This section summarises research on the association between prenatal smoking and:
It also summarises evidence on:
Maternal smoking during pregnancy is the most common preventable risk factor for pregnancy complications (see Section 3.7),1 and can also impact child health in a myriad of ways with potential lifelong consequences. During pregnancy, a foetus can be exposed to tobacco compounds via a pregnant woman smoking or being exposed to secondhand smoke. Following birth, infants may be exposed to tobacco compounds through breastfeeding, and through the presence of secondhand and thirdhand smoke in the home. Both prenatal and postnatal exposure can contribute to several health conditions in children.
The mechanisms underlying the adverse health effects of maternal smoking during pregnancy on the child remain poorly understood, although emerging evidence suggests that decreased oxygen supply, direct effects of toxic chemicals, changes in gene expression and other factors most likely play a role. Delineating the impact of each route of exposure in the causation of disease can sometimes be difficult, particularly for rarer childhood conditions.
3.8.1 Foetal growth and birthweight
Smoking during pregnancy restricts foetal growth and causes low birthweight in the infant.2-7 Babies born with low birthweight have a higher risk of subsequent illness, death and poor health outcomes through childhood and adult life.2 Low birthweight is associated with heart disease, type 2 diabetes, high blood pressure and being overweight in adulthood.8,9
Babies born to women who smoke, weigh, on average, about 150 g to 200 g less than babies born to women who do not smoke.10 A 2022 meta-analysis of 55 cohort studies found that maternal smoking during pregnancy is associated with 1.89-fold increased odds of low birthweight in offspring.6 Similarly, a Canadian study of over 9 million births found that babies born to women who smoke have over 2-fold increased chance of being small for gestational age, which was defined as birthweight that is below the 10th percentile for their gestational age and sex.7 Australian data have also shown that babies of women who smoke during pregnancy are twice as likely to be of low birthweight (defined as weighing less than 2500 g) compared to babies whose mothers do not smoke, and are more likely to be admitted to special care nurseries or neonatal intensive care units.11 In Australia in 2004‒05, it was estimated that about 14% of all deaths due to low birthweight were attributable to tobacco use in pregnancy.12
The effect of maternal smoking on low birthweight is largely due to intrauterine growth restriction (reduced foetal growth) and to a lesser extent shortened gestation.10 Reduced foetal measurements are apparent from the second trimester onwards.13 Intrauterine growth restriction is likely to be caused by chronic mild oxygen deprivation in the foetus from exposure to carbon monoxide, with a more minor role played by the effects of smoking on the placenta leading to nutritional deficiency of the foetus.10
There appears to be a non-linear dose-response relationship between the number of cigarettes smoked per day by the mother and the risk of low birthweight in the offspring. Research suggests that birthweight decreases far more sharply at low levels of exposure, such as that experienced by women exposed to secondhand smoke and possibly by women who smoke a low number of cigarettes per day.3,6,10,14-17 This may help account for the observation that the benefits of cutting down the number of cigarettes smoked per day on birthweight are considerably smaller than for complete smoking cessation.17-19
Women who stop smoking early in their pregnancy have babies with similar birthweights to women who do not smoke. Even women who stop smoking before their third trimester can avoid much of the effect of smoking on birthweight.2,13,20
Although babies born to parents who smoke are more likely to have low birthweight, older children with smoking parents may be at risk of overweight and obesity than those with non-smoking parents—see Section 3.8.7 for more information.
3.8.2 Perinatal and infant death
Perinatal deaths in Australia include stillbirths and neonatal deaths. Stillbirth is defined in Australia as the birth of a baby who shows no signs of life, after a pregnancy of at least 20 weeks gestation or weighing 400g or more.21 Neonatal mortality is defined in Australia as the death of a live born baby of 20 or more completed weeks of gestation or of 400 grams or more birthweight, within 28 days of birth.21
The World Health Organization (WHO) has different definitions, used for international comparisons. The WHO defines stillbirth as the foetal death of a baby born at 28 weeks' gestation or more, and/or weighing 1,000 grams or more.22 Neonatal mortality is defined by the WHO as all deaths in the first 0 to 27 days of life.22
3.8.2.1 Stillbirth and neonatal mortality
Maternal smoking is associated with an increased risk of stillbirth and neonatal mortality.2,18,23 It appears to be a dose–response relationship, such that the odds of stillbirth and neonatal mortality increase with the heaviness of smoking.23-25 In 2017 and 2018 in Australia, perinatal deaths were more common among babies of women who smoked throughout pregnancy compared to those whose mothers did not (17.0 and 8.7 deaths per 1,000 births, respectively). The perinatal death rate among babies of women who smoked only in the first 20 weeks of pregnancy was 10.5 deaths per 1,000 births.26
Proposed mechanisms by which smoking increases perinatal mortality include complications of pregnancy (abruption, placenta previa), preterm delivery, premature and prolonged rupture of the membranes (“water breaking”), and through physiologic responses of the foetus and newborn to stress.27
3.8.2.2 Sudden infant death syndrome
Sudden infant death syndrome (SIDS) refers to the sudden, unexpected, and unexplained death of a child before the age of one. Smoking has been established as a cause of SIDS, whether the child has been exposed to smoking before birth or in the home following birth.2 The biological pathway remains uncertain, but it may be due to the effects of chronic oxygen deficiency on the development of the central nervous system and other neurotoxic effects of tobacco smoke on the foetal brain.2 Neurochemical changes to the cardiorespiratory control centres of the brainstem can result in changes in the development of respiratory control. Several studies have linked smoking during pregnancy to alterations in breathing patterns, ventilatory responses, and arousal responses in infants.2,28
For information on secondhand smoke and SIDS see Section 4.17.2.
