Am J Perinatol 2021; 38(03): 218-223
DOI: 10.1055/s-0040-1715845
SMFM Fellowship Series Article

Prenatal Tobacco Exposure and Childhood Neurodevelopment among Infants Born Prematurely

Lindsay S. Robbins
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Christina T. Blanchard
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Rachel G. Sinkey
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Stacy L. Harris
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Alan T. Tita
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Lorie M. Harper
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations
Funding None.

Abstract

Objective Nicotine is an established neuroteratogen, and prenatal tobacco exposure alters the structure of the developing nervous system. An association between prenatal tobacco exposure and impaired neurologic function is less well established. We examine the association between prenatal tobacco exposure and childhood neurodevelopment among infants born preterm.

Study Design Secondary analysis of a multicenter randomized controlled trial assessing the benefits of magnesium sulfate for the prevention of cerebral palsy in preterm infants. Women were included if they delivered a singleton and nonanomalous infant before 37 weeks. Exposure was any self-reported prenatal tobacco use. Primary outcome was the original trial composite outcome of moderate or severe cerebral palsy at 2 years of age, or stillbirth, or infant death by 1 year of age. Secondary outcomes included components of the composite and mild cerebral palsy at 2 years, Bayley Scales of Infant Development II motor and mental scores, death before two years, and use of auditory aids or corrective lenses. Multivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) with 95% confidence intervals.

Results Of 1,826 women included, 503 (27.5%) used tobacco. Tobacco users were more likely to be older, unmarried, and white; have a prior preterm birth; have received no prenatal care; and to use illicit drugs or alcohol. Gestational age at delivery, betamethasone exposure, and magnesium exposure were not different between groups. There were no differences in the composite primary outcome or in rates of cerebral palsy by tobacco use. Moderate developmental delay was more common among tobacco exposed in bivariate but not adjusted analysis (20.5 vs. 15.9%, p = 0.035). In adjusted analysis, tobacco exposure was associated with increased use of corrective lenses (5.0 vs. 2.9%, aOR: 2.28, 95% confidence interval: 1.28–4.07).

Conclusion Prenatal tobacco exposure is not associated with neurodevelopmental impairment in infants born preterm. However, tobacco exposure may be associated with impaired vision.

Key Points

  • Tobacco exposure is not associated with impaired neurodevelopment in this preterm population.

  • Prenatal tobacco exposure is associated with increased need for corrective lenses.

  • Tobacco use in pregnancy may be a risk factor for poorer visual acuity in children.

Note

This study was conducted in Birmingham, Alabama, United States. This paper was presented as an oral presentation (Abstract No. 13) at the SMFM 39th Annual Pregnancy Meeting in Las Vegas, NV, held on February 11–16, 2019.




Publication History

Received: 30 April 2020

Accepted: 21 July 2020

Article published online:
30 August 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Kirby RS. A commentary on maternal smoking during pregnancy: the story behind the trends. Public Health Rep 2018; 133 (06) 635-636
  • 2 Hansen AR, Akomolafe TO, McGalliard Z, Belle-Isle L, Zhang J. Striving to meet Healthy People 2020 objectives: trend analysis of maternal smoking. Public Health Rep 2018; 133 (06) 644-649
  • 3 Dietz PM, England LJ, Shapiro-Mendoza CK, Tong VT, Farr SL, Callaghan WM. Infant morbidity and mortality attributable to prenatal smoking in the U.S. Am J Prev Med 2010; 39 (01) 45-52
  • 4 Herrmann M, King K, Weitzman M. Prenatal tobacco smoke and postnatal secondhand smoke exposure and child neurodevelopment. Curr Opin Pediatr 2008; 20 (02) 184-190
  • 5 U.S. Department of Health and Human Services. The health consequences of smoking: 50 years of progress: a report of the surgeon general. Atlanta, GA: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014
  • 6 Roza SJ, Verburg BO, Jaddoe VW. et al. Effects of maternal smoking in pregnancy on prenatal brain development. The Generation R Study. Eur J Neurosci 2007; 25 (03) 611-617
  • 7 Vohr BR, Stephens BE, Higgins RD. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Are outcomes of extremely preterm infants improving? Impact of Bayley assessment on outcomes. J Pediatr 2012; 161 (02) 222-8.e3
  • 8 Leung MP, Thompson B, Black J, Dai S, Alsweiler JM. The effects of preterm birth on visual development. Clin Exp Optom 2018; 101 (01) 4-12
  • 9 Rouse DJ, Hirtz DG, Thom E. et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 2008; 359 (09) 895-905
  • 10 Eskenazi B, Castorina R. Association of prenatal maternal or postnatal child environmental tobacco smoke exposure and neurodevelopmental and behavioral problems in children. Environ Health Perspect 1999; 107 (12) 991-1000
  • 11 Ernst M, Moolchan ET, Robinson ML. Behavioral and neural consequences of prenatal exposure to nicotine. J Am Acad Child Adolesc Psychiatry 2001; 40 (06) 630-641
  • 12 Morris CV, DiNieri JA, Szutorisz H, Hurd YL. Molecular mechanisms of maternal cannabis and cigarette use on human neurodevelopment. Eur J Neurosci 2011; 34 (10) 1574-1583
  • 13 Chatterton Z, Hartley BJ, Seok MH. et al. In utero exposure to maternal smoking is associated with DNA methylation alterations and reduced neuronal content in the developing fetal brain. Epigenetics Chromatin 2017; 10 (04) 4
  • 14 Smith AM, Dwoskin LP, Pauly JR. Early exposure to nicotine during critical periods of brain development: mechanisms and consequences. J Pediatr Biochem 2010; 1 (02) 125-141
  • 15 El Marroun H, Schmidt MN, Franken IH. et al. Prenatal tobacco exposure and brain morphology: a prospective study in young children. Neuropsychopharmacology 2014; 39 (04) 792-800
  • 16 Pueyo V, Güerri N, Oros D. et al. Effects of smoking during pregnancy on the optic nerve neurodevelopment. Early Hum Dev 2011; 87 (05) 331-334
  • 17 Polańska K, Jurewicz J, Hanke W. Smoking and alcohol drinking during pregnancy as the risk factors for poor child neurodevelopment: a review of epidemiological studies. Int J Occup Med Environ Health 2015; 28 (03) 419-443
  • 18 Chen R, Clifford A, Lang L, Anstey KJ. Is exposure to secondhand smoke associated with cognitive parameters of children and adolescents?--a systematic literature review. Ann Epidemiol 2013; 23 (10) 652-661
  • 19 Ediger K, Hasan SU, Synnes A. et al; Canadian Neonatal Network, Canadian Neonatal Follow-Up Network. Maternal smoking and neurodevelopmental outcomes in infants <29 weeks gestation: a multicenter cohort study. J Perinatol 2019; 39 (06) 791-799
  • 20 Walsh RA, Redman S, Adamson L. The accuracy of self-report of smoking status in pregnant women. Addict Behav 1996; 21 (05) 675-679
  • 21 McDonald SD, Perkins SL, Walker MC. Correlation between self-reported smoking status and serum cotinine during pregnancy. Addict Behav 2005; 30 (04) 853-857
  • 22 Kvalvik LG, Nilsen RM, Skjærven R. et al. Self-reported smoking status and plasma cotinine concentrations among pregnant women in the Norwegian Mother and Child Cohort Study. Pediatr Res 2012; 72 (01) 101-107