, as well as for the new born baby and breastfeeding, including the effect of quitting smoking in the first trimester of pregnancy. METHODS A prospective longitudinal study was carried out with a sample of 800 pregnant women. Four evaluations were made: first and third trimester of pregnancy, and 2 and 6/8 months postpartum. Sociodemographic, obstetric, health and tobacco consumption information was collected, with biochemical tests being performed to confirm the self-reported abstinence. RESULTS Being an active and passive smoker predicted suffering complications in pregnancy (OR 2.50; 95% CI; 1.42-4.35) and delivery (OR 3.10; 95% CI; 1.75-5.51), and also intend not to breastfeed (OR 2.44; 95% CI; 1.35-4.42). Being an active smoker predicted complications at childbirth (OR 5.58; 95% CI; 2.64-7.77), for the baby (OR 3.77; 95% CI; 1.53-9.36) and not breastfeeding at 2 (OR 25.73; 95% CI; 11.95-55.40), and 6/8 months postpartum (OR 6.61; 95% CI; 3.21-13.58). Being a passive smoker reduces the intention to breastfeed (OR 1.81; 95% CI; 1.11-2.95), and the practice of breastfeeding at 2 months postpartum (OR 1.94; 95% CI; 1.11-3.37). Women who quit smoking are less likely to suffer complications in pregnancy and childbirth, and are more likely to attend antenatal and breastfeeding classes, and to have babies with higher birth weight. CONCLUSIONS Active and passive tobacco consumption has significant implications during pregnancy and postpartum period. Smoking cessation at the beginning of pregnancy reverses much of these effects.
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Affiliation(s)
- M Carmen Míguez
- Departamento de Psicología Clínica y Psicobiología, Facultad de Psicología, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, España.
| | - Beatriz Pereira
- Departamento de Psicología Clínica y Psicobiología, Facultad de Psicología, Universidade de Santiago de Compostela, Santiago de Compostela, A Coruña, España
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Ueda K, Kitano N, Suzuki K. Description of Maternal Smoking Status Before and After Pregnancy: A Longitudinal, Community-Based Cohort Study. J Epidemiol 2020; 30:295-300. [PMID: 31474674 PMCID: PMC7280056 DOI: 10.2188/jea.je20180187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Maternal smoking during pregnancy is a major risk for adverse perinatal outcomes, as well as children’s health status. Thus, it is important to describe maternal smoking status during pregnancy and child-rearing to devise better intervention strategies. However, there have been no longitudinal studies to describe the status. Thus, in this study, we aimed to describe maternal smoking status during pregnancy and child-rearing based on population-based maternal and child health information. Moreover, we explored the factors associated with maternal smoking relapse after delivery. Methods We performed a survey of 1,220 mothers in a Japanese rural area who responded to a questionnaire upon registration of their pregnancies. When their children received health checkups at 4, 18, and 36 months of age, maternal smoking status was also surveyed. We then performed multiple logistic regression analysis to explore factors associated with maternal smoking relapse after delivery. Results Ultimately, the total number of mothers with data available for longitudinal analysis was 727 (59.6%). At the time of pregnancy registration, there were 74 current smokers (10.2%) and 176 former smokers (24.2%). Among them, 59 (33.5%) relapsed after delivery. Under 28 years of maternal age at pregnancy registration (OR 2.6; 95% CI, 1.2–5.4) was associated with maternal smoking relapse after delivery. Conclusions Longitudinal analyses showed that about 60% of mothers who smoked before and after delivery failed smoking cessation. In addition, younger mothers were significantly likely to relapse smoking after delivery.
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Affiliation(s)
| | - Naomi Kitano
- Research Center for Community Medicine and Department of Public Health, School of Medicine, Wakayama Medical University
| | - Kohta Suzuki
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine
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Mbarek H, van Beijsterveldt CEM, Jan Hottenga J, Dolan CV, Boomsma DI, Willemsen G, Vink JM. Association Between rs1051730 and Smoking During Pregnancy in Dutch Women. Nicotine Tob Res 2020; 21:835-840. [PMID: 29228387 DOI: 10.1093/ntr/ntx267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/05/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The common genetic variant (rs1051730) in the 15q24 nicotinic acetylcholine receptor gene cluster CHRNA5-CHRNA3-CHRNB4 was associated with smoking quantity and has been reported to be associated also with reduced ability to quit smoking in pregnant women but results were inconsistent in nonpregnant women. The aim of this study was to explore the association between rs1051730 and smoking cessation during pregnancy in a sample of Dutch women. METHODS Data on smoking during pregnancy were available from 1337 women, who ever smoked, registered at the Netherlands Twin Register (NTR). Logistic regression was used to assess evidence for the association of rs1051730 genotype on smoking during pregnancy. In a subsample of 561 women, we investigated the influence of partner's smoking. Educational attainment and year of birth were used as covariates in both analyses. RESULTS There was evidence for a significant association between having one or more T alleles of the rs1051730 polymorphism and the likelihood of smoking during pregnancy (p = .03, odds ratio = 1.28, 95% CI = 1.02 to 1.61). However, this association attenuated when adjusting for birth cohort and educational attainment (p = .37, odds ratio = 1.12, 95% CI = 0.87 to 1.43). In the subsample, smoking spouse was highly associated with smoking during pregnancy, even when educational attainment and birth cohort were included in the model. CONCLUSIONS Our results did not support a strong association between this genetic variant and smoking during pregnancy. However, a strong association was observed with the smoking behavior of the partner, regardless of the genotype of the women. IMPLICATIONS The present study emphasizes the importance of social influences like spousal smoking on the smoking behavior of pregnant women. Further research is needed to address the role of rs1051730 genetic variant in influencing smoking cessation and the interaction with important environmental factors like the smoking behavior of the partner.