3.8.3 Birth defects
A substantial body of research has demonstrated that maternal smoking during pregnancy is associated with an increased risk of birth defects.29-35 The 2014 US Surgeon General’s report concluded that the evidence suggests a causal relationship between maternal smoking during early pregnancy and clubfoot, gastroschisis, and atrial septal heart defects.27
A 2011 meta-analysis found that maternal smoking during pregnancy is associated with an increased risk of cardiovascular/heart defects, musculoskeletal defects, limb reduction defects, club foot, craniosynostosis (premature fusing of the skull bones), facial defects, eye defects, orofacial clefts, gastrointestinal defects, gastroschisis (development of the intestines outside of the body), anal atresia, hernia, and undescended testes.29 Further research has demonstrated that maternal smoking during pregnancy is associated with urogenital malformations,34 congenital heart diseases,36-38 and limb reduction defects.32
Orofacial clefts are a common type of birth defect affecting the mouth and lip. The 2014 US Surgeon General’s report concluded that maternal smoking during early pregnancy is a cause of orofacial clefts among offspring.27 Subsequent meta-analyses have made similar conclusions.35,39 A 2021 meta-analysis of 16 studies found that maternal smoking was associated with 1.42-fold increased odds of cleft lip and/or palate among offspring.35
It is thought that prenatal tobacco smoke exposure alters embryonic movements in early pregnancy that are important to the development of organ systems. It has also been suggested that smoking reduces the supply of essential nutrients (such as vitamins and folate) to embryonic tissues and increases the risk of foetal oxygen deficiency and DNA damage.27
A large study from China found an increased risk of birth defects in the children of men who smoked prior to conception. These children had an increased risk of birth defects (such as congenital heart diseases, limb abnormalities, digestive tract anomalies and neural tube defects). The children of men who previously smoked were at reduced risk compared to offspring of men who currently smoked.40 Research also supports an increased risk of oral clefts with paternal smoking, although it is not clear whether this is due to exposure of the mother to secondhand smoke or if it is due to the effects of tobacco smoke on sperm.10
3.8.4 Respiratory health
Maternal smoking during pregnancy is a cause of reduced lung function in infants and is associated with an increased number of lower respiratory tract illnesses during infancy.2 It is also likely that maternal smoking during pregnancy is a cause of impaired lung function in childhood and adulthood.2
There is evidence to suggest that maternal smoking during pregnancy is associated with an increased risk of wheezing among offspring.41-44 A 2020 meta-analysis demonstrated that infants born to mothers who were active tobacco users during pregnancy had 1.50-fold increased odds of wheezing episodes in the first year of life.42 Similarly, a 2024 cohort study of more than 73,000 births found that maternal smoking during pregnancy is associated with an increased risk of wheezing in offspring up to the age of 3 years.43
As described in Section 4.17.3, secondhand smoke exposure in childhood is a cause of asthma. There is emerging research to suggest that maternal smoking during pregnancy may be associated with an increased risk of asthma in offspring.45,46 A 2023 cohort study of more than 75,000 mother-child pairs demonstrated that children whose mothers continued smoking during pregnancy had an increased risk of asthma at 3 years of age. Children whose mothers quit smoking before, or early on in pregnancy also had an increased risk of asthma compared to children whose mothers never smoked.45
Bronchopulmonary dysplasia is a chronic lung disease common in preterm infants. A 2020 meta-analysis of 17 studies found that smoking during pregnancy is associated with a 1.13-fold higher risk of bronchopulmonary dysplasia by 36 weeks after birth.47
Maternal smoking during pregnancy impairs foetal lung development which may predispose the infant to reduced lung function and an increased number of lower respiratory tract illnesses.2 Australian research has indicated that infants born to women who smoked during pregnancy have weakened innate immune defences and develop their acquired immune system more slowly than infants of mothers who never smoked. This may explain why infants of women who smoke are more prone to be asthmatic and to develop respiratory infections.48
See Section 3.2 for information about smoking and respiratory diseases.
3.8.5 Allergies and skin disease
Maternal smoking during pregnancy may be associated with certain types of childhood allergies and atopic diseases. A 2021 meta-analysis demonstrated that maternal smoking during pregnancy is associated with a 1.13 times greater risk of allergic rhinitis (hay fever) in offspring. This risk was even greater for offspring of women exposed to secondhand smoke during pregnancy.49 A large Danish study found that prenatal tobacco exposure may increase the risk of paediatric psoriasis.50
However, a 2023 meta-analysis found no association between maternal smoking (during the preconception, pregnancy, and postnatal periods) and the risk of eczema, food allergies, and food sensitisation in offspring. Rather, maternal exposure to secondhand smoke during pregnancy was associated with an increased risk of eczema in offspring.51
See Section 3.14 for a discussion about smoking and its effects on the skin.
3.8.6 Neurodevelopmental disorders
Neurodevelopmental disorders affect the development and function of the brain, and include autism spectrum disorder, intellectual disabilities, motor disabilities, seizures, learning disabilities, and attention deficit hyperactivity disorder. Investigating the effect of maternal smoking during pregnancy on the neurodevelopment of children is challenging as many genetic and environmental factors are involved. However, a substantial body of emerging research suggests that maternal smoking during pregnancy may influence some of these neurodevelopmental outcomes.
The 2014 US Surgeon General’s report concluded that the evidence is suggestive of a causal relationship between maternal smoking during pregnancy and attention-deficit/hyperactivity disorder (ADHD) in children.27 Subsequent meta-analyses have similarly found an association between maternal smoking during pregnancy and an increased risk of ADHD in children.52-55 A 2020 meta-analysis demonstrated that children born to women who smoked during pregnancy had a 1.58-fold increased risk of ADHD.52
There is also evidence to suggest that maternal smoking during pregnancy is associated with other behavioural problems in children.56,57 A 2020 meta-analysis found prenatal cigarette exposure is associated with a range of neurobehavioural consequences in the first year of life including negative affect, attention, excitability, irritability, orientation, muscle tone, regulation, and difficult temperament.57
Maternal smoking during pregnancy may also be associated with reduced academic achievement in children.56,58,59 A 2024 meta-analysis of 8 studies found a 49% higher risk of reduced academic achievement in offspring whose mothers smoked during pregnancy.58 A 2021 Australian study demonstrated that adolescent offspring whose mothers smoked during pregnancy had an increased risk of substandard academic performance, specifically for spelling, writing, reading and numeracy.59
The 2014 US Surgeon General’s report concluded that there is insufficient evidence to infer a causal relationship between maternal smoking during pregnancy and Tourette syndrome.27 Results from subsequent meta-analyses have been conflicting.60,61 A 2021 meta-analysis of 7 studies demonstrated that maternal smoking during pregnancy significantly increases the risk of Tourette syndrome and other chronic tic disorders in offspring.60 However, a 2023 meta-analysis found no significant association.61
There is some evidence to suggest that maternal smoking during pregnancy may be associated with an increased risk of offspring seizures.62,63 A 2026 meta-analysis of 14 studies with more than 12 million participants found that maternal smoking during pregnancy is associated with a 49% increased risk of seizure among offspring.62
There does not appear to be a relationship between maternal smoking during pregnancy and autism spectrum disorder in offspring.64
3.8.7 Overweight and obesity
Despite maternal smoking during pregnancy being associated with having a baby of low birthweight, there is evidence to suggest that they have an increased risk of becoming overweight or obese in childhood,65-71 as well as in adulthood.72,73 A 2017 meta-analysis demonstrated that children who were prenatally exposed to tobacco smoke had a 37% and 55% greater odds of being overweight and obese respectively, compared to children who were not prenatally exposed to tobacco smoke.65
It is not entirely clear why children born to mothers who smoked during pregnancy have a greater risk of overweight and obesity. However, proposed mechanisms include the catch-up growth theory (accelerated growth of a low birthweight baby), the thrifty phenotype theory (metabolic adaptations in the foetus), neurotransmitter or endocrine imbalances, and genetic modifications.74
See Section 3.29 for further discussion about smoking and body weight.
