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Maternal smoking during pregnancy links to childhood blood pressure through birth weight and body mass index: NHANES 1999–2018

Journal of Human Hypertension volume 38, pages 134–139 (2024)Cite this article

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Abstract

Maternal smoking during pregnancy (MSDP) is associated with lower birth weight, childhood obesity, and elevated blood pressure (BP) in offspring. We aimed to examine whether birth weight and body mass index (BMI) mediate the effect of MSDP on BP in children. The study included 14,713 children aged 8 to 15 years from the National Health and Nutrition Examination Surveys from 1999 to 2018. General third-variable models were used to examine the mediating effects of birth weight and BMI on the association of MSDP with BP. A total of 1928 (13.1%) children were exposed to MSDP. MSDP was associated with reduced birth weight (p < 0.001), increased BMI (p < 0.001), and elevated systolic BP (p = 0.005). MSDP was not associated with systolic BP after adjustment for birth weight and BMI z-score (p = 0.875), with 95.0% of the effect of MSDP on BP mediated by birth weight (39.1%) and BMI (55.9%). In conclusion, lower birth weight and increased obesity measures mediate the adverse effects of MSDP on BP in children. These findings provide novel mechanistic insight into the adverse effect of MSDP on BP in children and have implications for preventing hypertension in later life.

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Fig. 1: Birth weight by month of smoking cessation during pregnancy.
Fig. 2: Mediation analysis results with maternal smoking as the exposure (X), systolic blood pressure (SBP) as the outome (Y), and BMIz and birth weight as mediators (M).

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Data availability

Data used in the current study are publicly available at https://wwwn.cdc.gov/Nchs/Nhanes/.

References

  1. Barker DJ, Gluckman PD, Godfrey KM, Harding JE, Owens JA, Robinson JS. Fetal nutrition and cardiovascular disease in adult life. Lancet. 1993;341:938–41.

    Article  PubMed  CAS  Google Scholar 

  2. Li S, Chen W, Srinivasan SR, Bond MG, Tang R, Urbina EM, et al. Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study. JAMA. 2003;290:2271–6.

    Article  PubMed  CAS  Google Scholar 

  3. Fernandez-Twinn DS, Hjort L, Novakovic B, Ozanne SE, Saffery R. Intrauterine programming of obesity and type 2 diabetes. Diabetologia. 2019;62:1789–801.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Philips EM, Santos S, Trasande L, Aurrekoetxea JJ, Barros H, von Berg A, et al. Changes in parental smoking during pregnancy and risks of adverse birth outcomes and childhood overweight in Europe and North America: An individual participant data meta-analysis of 229,000 singleton births. PLoS Med. 2020;17:e1003182.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cabral M, Fonseca MJ, Gonzalez-Beiras C, Santos AC, Correia-Costa L, Barros H. Maternal smoking: a life course blood pressure determinant? Nicotine Tob Res. 2018;20:674–80.

    Article  PubMed  Google Scholar 

  6. Hogberg L, Cnattingius S, Lundholm C, D’Onofrio BM, Langstrom N, Iliadou AN. Effects of maternal smoking during pregnancy on offspring blood pressure in late adolescence. J Hypertens. 2012;30:693–9.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cupul-Uicab LA, Skjaerven R, Haug K, Melve KK, Engel SM, Longnecker MP. In utero exposure to maternal tobacco smoke and subsequent obesity, hypertension, and gestational diabetes among women in the MoBa cohort. Environ Health Perspect. 2012;120:355–60.

    Article  PubMed  CAS  Google Scholar 

  8. Jacobs DR Jr, Woo JG, Sinaiko AR, Daniels SR, Ikonen J, Juonala M, et al. Childhood cardiovascular risk factors and adult cardiovascular events. N Engl J Med. 2022;386:1877–88.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Raitakari OT, Juonala M, Kähönen M, Taittonen L, Laitinen T, Mäki-Torkko N, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA. 2003;290:2277–83.