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Affiliation(s)
- Hamdi Mbarek
- Department of Biological Psychology, Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Catharina E M van Beijsterveldt
- Department of Biological Psychology, Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jouke Jan Hottenga
- Department of Biological Psychology, Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Conor V Dolan
- Department of Biological Psychology, Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Dorret I Boomsma
- Department of Biological Psychology, Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Gonneke Willemsen
- Department of Biological Psychology, Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jacqueline M Vink
- Department of Biological Psychology, Amsterdam Public Health research institute, Vrije Universiteit, Amsterdam, The Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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Míguez MC, Pereira B, Pinto TM, Figueiredo B. Continued tobacco consumption during pregnancy and women's depression and anxiety symptoms. Int J Public Health 2019; 64:1355-1365. [PMID: 31628523 DOI: 10.1007/s00038-019-01308-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/31/2019] [Accepted: 10/05/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES This study aimed to analyse depression and anxiety symptoms changes from the first to the third trimester of pregnancy in non-smokers versus quitters versus continuous smokers, and the contribution of depression and anxiety symptoms to continued tobacco consumption during pregnancy. METHODS The sample comprises 850 Spanish pregnant women (595 non-smokers, 123 quitters, and 132 continuous smokers), assessed at the first and the third trimester of pregnancy with a questionnaire concerning socio-demographic, obstetric, and tobacco consumption information, and measures of depression and anxiety. RESULTS Continuous smokers during pregnancy showed more depression and anxiety symptoms than both non-smokers and quitters and no changes from the first trimester to the third trimester of pregnancy, while both non-smokers and quitters revealed a decrease in depression and anxiety symptoms. More anxiety symptoms at the first trimester (OR 1.03) and depression symptoms at the third trimester (OR 1.14) were associated with continued smoking during pregnancy. CONCLUSIONS Anxiety and depression symptoms need to be considered to screening for women at risk of smoking during pregnancy. Future prenatal smoking cessation interventions must take into account these variables.
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Affiliation(s)
- M Carmen Míguez
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Campus Vida, 15782, Santiago de Compostela, Spain.
| | - Beatriz Pereira
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Campus Vida, 15782, Santiago de Compostela, Spain
| | - Tiago Miguel Pinto
- School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Bárbara Figueiredo
- School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
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Association between Maternal Smoking during Pregnancy and Low Birthweight: Effects by Maternal Age. PLoS One 2016; 11:e0146241. [PMID: 26795494 PMCID: PMC4721610 DOI: 10.1371/journal.pone.0146241] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 12/15/2015] [Indexed: 11/20/2022] Open
Abstract
Background Maternal smoking during pregnancy has been consistently related to low birthweight. However, older mothers, who are already at risk of giving birth to low birthweight infants, might be even more susceptible to the effects of maternal smoking. Therefore, this study aimed to examine the modified association between maternal smoking and low birthweight by maternal age. Methods Data were obtained from a questionnaire survey of all mothers of children born between 2004 and 2010 in Okinawa, Japan who underwent medical check-ups at age 3 months. Variables assessed were maternal smoking during pregnancy, maternal age, gestational age, parity, birth year, and complications during pregnancy. Stratified analyses were performed using a logistic regression model. Results In total, 92641 participants provided complete information on all variables. Over the 7 years studied, the proportion of mothers smoking during pregnancy decreased from 10.6% to 5.0%, while the prevalence of low birthweight did not change remarkably (around 10%). Maternal smoking was significantly associated with low birthweight in all age groups. The strength of the association increased with maternal age, both in crude and adjusted models. Conclusions Consistent with previous studies conducted in Western countries, this study demonstrates that maternal age has a modifying effect on the association between maternal smoking and birthweight. This finding suggests that specific education and health care programs for older smoking mothers are important to improve their foetal growth.