3.8.8 Cardiovascular health
As described in Section 3.8.7, maternal smoking during pregnancy is associated with an increased risk of childhood overweight and obesity, which is an important risk factor for cardiovascular disease later in adulthood.75 Maternal smoking during pregnancy also increases the risk of adverse lipid profiles in adult offspring.76,77 A 2021 cohort study found that found that perinatal exposure to maternal smoking was associated with an increased risk of cardiovascular disease, myocardial infarction, and stroke later in adulthood.78
There is emerging research to suggest that maternal smoking during pregnancy is associated with an increased risk of hypertension in children.79,80 A 2023 meta-analysis of 15 studies demonstrated that maternal smoking during pregnancy is associated with an increased systolic blood pressure in offspring aged 3–17 years.79 Similarly, a 2025 study using data from the Longitudinal Study of Australian Children found that the children of mothers who ever smoked during pregnancy had 1.44 times the odds of developing hypertension by early adolescence, while those exposed to more than 10 cigarettes per day had nearly double the risk compared to children of non-smoking mothers.80 There is also some research that indicates that maternal smoking during pregnancy leads to impaired blood pressure regulation in infants.81
A small study found that the foetuses of smoking mothers are more likely to have lesions in the walls of the foetal artery and adjoining vessels, which are the initial stages of atherosclerosis (narrowing of the arteries by fatty deposits).82 Smoking during pregnancy is a risk factor for cardiovascular developmental changes, including aortic narrowing, in early childhood and adolescence.83,84
Maternal smoking during pregnancy is also associated with an increased risk of congenital heart diseases in children.36-38 A 2026 cross-sectional study found that babies whose mothers reported smoking during pregnancy had 3.58-fold increased odds of having a congenital heart disease and 2.82-fold increased odds of greater congenital heart disease severity.36 See Section 3.8.3 for information about other congenital abnormalities.
See Section 3.1 for a detailed discussion about smoking and cardiovascular disease.
3.8.9 Eye health
There is some evidence to suggest that maternal smoking during pregnancy is associated with vision difficulties among children. A 2015 systematic review found that there were higher rates of strabismus (crossed eyes), refractive errors, and retinopathy among children of women who smoked during pregnancy.85 Subsequent meta-analyses have also found associations between maternal smoking during pregnancy and strabismus,86 as well as hyperopia (farsightedness) and amblyopia (lazy eye),87 and deficits in retinal nerve fibre thickness.88 A 2021 study indicated that maternal smoking during pregnancy is an independent risk factor for severe retinopathy in preterm infants born before 32 weeks of gestation.89
See Section 3.10 for more information about smoking and eye diseases.
3.8.10 Reproductive health
Some research suggests that maternal smoking during pregnancy affects the reproductive health of offspring. Meta-analyses have suggested that prenatal tobacco smoke exposure may decrease the age of menarche (age of first period).90,91 Other studies have found an association between maternal smoking during pregnancy and a smaller uterus, a reduced number of somatic cells (which are necessary for egg survival), and slightly lower fertility in female offspring.10,92-94 Several studies suggest that smoking during pregnancy may affect the reproductive development of male offspring, increasing the risk for lower sperm counts and quality, lower fertility, smaller testicles, cryptorchidism (undescended testes) and hypospadias (a penis abnormality).10,29,95-101
See Section 3.6 for information about smoking and reproductive health.
3.8.11 Nicotine dependence
There is some evidence to suggest that exposure to nicotine in utero predisposes an individual to a greater likelihood of nicotine dependence later in life, independent of socio-economic and other factors that influence uptake of smoking.102 It is possible that this may occur by nicotine having a direct effect on the developing foetal brain, causing permanent abnormalities in neurotransmitter regulation.102 Other research, while confirming that the offspring of women who smoked during pregnancy are more likely to smoke in early adolescence, suggests that environmental influences on smoking uptake such as the mother’s current smoking status and peer group behaviour are stronger predictors.103
3.8.12 Other child health effects
Maternal smoking during pregnancy is associated with other health effects in the child. Meta-analyses and large cohort studies have found associations between maternal smoking and an increased risk of childhood dental caries,104,105 bone fractures,106-108 and gastrointestinal morbidities.109 Other studies have reported an association between maternal smoking, both during and after pregnancy, and infantile colic or excessive crying.110,111
In 2009, the International Agency for Research in Cancer concluded that children born to parents who smoke (father, mother or both, including the preconception period and during pregnancy) have an increased risk of developing hepatoblastoma (a rare type of liver cancer).112 Subsequent research investigating the relationship between maternal smoking during pregnancy and childhood cancer has been limited. A 2023 case-control study found that maternal smoking during late pregnancy or early postpartum is associated with an increased risk of retinoblastoma (a rare type of eye cancer) in offspring.113
A 2025 meta-analysis demonstrated that maternal smoking during pregnancy is associated with a decreased risk of childhood type one diabetes.114
3.8.13 Health effects later in life
Maternal smoking during pregnancy has health consequences for offspring later in life. Research has found associations between prenatal tobacco smoke exposure and an increased risk of overweight and obesity,72,73 cardiovascular disease,78,115 chronic obstructive pulmonary disease,116,117 and some types of cancer in adulthood.118,119 A 2023 cohort study of nearly 400,000 participants found that in-utero exposure to tobacco smoke was associated with a slight increase in the risk of cancer overall, and an increase in the risk of respiratory and gastrointestinal cancers.118 Another study found that maternal smoking during pregnancy was associated with an increased risk of all-cause mortality, and mortality due to neoplasms as well as circulatory, respiratory, and digestive system diseases among offspring.120 Other studies using UK Biobank data have found associations for accelerated ageing,121 frailty,122 and chronic liver disease.123
The 2014 US Surgeon General’s report concluded that the evidence is insufficient to infer a causal relationship between maternal smoking during pregnancy and anxiety, depression, and schizophrenia in offspring.27 However, subsequent meta-analyses have demonstrated that maternal smoking during pregnancy is associated with an increased risk of anxiety, depression, and other mood disorders in adolescent and adult offspring.124,125 A 2025 meta-analysis found that individuals whose mothers used tobacco during pregnancy had a 33% higher risk of developing depression. Heavier tobacco consumption during pregnancy was associated with a further increased risk of depression and an increased risk of anxiety.124 For a detailed discussion about smoking among people with mental illnesses see Section 9A.3.
