A systematic review of maternal smoking during pregnancy and fetal measurements with meta-analysis

Miriam Abraham, Salem Alramadhan, Carmen Iniguez, Liesbeth Duijts, Vincent W.V. Jaddoe, Herman T. Den Dekker, Sarah Crozier, Keith M. Godfrey, Peter Hindmarsh, Torstein Vik, Geir W. Jacobsen, Wojciech Hanke, Wojciech Sobala, Graham Devereux, Steve Turner

Research output: Contribution to journalReview articlepeer-review

118 Citations (Scopus)
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Background Maternal smoking during pregnancy is linked to reduced birth weight but the gestation at onset of this relationship is not certain. We present a systematic review of the literature describing associations between maternal smoking during pregnancy and ultrasound measurements of fetal size, together with an accompanying meta-analysis. 

Methods Studies were selected from electronic databases (OVID, EMBASE and Google Scholar) that examined associations between maternal smoking or smoke exposure and antenatal fetal ultrasound measurements. Outcome measures were first, second or third trimester fetal measurements. 

Results There were 284 abstracts identified, 16 papers were included in the review and the meta-analysis included data from eight populations. Maternal smoking was associated with reduced second trimester head size (mean reduction 0.09 standard deviation (SD) [95% CI 0.01, 0.16]) and femur length (0.06 [0.01, 0.10]) and reduced third trimester head size (0.18SD [0.13, 0.23]), femur length (0.27 SD [0.21, 0.32]) and estimated fetal weight (0.18 SD [0.11, 0.24]). Higher maternal cigarette consumption was associated with a lower z score for head size in the second (mean difference 0.09 SD [0, 0.19]) and third (0.15 SD [0.03, 0.26]) trimesters compared to lower consumption. Fetal measurements were not reduced for those whose mothers quit before or after becoming pregnant compared to mothers who had never smoked. 

Conclusions Maternal smoking during pregnancy is associated with reduced fetal measurements after the first trimester, particularly reduced head size and femur length. These effects may be attenuated if mothers quit or reduce cigarette consumption during pregnancy.

Original languageEnglish
Article numbere0170946
Pages (from-to)1-13
Number of pages13
JournalPloS ONE
Issue number2
Publication statusPublished - 23 Feb 2017


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