    Article  PubMed  CAS  Google Scholar 

  10. Räisänen S, Sankilampi U, Gissler M, Kramer MR, Hakulinen-Viitanen T, Saari J, et al. Smoking cessation in the first trimester reduces most obstetric risks, but not the risks of major congenital anomalies and admission to neonatal care: a population-based cohort study of 1,164,953 singleton pregnancies in Finland. J Epidemiol Community Health. 2014;68:159–64.

    Article  PubMed  Google Scholar 

  11. McCowan LM, Dekker GA, Chan E, Stewart A, Chappell LC, Hunter M, et al. Spontaneous preterm birth and small for gestational age infants in women who stop smoking early in pregnancy: prospective cohort study. BMJ. 2009;338:b1081.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Harris HR, Willett WC, Michels KB. Parental smoking during pregnancy and risk of overweight and obesity in the daughter. Int J Obes (Lond). 2013;37:1356–63.

    Article  PubMed  CAS  Google Scholar 

  13. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140:e20171904.

    Article  PubMed  Google Scholar 

  14. Hales CM, Freedman DS, Akinbami L, Wei R, Ogden CL. Evaluation of alternative body mass index (BMI) metrics to monitor weight status in children and adolescents with extremely high BMI using CDC BMI-for-age growth charts. Vital- Health Stat. 2022;1:1–42.

    Google Scholar 

  15. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51:1173–82.

    Article  PubMed  CAS  Google Scholar 

  16. VanderWeele TJ. Mediation analysis: a practitioner’s guide. Annu Rev Public Health. 2016;37:17–32.

    Article  PubMed  Google Scholar 

  17. MacKinnon DP, Krull JL, Lockwood CM. Equivalence of the mediation, confounding and suppression effect. Prev Sci. 2000;1:173–81.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. MacKinnon DP, Lockwood CM, Hoffman JM, West SG, Sheets V. A comparison of methods to test mediation and other intervening variable effects. Psychol Methods. 2002;7:83–104.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Geerts CC, Grobbee DE, van der Ent CK, de Jong BM, van der Zalm MM, van Putte-Katier N, et al. Tobacco smoke exposure of pregnant mothers and blood pressure in their newborns: results from the wheezing illnesses study Leidsche Rijn birth cohort. Hypertension. 2007;50:572–8.

    Article  PubMed  CAS  Google Scholar 

  20. Li L, Peters H, Gama A, Carvalhal MI, Nogueira HG, Rosado-Marques V, et al. Maternal smoking in pregnancy association with childhood adiposity and blood pressure. Pediatr Obes. 2016;11:202–9.

    Article  PubMed  CAS  Google Scholar 

  21. Chen W, Srinivasan SR, Berenson GS. Amplification of the association between birthweight and blood pressure with age: the Bogalusa Heart Study. J Hypertens. 2010;28:2046–52.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Hua Y, Wang F, Zhang T, Zhang H, Chen W, Shen W, et al. Relation of birth weight to heart rate in childhood, adolescence, and adulthood (from the Bogalusa Heart Study). Am J Cardiol. 2016;118:828–32.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Wang F, Hua Y, Whelton PK, Zhang T, Fernandez CA, Zhang H, et al. Relationship between birth weight and the double product in childhood, adolescence, and adulthood (from the Bogalusa Heart Study). Am J Cardiol. 2017;120:1016–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Beratis NG, Panagoulias D, Varvarigou A. Increased blood pressure in neonates and infants whose mothers smoked during pregnancy. J Pediatr. 1996;128:806–12.

    Article  PubMed  CAS  Google Scholar 

  25. Lambers DS, Clark KE. The maternal and fetal physiologic effects of nicotine. Semin Perinatol. 1996;20:115–26.

    Article  PubMed  CAS  Google Scholar 

  26. Ion R, Bernal AL. Smoking and preterm birth. Reprod Sci. 2015;22:918–26.

    Article  PubMed  CAS  Google Scholar 

  27. Li MD, Parker SL, Kane JK. Regulation of feeding-associated peptides and receptors by nicotine. Mol Neurobiol. 2000;22:143–65.