3.8.14 Breastfeeding and smoking
Nicotine is found in the breast milk of mothers who smoke and can therefore be a key source of exposure to tobacco compounds among breastfed infants.126,127 Cotinine, one of the main metabolites of nicotine, is found in the urine of infants who are breastfed by a mother who smokes, as well as in the urine of infants who are exposed to secondhand smoke.128 One study found that the amount of cotinine present in the urine of infants breastfed by mothers who smoke was ten times higher than that found in bottle-fed infants whose mothers smoke.129 Tobacco smoke appears to have a direct negative effect on milk quality, as well as the quantity produced. It is thought that nicotine may affect the activity of prolactin, a hormone essential for milk production.18 Breast milk from smoking mothers has lower anti-oxidant effects, lower energy, lipid and protein content.130
Nicotine absorbed by infants through breast milk can produce short-term symptoms such as restlessness, insomnia, nausea, vomiting, diarrhea and rapid pulse, and may affect infants’ autonomic cardiovascular control and sleeping patterns.128,131 While babies who are breastfed gain better levels of immunity to infectious disease, particularly against respiratory and ear infections associated with secondhand smoke exposure,18,132-134 one study found that the protective effect of breastfeeding on the onset of respiratory allergy in children from birth until five years appears to be lost when their mothers smoke.135 Studies have also found long-term effects of exposure to nicotine in breast milk.126 One review found that the adverse effects of maternal nicotine on breastfed infants include: reduction of iodine supply to the infant; histopathological damage in the liver and lung; intracellular oxidative damage; reduction of pancreatic ß cells; decreased glucose tolerance; increased body weight after weaning from maternal addiction, and hyperleptinemia.136
There is consistent evidence that women who smoke are less likely to breastfeed their infant and are more likely to wean their child earlier than mothers who do not smoke.127,137 This effect persists even after adjusting for other influences on the decision to breastfeed, such as socio-economic factors.18 Women who choose to breastfeed and smoke should be informed about harmful chemicals contained in cigarettes that can be secreted into breast milk and should be strongly encouraged to quit136 (see Section 7.11). However, as nicotine has a short half-life in milk of about two hours, breastfeeding mothers who cannot quit can reduce the exposure of their baby to nicotine by prolonging the time between their last cigarette and breastfeeding.128
3.8.15 Health effects of paternal smoking
Research is starting to explore the consequences of paternal smoking on child health. Paternal smoking may damage sperm DNA and alter the expression of genes in the offspring (see Section 3.6.2), which may then increase the genetic disease burden in children.138-140 A 2017 review estimated that, with even a 25% increase in sperm mutation frequency caused by exposure to tobacco smoke, for each generation there will be millions of smoking-induced mutations transmitted from fathers to offspring.141
Studies have found associations between paternal smoking, birth defects and childhood cancers.139 A 2020 meta-analysis of observational studies found an association between paternal smoking before conception or during pregnancy and an increased risk of childhood acute lymphoblastic leukemia.142 A large Chinese study found an increased risk for birth defects (such as congenital heart diseases, limb abnormalities, digestive tract anomalies and neural tube defects) in the children of men who smoked. The children of men who previously smoked were at reduced risk compared to offspring of men who currently smoked.40 A French study found a weak association between paternal smoking in the year before the child's birth and childhood brain tumours.143
Paternal smoking has also been associated with lower sperm counts in sons, independent of the level maternal nicotine exposure during the pregnancy.144 Preliminary research suggests that paternal smoking at conception may be a risk factor for ADHD in offspring.145 While some research has found an association between early uptake of smoking by fathers and obesity in their sons,146 others have found no such relationship.147 Early paternal smoking may also be associated with an increased risk of asthma in offspring.148
3.8.16 Health effects of grandparental smoking
Research is also starting to investigate the effects of grandmaternal smoking on the health of grandchildren. It is thought that grandmaternal smoking during pregnancy causes epigenetic modifications to DNA that can be passed down to the grandchild via the mother or father.149 Several studies have found that grandmaternal smoking is associated with an increased risk of asthma among grandchildren,148,150-154 and that this association may be a dose–response relationship.150 Other studies have found an increased risk for low birthweight,155-159 stillbirth,160 and attention-deficit/hyperactivity disorder.161
Grandparental smoking may also affect the health of their grandchildren by exposing them to secondhand smoke—see Section 4.17.
Related reading
Relevant news and research
A comprehensive compilation of news items and research published on this topic
Read more on this topic
Test your knowledge
References
1. Australian Institute of Health and Welfare. Australia's mothers and babies. AIHW, Australian Government. 2026. Available from: https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies
2. US Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2004. Available from: https://pubmed.ncbi.nlm.nih.gov/20669512/
3. Quelhas D, Kompala C, Wittenbrink B, Han Z, Parker M, et al. The association between active tobacco use during pregnancy and growth outcomes of children under five years of age: a systematic review and meta-analysis. BMC Public Health, 2018; 18(1):1372. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30545322
4. Adibelli D and Kirca N. The relationship between gestational active and passive smoking and early postpartum complications. Journal of Maternal-Fetal and Neonatal Medicine, 2020; 33(14):2473-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32393083
5. Olives JP, Elias-Billon I, Barnier-Ripet D, and Hospital V. Negative influence of maternal smoking during pregnancy on infant outcomes. Archives de Pediatrie, 2020; 27(4):189-95. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32331915
6. Di HK, Gan Y, Lu K, Wang C, Zhu Y, et al. Maternal smoking status during pregnancy and low birth weight in offspring: systematic review and meta-analysis of 55 cohort studies published from 1986 to 2020. World J Pediatr, 2022; 18(3):176-85. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35089538
7. Feferkorn I, Badeghiesh A, Baghlaf H, and Dahan MH. The relation between cigarette smoking with delivery outcomes. An evaluation of a database of more than nine million deliveries. Journal of Perinatal Medicine, 2022; 50(1):56-62. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34331422
8. Barker DJ, Eriksson JG, Forsen T, and Osmond C. Fetal origins of adult disease: strength of effects and biological basis. International Journal of Epidemiology, 2002; 31(6):1235-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12540728