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Smoking Prevalence and Associated Factors as well as Attitudes and Perceptions towards Tobacco Control in Northeast China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015. [PMID: 26206569 PMCID: PMC4515736 DOI: 10.3390/ijerph120708606] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectives: The present study aimed to investigate the prevalence of smoking and environmental tobacco smoke (ETS), the associated factors of current smoking among adults, and their attitudes and perceptions towards tobacco control. Methods: A population-based cross-sectional survey was conducted in 2012 using a self-reported questionnaire. A representative sample of adults aged 18–79 years was collected in the Jilin Province of Northeast China by a multistage stratified random cluster sampling design. Descriptive data analysis was conducted, and 95% confidence intervals (CI) of prevalence/frequency were calculated to enable comparisons between the alleged differences and similarities. Multivariable logistic regressions were used to examine the risk factors associated with current smoking. Results: 21,435 adults responded to the survey (response rate: 84.9%). The overall prevalence of ever smoking, current smoking, and former smoking or smoking cessation was 39.1% (95% CI: 38.3–39.9), 31.8% (95% CI 31.1–32.6), and 7.3% (95% CI: 6.9–7.7), respectively. The proportion of ETS exposure among adult non-smokers in Jilin Province was 61.1% (95% CI: 60.1–62.1), and 23.1% (95% CI: 22.3–24.0) of the non-smokers reported daily ETS exposure. The proportion of ETS exposure at home was 33.4% (95% CI: 32.5–34.4), but the proportion of ETS exposure at restaurants was lower (6.5%) (95% CI: 6.0–7.1). More than 90% of the participants had positive attitudes and perceptions towards tobacco control, but 23.2% (95% CI: 22.5–24.0) of them did not agree with the perception of “smoking is fully quit in public places”, and almost half of the adults (49.5%) (95% CI: 48.7–50.3) did not agree with the perception of “hazards of low-tar cigarettes are equal to general cigarettes”. Conclusions: Smoking and exposure to ETS are prevalent among adults from the Jilin Province of Northeast China. Our findings suggest that tobacco control should be advocated in Northeast China. Anti-smoking campaigns and legislation should be built into the public health curriculum and government policy.
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Suzuki K. Longitudinal analyses of childhood growth: evidence from Project Koshu. J Epidemiol 2014; 25:2-7. [PMID: 25283310 PMCID: PMC4275431 DOI: 10.2188/jea.je20140130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/29/2014] [Indexed: 11/27/2022] Open
Abstract
Recently, it has been suggested that fetal and infant environments are associated with childhood and adulthood health status, specifically regarding presence of obesity and chronic diseases. This concept is known as the "Developmental Origins of Health and Disease (DOHaD) hypothesis." Thus, it is necessary to collect information about the fetal and infancy periods in order to examine the association between fetal and infancy exposures and later growth. Based on the DOHaD hypothesis, childhood growth trajectories, which were described by multilevel analysis, might be important in examining the effects of early-life environment on later-life health. The author and colleagues examined the association between maternal smoking during pregnancy and fetal/childhood growth, specifically risk of childhood obesity, by using the dataset from an ongoing prospective cohort study called "Project Koshu," which enrolled pregnant women and their children from a rural area of Japan. Children born to smoking mothers were likely to have lower birth weights and, thereafter, to show an increase in body mass index compared to children of non-smoking mothers. Differences in pubertal growth patterns by gender and childhood weight status were then examined. Growth rate and height gain trajectories were similar between genders, although pubertal growth spurts were observed earlier in girls than in boys. The overweight/obese children grew faster than did the non-overweight children in the early pubertal stages, and the non-overweight children caught up and showed greater height gains at older ages. Because Project Koshu is ongoing, further studies examining new research questions will be conducted with larger sample sizes.
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Affiliation(s)
- Kohta Suzuki
- Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Technology, University of Yamanashi
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Shinjo A, Ventura W, Koide K, Hori K, Yotsumoto J, Matsuoka R, Ichizuka K, Sekizawa A. Maternal Smoking and Placental Expression of a Panel of Genes Related to Angiogenesis and Oxidative Stress in Early Pregnancy. Fetal Diagn Ther 2014; 35:289-95. [DOI: 10.1159/000357704] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 11/29/2013] [Indexed: 11/19/2022]
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Effects of maternal cigarette smoking during pregnancy on cognitive parameters of children and young adults: a literature review. Neurotoxicol Teratol 2012; 34:560-70. [PMID: 23022448 DOI: 10.1016/j.ntt.2012.09.004] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 09/18/2012] [Accepted: 09/18/2012] [Indexed: 11/20/2022]
Abstract
The long term effects of maternal smoking during pregnancy on the cognitive development of the child are not well understood due to conflicting findings in past research. The aim of this paper was to provide an up to date, critical review of the literature to determine whether there is evidence of a relationship between tobacco smoke exposure in utero and cognitive functioning. We systematically reviewed observational studies (dated 2000-2011) that examined associations between tobacco smoke exposure in utero due to maternal smoking and performance on cognitive, intelligence, neurodevelopmental and academic tests. Eligible studies were identified through searches of Web of Knowledge, Medline, Science Direct, Google Scholar, CINAHL, EMBASE, Zetoc and Clinicaltrials.gov databases. The review found evidence of a relationship between tobacco smoke exposure in utero and reduced academic achievement and cognitive abilities independent of other variables. Maternal smoking during pregnancy may therefore be a modifiable risk factor for reduced cognitive abilities later in the life of the child. Giving up smoking during pregnancy should be initiated as early as possible to reduce the impact on the child's cognitive development.
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