    Article  PubMed  CAS  Google Scholar 

  28. Fleisch AF, Rifas-Shiman SL, Rokoff LB, Hivert MF, Mantzoros CS, Oken E. Associations of maternal prenatal smoking with umbilical cord blood hormones: the Project Viva cohort. Metabolism. 2017;72:18–26.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Morales E, Vilahur N, Salas LA, Motta V, Fernandez MF, Murcia M, et al. Genome-wide DNA methylation study in human placenta identifies novel loci associated with maternal smoking during pregnancy. Int J Epidemiol. 2016;45:1644–55.

    Article  PubMed  Google Scholar 

  30. Cardenas A, Lutz SM, Everson TM, Perron P, Bouchard L, Hivert MF. Mediation by placental DNA methylation of the association of prenatal maternal smoking and birth weight. Am J Epidemiol. 2019;188:1878–86.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Koshy G, Delpisheh A, Brabin BJ. Dose response association of pregnancy cigarette smoke exposure, childhood stature, overweight and obesity. Eur J Public Health. 2011;21:286–91.

    Article  PubMed  Google Scholar 

  32. Joubert BR, Felix JF, Yousefi P, Bakulski KM, Just AC, Breton C, et al. DNA methylation in newborns and maternal smoking in pregnancy: Genome-wide consortium meta-analysis. Am J Hum Genet. 2016;98:680–96.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Richmond RC, Simpkin AJ, Woodward G, Gaunt TR, Lyttleton O, McArdle WL, et al. Prenatal exposure to maternal smoking and offspring DNA methylation across the lifecourse: findings from the Avon Longitudinal Study of Parents and Children (ALSPAC). Hum Mol Genet. 2015;24:2201–17.

    Article  PubMed  CAS  Google Scholar 

  34. Parmar P, Lowry E, Cugliari G, Suderman M, Wilson R, Karhunen V, et al. Association of maternal prenatal smoking GFI1-locus and cardio-metabolic phenotypes in 18,212 adults. EBioMedicine. 2018;38:206–16.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  35. Das M, Sha J, Hidalgo B, Aslibekyan S, Do AN, Zhi D, et al. Association of DNA methylation at CPT1A locus with metabolic syndrome in the Genetics of Lipid Lowering Drugs and Diet Network (GOLDN) Study. PLoS One. 2016;11:e0145789.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Oken E, Levitan EB, Gillman MW. Maternal smoking during pregnancy and child overweight: systematic review and meta-analysis. Int J Obes (Lond). 2008;32:201–10.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

We thank Nicole K. Trower for her help with converting BP to age-, sex-, and height-specific z-scores. We also thank Kristen Griffin and Martin Cozza for their help with the editing of the manuscript.

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Authors and Affiliations

  1. Children’s Minnesota Research Institute, Children’s Minnesota, Minneapolis, MN, USA

    Shengxu Li & Dave Watson

  2. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Chao Cao

  3. Department of Cancer Epidemiology and Prevention Research, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada

    Lin Yang

  4. Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Lin Yang

  5. HealthPartners Institute, Minneapolis, MN, USA

    Elyse O. Kharbanda

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Contributions

S.L. and E.O.C. conceptualized the study. S.L. performed the data analysis and wrote the first draft. C.C., D.W., L.Y., and E.O.K. provided critical comments and edited the manuscript. All authors approved the contents of the manuscript.

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Correspondence to Shengxu Li or Elyse O. Kharbanda.

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The authors declare no competing interests.

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The NCHS Institutional Review Board reviewed and approved all study protocols. Written consent was obtained from parents or legal guardians.

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Li, S., Cao, C., Watson, D. et al. Maternal smoking during pregnancy links to childhood blood pressure through birth weight and body mass index: NHANES 1999–2018. J Hum Hypertens 38, 134–139 (2024). https://doi.org/10.1038/s41371-023-00865-3

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