9. Barker DJ. In utero programming of chronic disease. Clinical Science, 1998; 95(2):115-28. Available from: https://www.ncbi.nlm.nih.gov/pubmed/9680492
10. US Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease. Atlanta, Georgia: Centers for Disease Control and Prevention. 2010. Available from: https://www.ncbi.nlm.nih.gov/books/NBK53017/
11. Laws P, Grayson N, and Sullivan E. Smoking and pregnancy. AIHW cat. no. PER 33.Sydney: Australian Institute of Health and Welfare National Perinatal Statistics Unit. 2006. Available from: https://www.aihw.gov.au/getmedia/f44090f1-1bed-42c1-b56f-dac0d3239d88/smoking-pregnancy.pdf.aspx
12. Collins D and Lapsley H. The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004/05. Canberra: Department of Health and Ageing. 2008. Available from: https://nadk.flinders.edu.au/files/3013/8551/1279/Collins__Lapsley_Report.pdf
13. Abraham M, Alramadhan S, Iniguez C, Duijts L, Jaddoe VW, et al. A systematic review of maternal smoking during pregnancy and fetal measurements with meta-analysis. PLoS ONE, 2017; 12(2):e0170946. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28231292
14. Ellard GA, Johnstone FD, Prescott RJ, Ji-Xian W, and Jian-Hua M. Smoking during pregnancy: the dose dependence of birthweight deficits. British Journal of Obstetrics and Gynaecology, 1996; 103(8):806-13. Available from: https://www.ncbi.nlm.nih.gov/pubmed/8760712
15. England L, Kendrick J, Gargiullo P, Zahniser S, and Hannon W. Measures of maternal tobacco exposure and infant birth weight at term. American Journal of Epidemiology, 2001; 153(10):954–60. Available from: http://aje.oxfordjournals.org/cgi/content/full/153/10/954
16. England LJ, Kendrick JS, Wilson HG, Merritt RK, Gargiullo PM, et al. Effects of smoking reduction during pregnancy on the birth weight of term infants. American Journal of Epidemiology, 2001; 154(8):694-701. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11590081
17. Secker-Walker RH and Vacek PM. Infant birth weight as a measure of harm reduction during smoking cessation trials in pregnancy. Health Education and Behavior, 2002; 29(5):557-69. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12238700
18. US Department of Health and Human Services. Women and smoking. A report of the US Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2001. Available from: https://www.cdc.gov/tobacco/data_statistics/sgr/2001/index.htm
19. Pisinger C and Godtfredsen NS. Is there a health benefit of reduced tobacco consumption? A systematic review. Nicotine and Tobacco Research, 2007; 9(6):631–46. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17558820
20. Veisani Y, Jenabi E, Delpisheh A, and Khazaei S. Effect of prenatal smoking cessation interventions on birth weight: meta-analysis. Journal of Maternal-Fetal and Neonatal Medicine, 2019; 32(2):332-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28889768
21. Australian Institute of Health and Welfare. Stillbirths and neonatal deaths in Australia. AIHW, Australian Government. 2020. Available from: https://www.aihw.gov.au/reports/mothers-babies/stillbirths-and-neonatal-deaths-in-australia
22. World Health Organization. Global reference list of 100 core health indicators. Geneva, Switzerland: WHO. 2015. Available from: http://apps.who.int/iris/bitstream/handle/10665/173589/WHO_HIS_HSI_2015.3_eng.pdf;jsessionid=4ACB2191D71D20704B374666FB60490B?sequence=1
23. Marufu TC, Ahankari A, Coleman T, and Lewis S. Maternal smoking and the risk of still birth: systematic review and meta-analysis. BMC Public Health, 2015; 15:239. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25885887
24. Pineles BL, Hsu S, Park E, and Samet JM. Systematic Review and Meta-Analyses of Perinatal Death and Maternal Exposure to Tobacco Smoke During Pregnancy. American Journal of Epidemiology, 2016; 184(2):87-97. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27370789
25. Sun J, Liu X, Zhao M, Magnussen CG, and Xi B. Dose-response association between maternal smoking during pregnancy and the risk of infant death: a nationwide, population-based, retrospective cohort study. EClinicalMedicine, 2023; 57:101858. Available from: https://www.ncbi.nlm.nih.gov/pubmed/36879656
26. Australian Institute of Health and Welfare. Stillbirths and neonatal deaths in Australia 2017- 2018. Cat. no: PER 115.Canberra: AIHW. 2021. Available from: https://www.aihw.gov.au/reports/mothers-babies/stillbirths-and-neonatal-deaths-in-australia-2017/summary
27. US Department of Health and Human Services. The health consequences of smoking: 50 years of progress. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2014. Available from: https://www.ncbi.nlm.nih.gov/books/NBK179276/pdf/Bookshelf_NBK179276.pdf
28. Sawnani H, Olsen E, and Simakajornboon N. The Effect of In Utero Cigarette Smoke Exposure on Development of Respiratory Control: A Review. Pediatric Allergy, Immunology, and Pulmonology, 2010; 23(3):161-7. Available from: https://www.liebertpub.com/doi/10.1089/ped.2010.0036
29. Hackshaw A, Rodeck C, and Boniface S. Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls. Human Reproduction Update, 2011; 17(5):589-604. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21747128
30. Nicoletti D, Appel LD, Siedersberger Neto P, Guimaraes GW, and Zhang L. Maternal smoking during pregnancy and birth defects in children: a systematic review with meta-analysis. Cadernos de Saude Publica, 2014; 30(12):2491-529. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26247979
31. Zhang D, Cui H, Zhang L, Huang Y, Zhu J, et al. Is maternal smoking during pregnancy associated with an increased risk of congenital heart defects among offspring? A systematic review and meta-analysis of observational studies. Journal of Maternal-Fetal and Neonatal Medicine, 2017; 30(6):645-57. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27126055
32. Cevik J, Salehi O, Gaston J, and Rozen WM. Maternal Cigarette Smoking and Congenital Upper and Lower Limb Differences: A Systematic Review and Meta-Analysis. J Clin Med, 2023; 12(13). Available from: https://www.ncbi.nlm.nih.gov/pubmed/37445217
33. Han J, Zhang Y, Liu Y, Liu J, Zhang Y, et al. Parental Smoking and the Risk of Birth Defects in Offspring in China: A Systematic Review and meta-Analysis. Birth Defects Res, 2024; 116(12):e2422. Available from: https://www.ncbi.nlm.nih.gov/pubmed/39648656
34. Zhang Q, Zhang ZC, He XY, Liu ZM, Wei GH, et al. Maternal smoking during pregnancy and the risk of congenital urogenital malformations: A systematic review and meta-analysis. Front Pediatr, 2022; 10:973016. Available from: https://www.ncbi.nlm.nih.gov/pubmed/36263151
35. Fell M, Dack K, Chummun S, Sandy J, Wren Y, et al. Maternal Cigarette Smoking and Cleft Lip and Palate: A Systematic Review and Meta-Analysis. Cleft Palate-Craniofacial Journal, 2021:10556656211040015. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34569861
36. Shaffer M, Gray G, Maldonado JR, Gaddy JA, Masenga SK, et al. Maternal Smoking Status and Residual Risk: Current and Former Smoking Amplify Congenital Heart Disease Incidence and Severity in Offspring. Res Sq, 2026. Available from: https://www.ncbi.nlm.nih.gov/pubmed/41960326
37. Taylor K, Elhakeem A, Thorbjornsrud Nader JL, Yang TC, Isaevska E, et al. Effect of Maternal Prepregnancy/Early-Pregnancy Body Mass Index and Pregnancy Smoking and Alcohol on Congenital Heart Diseases: A Parental Negative Control Study. J Am Heart Assoc, 2021; 10(11):e020051. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34039012
