ArticleBMJ (Clinical research ed.)2020
Maternal smoking during pregnancy and fractures in offspring: national register based sibling comparison study.
Article in BMJ (Clinical research ed.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 43 citations in OpenAlex.
- Association between maternal smoking and child bone mineral density: a systematic review and meta-analysis.Environmental science and pollution research international · 2020Pooled it
- Infant, maternal and pregnancy associated risk factors for offspring fractures during infancy - A population-based study.Child abuse & neglect · 2026Article
- Memory under siege: the cognitive costs of smoking and vaping.Brain, behavior, & immunity - health · 2025Review
- Association of secondhand smoke exposure during pregnancy with left ventricle structure and function in offspring at 4 years old: a prospective birth cohort study.BMC pregnancy and childbirth · 2025Article
- Early-life tobacco smoke elevating later-life osteoporosis risk: Mediated by telomere length and interplayed with genetic predisposition.Journal of advanced research · 2025Article
- The association between maternal smoking during pregnancy and multimorbidity of non-communicable chronic diseases trajectory in offspring.BMC public health · 2024Article
- Gestational vitamin D and offspring fracture risk: do associations persist into mid adolescence?European journal of clinical nutrition · 2024Article
- Smoking in pregnancy increases offspring fracture risk: yet another reason to encourage smoking cessation.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2024Article
- The relationship between perceived stress and pregnancy distress with self-care of pregnant women: The mediating role of social support-A cross-sectional study.Health science reports · 2023Article
- Early Life Programming of Skeletal Health.Current osteoporosis reports · 2023Review
- Maternal smoking during pregnancy and type 1 diabetes in the offspring: a nationwide register-based study with family-based designs.BMC medicine · 2022Article
- Women's holistic self-care behaviors during pregnancy and associations with psychological well-being: implications for maternal care facilities.BMC pregnancy and childbirth · 2022Article
- Association of Maternal Tobacco Use During Pregnancy With Preadolescent Brain Morphology Among Offspring.JAMA network open · 2022Article
- Is correcting exposure misclassification bias an additional option in meta-analyses?Clinical and experimental pediatrics · 2021Article
- Maternal and Neonatal Factors Affecting Bone Mineral Content of Indonesian Term Newborns.Frontiers in pediatrics · 2021Article
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
Abstract
objectiveTo study the impact of maternal smoking during pregnancy on fractures in offspring during different developmental stages of life.
designNational register based birth cohort study with a sibling comparison design.
settingSweden.
participants1 680 307 people born in Sweden between 1983 and 2000 to women who smoked (n=377 367, 22.5%) and did not smoke (n=1 302 940) in early pregnancy. Follow-up was until 31 December 2014.
main outcome measureFractures by attained age up to 32 years.
resultsDuring a median follow-up of 21.1 years, 377 970 fractures were observed (the overall incidence rate for fracture standardised by calendar year of birth was 11.8 per 1000 person years). The association between maternal smoking during pregnancy and risk of fracture in offspring differed by attained age. Maternal smoking was associated with a higher rate of fractures in offspring before 1 year of age in the entire cohort (birth year standardised fracture rates in those exposed and unexposed to maternal smoking were 1.59 and 1.28 per 1000 person years, respectively). After adjustment for potential confounders the hazard ratio for maternal smoking compared with no smoking was 1.27 (95% confidence interval 1.12 to 1.45). This association followed a dose dependent pattern (compared with no smoking, hazard ratios for 1-9 cigarettes/day and ≥10 cigarettes/day were 1.20 (95% confidence interval 1.03 to 1.39) and 1.41 (1.18 to 1.69), respectively) and persisted in within-sibship comparisons although with wider confidence intervals (compared with no smoking, 1.58 (1.01 to 2.46)). Maternal smoking during pregnancy was also associated with an increased fracture incidence in offspring from age 5 to 32 years in whole cohort analyses, but these associations did not follow a dose dependent gradient. In within-sibship analyses, which controls for confounding by measured and unmeasured shared familial factors, corresponding point estimates were all close to null. Maternal smoking was not associated with risk of fracture in offspring between the ages of 1 and 5 years in any of the models.
conclusionPrenatal exposure to maternal smoking is associated with an increased rate of fracture during the first year of life but does not seem to have a long lasting biological influence on fractures later in childhood and up to early adulthood.
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