Smoking during pregnancy as a possible risk factor for pediatric neoplasms in the offspring: A population-based cohort study

Publication date: Available online 27 November 2018

Source: Addictive Behaviors

Author(s): Roy Kessous, Tamar Wainstock, Eyal Sheiner

Abstract

Objective

The aim of this study was to evaluate the association between maternal smoking during pregnancy and future risk of childhood neoplasm risk.

Study design

A population based cohort analysis comparing the risk for long-term childhood neoplasms in children born (1991–2014) to mothers that smoked during pregnancy vs. those that did not. Childhood neoplasms were pre-defined based on ICD-9 codes, as recorded in the hospital medical files. Children with congenital malformations and multiple gestations were excluded from the analysis. Kaplan-Meier survival curves were constructed to compare cumulative oncological morbidity over time. Cox proportional hazards model was used to control for confounders.

Results

241,273 infants met the inclusion criteria; out of those 2841 were born to mothers that smoked during pregnancy. Offspring to smoking mothers had higher incidence of benign (OR 1.6, 95%CI 1.02–2.58; p value = .038) but not malignant tumors. Total cumulative neoplasm incidence was significantly higher in smoking women (Log Rank = 0.001) but no significant difference in the incidence of malignant tumors was noted (Log Rank = 0.834). In a Cox regression model controlling for maternal confounders; a history of maternal smoking during pregnancy remained independently associated only with increased risk for benign tumors (adjusted HR 2.5, 95%CI 1.57–3.83, p = .001).

Conclusion

Maternal smoking during pregnancy is associated with increased long-term risk for benign but not malignant tumors. This is important when counseling mothers regarding potential future risks and recommended lifestyle modifications. Despite this large population study with long follow-up, childhood malignancies are rare, and clarifying the possible association may require further studies.

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