38. Wang T, Chen L, Ni B, Sheng X, Huang P, et al. Maternal pre-pregnancy/early-pregnancy smoking and risk of congenital heart diseases in offspring: A prospective cohort study in Central China. J Glob Health, 2022; 12:11009. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35916623
39. Vathulya M, Singh N, Naithani M, and Kessler P. An intercontinental comparison of the influence of smoking on the occurrence of nonsyndromic cleft lip and palate: a meta-analysis and systematic review. Arch Craniofac Surg, 2024; 25(2):51-61. Available from: https://www.ncbi.nlm.nih.gov/pubmed/38742331
40. Zhou Q, Zhang S, Wang Q, Shen H, Zhang Y, et al. Association between preconception paternal smoking and birth defects in offspring: evidence from the database of the National Free Preconception Health Examination Project in China. BJOG, 2020; 127(11):1358-64. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32339375
41. Duan C, Wang M, Ma X, Ding M, Yu H, et al. Association between maternal smoking during pregnancy and recurrent wheezing in infancy: evidence from a meta-analysis. International Journal of Clinical and Experimental Medicine, 2015; 8(5):6755-61. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26221213
42. De Queiroz Andrade E, Da Silva Sena CR, Collison A, Murphy VE, Gould GS, et al. Association between active tobacco use during pregnancy and infant respiratory health: a systematic review and meta-analysis. BMJ Open, 2020; 10(9):e037819. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32998922
43. Wada T, Adachi Y, Murakami S, Ito Y, Itazawa T, et al. Maternal exposure to smoking and wheezing phenotypes in children: a cohort study of the Japan Environment and Children's Study. BMC Pediatrics, 2024; 24(1):624. Available from: https://www.ncbi.nlm.nih.gov/pubmed/39354379
44. Silvestri M, Franchi S, Pistorio A, Petecchia L, and Rusconi F. Smoke exposure, wheezing, and asthma development: a systematic review and meta-analysis in unselected birth cohorts. Pediatric Pulmonology, 2015; 50(4):353-62. Available from: https://pubmed.ncbi.nlm.nih.gov/24648197/
45. Miyake K, Kushima M, Shinohara R, Horiuchi S, Otawa S, et al. Maternal smoking status before and during pregnancy and bronchial asthma at 3 years of age: a prospective cohort study. Sci Rep, 2023; 13(1):3234. Available from: https://www.ncbi.nlm.nih.gov/pubmed/36828882
46. Zhang S, Wang T, and Zeng P. Associations of Maternal Smoking During Pregnancy and Genetic Susceptibility with Incident Asthma from a Cohort Study. Prevention Science, 2025. Available from: https://www.ncbi.nlm.nih.gov/pubmed/40045075
47. Gonzalez-Luis GE, van Westering-Kroon E, Villamor-Martinez E, Huizing MJ, Kilani MA, et al. Tobacco Smoking During Pregnancy Is Associated With Increased Risk of Moderate/Severe Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis. Front Pediatr, 2020; 8:160. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32411634
48. Noakes PS, Hale J, Thomas R, Lane C, Devadason SG, et al. Maternal smoking is associated with impaired neonatal toll-like-receptor-mediated immune responses. European Respiratory Journal, 2006; 28(4):721-9. Available from: https://pubmed.ncbi.nlm.nih.gov/16870663/
49. Zhou Y, Chen J, Dong Y, Shen J, Tian M, et al. Maternal tobacco exposure during pregnancy and allergic rhinitis in offspring: A systematic review and meta-analysis. Medicine, 2021; 100(34):e26986. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34449468
50. Groot J, Nybo Andersen AM, Blegvad C, Pinot de Moira A, and Skov L. Prenatal, infantile, and childhood tobacco exposure and risk of pediatric psoriasis in the Danish National Birth Cohort offspring. Journal of the American Academy of Dermatology, 2020; 83(6):1625-32. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31973955
51. Lau HX, Lee JW, Yap QV, Chan YH, Samuel M, et al. Smoke exposure and childhood atopic eczema and food allergy: A systematic review and meta-analysis. Pediatric Allergy and Immunology, 2023; 34(8):e14010. Available from: https://www.ncbi.nlm.nih.gov/pubmed/37622263
52. He Y, Chen J, Zhu LH, Hua LL, and Ke FF. Maternal Smoking During Pregnancy and ADHD: Results From a Systematic Review and Meta-Analysis of Prospective Cohort Studies. Journal of Attention Disorders, 2020; 24(12):1637-47. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29039728
53. Dong T, Hu W, Zhou X, Lin H, Lan L, et al. Prenatal exposure to maternal smoking during pregnancy and attention-deficit/hyperactivity disorder in offspring: A meta-analysis. Reprod Toxicol, 2018; 76:63-70. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29294364
54. Tsegay L, Zena D, Abicho A, Gizachew Y, and Ayano G. Maternal and paternal smoking during pregnancy and the risk of ADHD in offspring: An umbrella review of systematic reviews and meta-analyses. Journal of Psychiatric Research, 2026; 193:441-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/41385914
55. Godleski S, Shisler S, Colton K, and Leising M. Prenatal Tobacco Exposure and Behavioral Disorders in Children and Adolescents: Systematic Review and Meta-Analysis. Pediatr Rep, 2024; 16(3):736-52. Available from: https://www.ncbi.nlm.nih.gov/pubmed/39311325
56. Polanska K, Jurewicz J, and Hanke W. Smoking and alcohol drinking during pregnancy as the risk factors for poor child neurodevelopment - A review of epidemiological studies. International Journal of Occupational Medicine and Environmental Health, 2015; 28(3):419-43. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26190723
57. Froggatt S, Covey J, and Reissland N. Infant neurobehavioural consequences of prenatal cigarette exposure: A systematic review and meta-analysis. Acta Paediatrica, 2020; 109(6):1112-24. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31821600
58. Duko B, Bedaso A, Dachew BA, Newnham E, Gebremedhin AT, et al. The effect of maternal prenatal tobacco smoking on offspring academic achievement: A systematic review and meta-analysis. Addictive Behaviors, 2024; 153:107985. Available from: https://www.ncbi.nlm.nih.gov/pubmed/38367506
59. Ayano G, Betts K, Dachew BA, and Alati R. Maternal smoking during pregnancy and poor academic performance in adolescent offspring: A registry data-based cohort study. Addictive Behaviors, 2021; 123:107072. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34364108
60. Ayubi E, Mansori K, and Doosti-Irani A. Effect of maternal smoking during pregnancy on Tourette syndrome and chronic tic disorders among offspring: a systematic review and meta-analysis. Obstet Gynecol Sci, 2021; 64(1):1-12. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33371659
61. Chen D, Niu Q, Liu S, Shao W, Huang Y, et al. The correlation between prenatal maternal active smoking and neurodevelopmental disorders in children: a systematic review and meta-analysis. BMC Public Health, 2023; 23(1):611. Available from: https://www.ncbi.nlm.nih.gov/pubmed/36997899
62. Yoo S, Kim K, Son E, Song TJ, Kim HW, et al. Maternal smoking during pregnancy and childhood seizure: a systematic review and meta-analysis. BMC Pregnancy Childbirth, 2026. Available from: https://www.ncbi.nlm.nih.gov/pubmed/41776500
63. Zhao Q, Ji Q, Liu Q, Xu Y, Lv X, et al. Maternal Smoking During Pregnancy, Smoking Initiation and the Risk of Epilepsy in the UK Biobank. Neuroepidemiology, 2025:1-20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/40730037
