Fractures in Childhood and Young Adulthood According to Maternal Smoking in Late Pregnancy. A Danish Cohort Study

Abstract

Background

Fractures account for the most frequent cause of hospitalization during childhood and numbers have increased over time. Of all fractures in childhood and young adulthood, 66% are recurrent fractures, suggesting that some people are predestined for fractures. The aim of this study was to investigate the association between maternal smoking during late pregnancy and the risk of fractures in the children.

Methods

The study included 11,082 mothers and their children from the cohort “Healthy Habits for Two” born between 1984 and 1987. Information about maternal smoking during pregnancy came from questionnaires filled out in pregnancy, while information about fractures was derived from the Danish National Patient Registry. Over a follow-up of 24 years (1994–2018), Cox regression with multiple failures was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for fractures in childhood and young adulthood according to maternal smoking in late pregnancy. Information about body mass index (BMI) and smoking status in young adulthood was included as time variant covariates.

Results

During an age span of 8–32 years, 6,420 fractures were observed. Of the mothers, 39.1% smoked during late pregnancy. Compared to children of mothers who did not smoke, children of mothers who smoked 1–9 cigarettes per day and 10+ cigarettes per day had an increased risk of fractures (HR 1.14 [CI: 1.06; 1.21] and HR 1.14 [CI: 1.07; 1.22], respectively). After adjusting for BMI and smoking status in young adulthood, the findings were slightly strengthened, showing an increased risk of fractures of 23 and 25% in children of mothers smoking 1–9 cigarettes per day and 10+ cigarettes per day, respectively.

Conclusion

Maternal smoking during late pregnancy was associated with a higher risk of fractures in the child. This result indicates that exposure to cigarette smoke in utero may play a role in lifelong bone health.

Zusammenfassung

Hintergrund

Frakturen sind nicht nur die häufigste Ursache für Krankenhauseinweisungen im Kindesalter, sondern haben im Laufe der Zeit sogar zugenommen. Tatsächlich sind 66% aller Frakturen im Kindes- und jungen Erwachsenenalter Rezidive, was darauf hindeutet, dass manche Menschen für Frakturen prädestiniert sind. Ziel dieser Studie war es, den Zusammenhang zwischen mütterlichem Rauchen während der späten Schwangerschaft und dem Frakturrisiko bei Kindern zu untersuchen.

Methoden

Die Studie inkludierte 11082 Mütter und ihre Kinder aus der Kohorte „Gesunde Gewohnheiten für Zwei“, Jahrgang 1984–1987. Die Informationen zu den mütterlichen Rauchgewohnheiten während der Schwangerschaft wurden Fragebögen entnommen, die begleitend während der Schwangerschaft ausgefüllt wurden. Die Informationen zu den Frakturen der Kinder wurden aus dem dänischen nationalen Patientenregister ergänzt. Über einen Follow-up-Zeitraum von 24 Jahren (1994–2018) wurden mittels multivariater Cox-Regression die Hazard Ratios (HR) mit 95%-Konfidenzintervall (KI) für Frakturen in der Kindheit und im jungen Erwachsenenalter entsprechend der Rauchgewohnheiten der Mutter in der späten Schwangerschaft analysiert. Als Kovariate wurden der Body-Mass-Index (BMI) und das Rauchverhalten der Kinder im jungen Erwachsenenalter verwendet.

Ergebnisse

In einer Altersspanne von 8–32 Jahren wurden 6420 Frakturen beobachtet. Von den Müttern rauchten 39,1% während der späten Schwangerschaft. Im Vergleich zu Kindern von Müttern, die nicht rauchten, hatten Kinder von Müttern, die 1–9 Zigaretten pro Tag und 10+ Zigaretten pro Tag rauchten, ein erhöhtes Frakturrisiko (HR 1,14 [KI: 1,06–1,21] bzw. 1,14 [KI: 1,07–1,22]). Nach Berücksichtigung des BMI und des Raucherstatus im jungen Erwachsenenalter wurden die Ergebnisse leicht gestärkt und zeigten ein erhöhtes Frakturrisiko von 23% bzw. 25% bei Kindern von Müttern, die 1–9 Zigaretten pro Tag bzw. 10+ Zigaretten pro Tag rauchten.

Schlussfolgerungen

Mütterliches Rauchen während der späten Schwangerschaft war mit einer erhöhten Frakturgefahr beim Kind assoziiert. Zigarettenrauchexposition des Fötus im Mutterleib spielt somit eine zentrale und negative Rolle für die lebenslange Knochengesundheit des Kindes.

Keywords

childhood fractures - maternal smoking - bone health

Schlüsselwörter

Fraktur - Knochengesundheit - mütterliches Rauchen

Publication History

Received: 18 July 2022

Accepted after revision: 31 May 2023

Article published online:
18 July 2023

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