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Original Research |

Fetal Exposure to Maternal and Paternal Smoking and the Risks of Wheezing in Preschool ChildrenFetal Smoke Exposure and Wheezing: The Generation R Study

Liesbeth Duijts, MD, PhD; Vincent W. V. Jaddoe, MD, PhD; Ralf J. P. van der Valk, MSc; John A. Henderson, MD, PhD; Albert Hofman, MD, PhD; Hein Raat, PhD; Eric A. P. Steegers, MD, PhD; Henriëtte A. Moll, MD, PhD; Johan C. de Jongste, MD, PhD
Author and Funding Information

From the Generation R Study Group (Drs Duijts and Jaddoe and Mr van der Valk); Department of Epidemiology (Drs Duijts, Jaddoe, and Hofman and Mr van der Valk); Division of Respiratory Medicine (Drs Duijts and de Jongste and Mr van der Valk), Department of Pediatrics; Department of Pediatrics (Dr Jaddoe and Moll); Department of Public Health (Dr Raat); and Division of Obstetrics and Prenatal Medicine (Dr Steegers), Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands; and Department of Community Based Medicine (Drs Duijts and Henderson), University of Bristol, Bristol, England.

Correspondence to: Liesbeth Duijts, MD, PhD, The Generation R Study (Ae 012), Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; e-mail: l.duijts@erasmusmc.nl


For editorial comment see page 839

Funding/Support: The Generation R Study is made possible by financial support from the Erasmus Medical Center; Erasmus University; The Netherlands Organization for Health Research and Development; The Netherlands Organisation for Scientific Research; the Ministry of Health, Welfare and Sport; and the Ministry of Youth and Families. Funding also was received from a European Respiratory Society/Marie Curie Joint Research Fellowship [MC 1226-2009 to Dr Duijts] under grant agreement RESPIRE, PCOFUND-GA-2008-229571 and from the seventh framework programme, project CHICOS [HEALTH-F2-2009-241504 to Dr Duijts]. Additional grants were received from The Netherlands Organization for Health Research and Development [ZonMw 90700303, 916.10159 to Dr Jaddoe].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(4):876-885. doi:10.1378/chest.11-0112
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Background:  Previous studies have suggested that fetal smoke exposure is associated with increased risks of wheezing during childhood. The underlying pathways are unknown. We examined the associations of parental smoking during pregnancy with wheezing in preschool children and whether these associations are explained by postnatal smoke exposure or small for gestational age at birth.

Methods:  This study was embedded in a population-based prospective cohort study. Parental smoking was prospectively assessed by questionnaires. Wheezing was reported at 1 to 4 years. Small for gestational age at birth was available from registries. The analyses were based on 4,574 subjects.

Results:  Maternal smoking during the first trimester only was not associated with wheezing. Continued maternal smoking in pregnancy was associated with the risk of wheezing at 1 to 4 years (P for trends < .05). The strongest effect estimates were observed for frequent wheezing (four or more episodes of wheezing per year) until age 3 years (OR [95% CI]: age 1,1.64 [1.12-2.40]; age 2, 1.64 [1.01-2.64]; age 3, 2.19 [1.24-3.86]). Among children of nonsmoking mothers, fetal exposure to paternal smoking was not consistently associated with the risks of wheezing. The associations of continued maternal smoking during pregnancy with wheezing symptoms were independent of postnatal smoke exposure or small for gestational age at birth.

Conclusions:  Fetal exposure to continued maternal smoking is associated with increased risks of wheezing in preschool children. Further research is needed to explore the effects of paternal smoking. Diminishing maternal smoking before conception or in early pregnancy is likely to have the greatest impact on reducing childhood wheezing.

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