64. Peltekidi A, Jotautis V, Tzitiridou-Chatzopoulou M, Georgakopoulou VE, Sousamli A, et al. Maternal Smoking During Pregnancy and Risk of Autism Spectrum Disorder in Offspring: A Systematic Review and Meta-Analysis. J Clin Med, 2025; 14(23). Available from: https://www.ncbi.nlm.nih.gov/pubmed/41375887
65. Rayfield S and Plugge E. Systematic review and meta-analysis of the association between maternal smoking in pregnancy and childhood overweight and obesity. Journal of Epidemiology and Community Health, 2017; 71(2):162-73. Available from: https://pubmed.ncbi.nlm.nih.gov/27480843/
66. Perkins J, Re T, Ong S, Niu Z, and Wen X. Meta-Analysis on Associations of Timing of Maternal Smoking Cessation before and during Pregnancy with Childhood Overweight and Obesity. Nicotine and Tobacco Research, 2022. Available from: https://www.ncbi.nlm.nih.gov/pubmed/36106723
67. Oken E, Levitan EB, and Gillman MW. Maternal smoking during pregnancy and child overweight: systematic review and meta-analysis. International Journal of Obesity, 2008; 32(2):201-10. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18278059
68. Albers L, Sobotzki C, Kuss O, Ajslev T, Batista RF, et al. Maternal smoking during pregnancy and offspring overweight: is there a dose-response relationship? An individual patient data meta-analysis. International Journal of Obesity, 2018; 42(7):1249-64. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29717267
69. Albers L, von Kries R, Sobotzki C, Gao HJ, Buka SL, et al. Differences in maternal smoking across successive pregnancies - dose-dependent relation to BMI z-score in the offspring: an individual patient data (IPD) meta-analysis. Obesity Reviews, 2018; 19(9):1248-55. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30035359
70. Riedel C, Schonberger K, Yang S, Koshy G, Chen YC, et al. Parental smoking and childhood obesity: higher effect estimates for maternal smoking in pregnancy compared with paternal smoking--a meta-analysis. International Journal of Epidemiology, 2014; 43(5):1593-606. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25080528
71. Ino T. Maternal smoking during pregnancy and offspring obesity: meta-analysis. Pediatrics International, 2010; 52(1):94-9. Available from: https://pubmed.ncbi.nlm.nih.gov/19400912/
72. Kataria Y, Gaewsky L, and Ellervik C. Prenatal smoking exposure and cardio-metabolic risk factors in adulthood: a general population study and a meta-analysis. International Journal of Obesity, 2019; 43(4):763-73. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30232417
73. Magalhaes E, Sousa BA, Lima NP, and Horta BL. Maternal smoking during pregnancy and offspring body mass index and overweight: a systematic review and meta-analysis. Cadernos de Saude Publica, 2019; 35(12):e00176118. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31800784
74. White O, Roeder N, Blum K, Eiden RD, and Thanos PK. Prenatal Effects of Nicotine on Obesity Risks: A Narrative Review. International Journal of Environmental Research and Public Health, 2022; 19(15). Available from: https://www.ncbi.nlm.nih.gov/pubmed/35954830
75. Chung ST, Krenek A, and Magge SN. Childhood Obesity and Cardiovascular Disease Risk. Current Atherosclerosis Reports, 2023; 25(7):405-15. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10230147/
76. Jaddoe V, de Ridder M, van den Elzen A, Hofman A, Uiterwaal C, et al. Maternal smoking in pregnancy is associated with cholesterol development in the offspring: a 27-years follow-up study. Atherosclerosis 2008; 196(1):42−8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17336310
77. Wen X, Triche EW, Hogan JW, Shenassa ED, and Buka SL. Birth weight and adult hypercholesterolemia: subgroups of small-for-gestational-age based on maternal smoking status during pregnancy. Epidemiology, 2010; 21(6):786-90. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20798636
78. Song Q, Sun D, Zhou T, Li X, Ma H, et al. Perinatal exposure to maternal smoking and adulthood smoking behaviors in predicting cardiovascular diseases: A prospective cohort study. Atherosclerosis, 2021; 328:52-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34091070
79. Mourino N, Varela-Lema L, Ahluwalia JS, Rey-Brandariz J, Candal-Pedreira C, et al. Maternal smoking in pregnancy and blood pressure during childhood and adolescence: a meta-analysis. European Journal of Pediatrics, 2023. Available from: https://www.ncbi.nlm.nih.gov/pubmed/36823476
80. Liu M, Soon EY, Lange K, Juonala M, Kerr JA, et al. Maternal Smoking Intensity During Pregnancy and Early Adolescent Cardiovascular Health. J Am Heart Assoc, 2025:e037806. Available from: https://www.ncbi.nlm.nih.gov/pubmed/39996442
81. Cohen G, Jeffery H, Lagercrantz H, and Katz-Salamon M. Long-term reprogramming of cardiovascular function in infants of active smokers. Hypertension, 2010; 55(3):722-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20100999
82. Mecchia D, Lavezzi AM, Mauri M, and Matturri L. Feto-placental atherosclerotic lesions in intrauterine fetal demise: role of parental cigarette smoking. Open Cardiovasc Med J, 2009; 3:51-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19572018
83. Geelhoed JJ, El Marroun H, Verburg BO, van Osch-Gevers L, Hofman A, et al. Maternal smoking during pregnancy, fetal arterial resistance adaptations and cardiovascular function in childhood. BJOG, 2011; 118(6):755-62. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21385303
84. Edstedt Bonamy AK, Bengtsson J, Nagy Z, De Keyzer H, and Norman M. Preterm birth and maternal smoking in pregnancy are strong risk factors for aortic narrowing in adolescence. Acta Paediatrica, 2008; 97(8):1080-5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18662347
85. Fernandes M, Yang X, Li JY, and Cheikh Ismail L. Smoking during pregnancy and vision difficulties in children: a systematic review. Acta Ophthalmol, 2015; 93(3):213-23. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25545121
86. Yang Y, Wang C, Gan Y, Jiang H, Fu W, et al. Maternal smoking during pregnancy and the risk of strabismus in offspring: a meta-analysis. Acta Ophthalmol, 2019; 97(4):353-63. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30402966
87. Li L, Qi Y, Shi W, Wang Y, Liu W, et al. A Meta-Analysis for Association of Maternal Smoking with Childhood Refractive Error and Amblyopia. J Ophthalmol, 2016; 2016:8263832. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27247800
88. Zhu L, Munch IC, Lee SS, Mackey DA, Sultan T, et al. Prenatal and childhood exposure to smoking and retinal nerve fibre layer thickness: A meta-analysis of three independent birth cohorts. Acta Ophthalmol, 2026. Available from: https://www.ncbi.nlm.nih.gov/pubmed/41794403
89. Hudalla H, Bruckner T, Poschl J, Strowitzki T, and Kuon RJ. Maternal smoking as an independent risk factor for the development of severe retinopathy of prematurity in very preterm infants. Eye (Lond), 2021; 35(3):799-804. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32398853
90. Chen Y, Liu Q, Li W, Deng X, Yang B, et al. Association of prenatal and childhood environment smoking exposure with puberty timing: a systematic review and meta-analysis. Environ Health Prev Med, 2018; 23(1):33. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30021511
91. Yermachenko A and Dvornyk V. A meta-analysis provides evidence that prenatal smoking exposure decreases age at menarche. Reprod Toxicol, 2015; 58:222-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26542102
