Maternal Smoking During Pregnancy, Growth, and Bone Mass in Prepubertal Children

There have been no studies of smoking during pregnancy and bone mineralization in children. The objective of this population-based longitudinal study was to determine whether maternal smoking during pregnancy is associated with bone mass and other growth variables in prepubertal children. We studied 330 8-year-old male and female children representing 47% of those who originally took part in a study of risk factors for Sudden Infant Death Syndrome in 1988. The main outcome measures were bone mineral density measured by a Hologic QDR2000 densitometer: birth weight, placental weight, height, and weight. Maternal smoking during pregnancy was associated with deficits in growth with these children having lower height (-1.53 cm, 95% confidence interval [CI] -3.03 to -0.03) and a trend to lower weight (-1.35 kg, 95% CI -2.75 to 0.11) at age 8. Furthermore, there was a disproportionate deficit in bone mass such that those children whose mothers smoked during pregnancy had lower size adjusted bone mass at the lumbar spine (-0.019 g/cm2, 95% CI -0.033 to -0.005) and femoral neck (-0.018 g/cm2, 95%CI -0.034 to -0.002) but not total body (-0.005 g/cm2, 95% CI -0.015 to 0.005). This association was only present for children born at term. Mothers who smoked during pregnancy also had lower placental weight (- 56 g, 95% CI -95 to -17), and further adjustment for placental weight led to nonsignificant results for smoking with both growth and bone parameters, suggesting that these associations may be mediated through placental size and function. Maternal smoking habit in 1996 was not significantly associated with bone mass at any site. In conclusion, this study has demonstrated a long-term negative association between maternal smoking during pregnancy and both growth and bone mass in children born at term, and suggests that the timing of exposure rather than the dose or duration is critical. If these associations are present in other populations and they persist until the attainment of peak bone mass, then our findings suggest that osteoporosis prevention programs should start very early in the life cycle.