92. Hart R, Sloboda DM, Doherty DA, Norman RJ, Atkinson HC, et al. Prenatal determinants of uterine volume and ovarian reserve in adolescence. Journal of Clinical Endocrinology and Metabolism, 2009; 94(12):4931-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19846735
93. Lutterodt MC, Sorensen KP, Larsen KB, Skouby SO, Andersen CY, et al. The number of oogonia and somatic cells in the human female embryo and fetus in relation to whether or not exposed to maternal cigarette smoking. Human Reproduction, 2009; 24(10):2558-66. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19553240
94. Ye X, Skjaerven R, Basso O, Baird DD, Eggesbo M, et al. In utero exposure to tobacco smoke and subsequent reduced fertility in females. Human Reproduction, 2010; 25(11):2901-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20817739
95. Fowler PA, Cassie S, Rhind SM, Brewer MJ, Collinson JM, et al. Maternal smoking during pregnancy specifically reduces human fetal desert hedgehog gene expression during testis development. Journal of Clinical Endocrinology and Metabolism, 2008; 93(2):619-26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18000085
96. Jensen MS, Mabeck LM, Toft G, Thulstrup AM, and Bonde JP. Lower sperm counts following prenatal tobacco exposure. Human Reproduction, 2005; 20(9):2559-66. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15919771
97. Fowler PA, Bhattacharya S, Flannigan S, Drake AJ, and O'Shaughnessy PJ. Maternal cigarette smoking and effects on androgen action in male offspring: unexpected effects on second-trimester anogenital distance. Journal of Clinical Endocrinology and Metabolism, 2011; 96(9):E1502-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21752894
98. Ravnborg TL, Jensen TK, Andersson AM, Toppari J, Skakkebaek NE, et al. Prenatal and adult exposures to smoking are associated with adverse effects on reproductive hormones, semen quality, final height and body mass index. Human Reproduction, 2011; 26(5):1000-11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21335416
99. Mamsen LS, Lutterodt MC, Andersen EW, Skouby SO, Sorensen KP, et al. Cigarette smoking during early pregnancy reduces the number of embryonic germ and somatic cells. Human Reproduction, 2010; 25(11):2755-61. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20823112
100. Yu C, Wei Y, Tang X, Liu B, Shen L, et al. Maternal smoking during pregnancy and risk of cryptorchidism: a systematic review and meta-analysis. European Journal of Pediatrics, 2019; 178(3):287-97. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30465272
101. Zhang L, Wang XH, Zheng XM, Liu TZ, Zhang WB, et al. Maternal gestational smoking, diabetes, alcohol drinking, pre-pregnancy obesity and the risk of cryptorchidism: a systematic review and meta-analysis of observational studies. PLoS ONE, 2015; 10(3):e0119006. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25798927
102. Buka SL, Shenassa ED, and Niaura R. Elevated risk of tobacco dependence among offspring of mothers who smoked during pregnancy: a 30-year prospective study. American Journal of Psychiatry, 2003; 160(11):1978-84. Available from: https://www.ncbi.nlm.nih.gov/pubmed/14594744
103. Cornelius M, Leech S, Goldschmidt L, and Day N. Is prenatal tobacco exposure a risk factor for early adolescent smoking? A follow-up study. Neurotoxicology and Teratology, 2005; 27:667-76. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16014324
104. Samani D, Ziaei S, Musaie F, Mokhtari H, Valipour R, et al. Maternal smoking during pregnancy and early childhood dental caries in children: a systematic review and meta-analysis. BMC Oral Health, 2024; 24(1):781. Available from: https://www.ncbi.nlm.nih.gov/pubmed/38997699
105. Zhong Y, Tang Q, Tan B, and Huang R. Correlation Between Maternal Smoking During Pregnancy and Dental Caries in Children: A Systematic Review and Meta-Analysis. Front Oral Health, 2021; 2:673449. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35048017
106. Ayubi E, Safiri S, and Mansori K. Association between Maternal Smoking during Pregnancy and Risk of Bone Fractures in Offspring: A Systematic Review and Meta-analysis. Clinical and Experimental Pediatrics, 2020. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32023402
107. Kaanta E, Parviainen R, Tikanmaki M, Alenius S, Sinikumpu JJ, et al. Maternal Smoking During Pregnancy and Offspring's Risk for Bone Fracture in Childhood and Adolescence. Journal of Bone and Mineral Research, 2023. Available from: https://www.ncbi.nlm.nih.gov/pubmed/37823763
108. Rasmussen JB, Rath SM, Wu C, Weile LKK, Schmal H, et al. Fractures in Childhood and Young Adulthood According to Maternal Smoking in Late Pregnancy. A Danish Cohort Study. Z Orthop Unfall, 2023. Available from: https://www.ncbi.nlm.nih.gov/pubmed/37463590
109. Karur O, Gutvirtz G, Wainstock T, and Sheiner E. Maternal prenatal smoking and long-term gastrointestinal morbidity of the offspring: A population-based cohort analysis. Reprod Toxicol, 2021. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34015473
110. Shenassa ED and Brown MJ. Maternal smoking and infantile gastrointestinal dysregulation: the case of colic. Pediatrics, 2004; 114(4):e497-505. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15466076
111. Canivet CA, Ostergren PO, Jakobsson IL, Dejin-Karlsson E, and Hagander BM. Infantile colic, maternal smoking and infant feeding at 5 weeks of age. Scand J Public Health, 2008; 36(3):284-91. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18519298
112. Secretan B, Straif K, Baan R, Grosse Y, El Ghissassi F, et al. A review of human carcinogens--Part E: tobacco, areca nut, alcohol, coal smoke, and salted fish. Lancet Oncology, 2009; 10(11):1033-4. Available from: https://pubmed.ncbi.nlm.nih.gov/19891056/
113. He D, Huang X, Uppal K, Coleman AL, Walker DD, et al. Biomarkers of Maternal Smoking and the Risk of Retinoblastoma in Offspring. Retina, 2023; 43(3):481-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/36730579
114. Zhang S, Zhao L, and Li J. Maternal smoking during pregnancy and risk of childhood-onset type 1 diabetes in offspring: A systematic review and meta-analysis. Biomol Biomed, 2025. Available from: https://www.ncbi.nlm.nih.gov/pubmed/41212794
115. Zheng Y, Xiong X, Bao J, Liu J, Wang J, et al. The impact of in utero tobacco exposure on smoking behaviors, cardiovascular disease risk and all-cause mortality in adulthood: A UK Biobank study. Curr Res Toxicol, 2025; 8:100226. Available from: https://www.ncbi.nlm.nih.gov/pubmed/40109875
116. Li J, Li G, Ma Z, Sun Z, Shi Y, et al. Effects of in utero tobacco exposure, age of smoking initiation, and environmental pollution on the risk of chronic obstructive pulmonary disease in adulthood: a large scale prospective cohort study. BMC Pulmonary Medicine, 2025; 25(1):535. Available from: https://www.ncbi.nlm.nih.gov/pubmed/41257811
117. Deng Y, Geng X, Lin Z, Yang M, Lin Q, et al. In-Utero and Early-Life Exposure to Tobacco Smoke, Genetic Risk, and Chronic Obstructive Pulmonary Disease Incidence in Adulthood. Nicotine and Tobacco Research, 2026. Available from: https://www.ncbi.nlm.nih.gov/pubmed/41553263
118. He H, Shen Q, He MM, Qiu W, Wang H, et al. In Utero and Childhood/Adolescence Exposure to Tobacco Smoke, Genetic Risk, and Cancer Incidence in Adulthood: A Prospective Cohort Study. Mayo Clinic Proceedings, 2023. Available from: https://www.ncbi.nlm.nih.gov/pubmed/37422733
119. He H, He MM, Wang H, Qiu W, Liu L, et al. In Utero and Childhood/Adolescence Exposure to Tobacco Smoke, Genetic Risk and Lung Cancer Incidence and Mortality in Adulthood. American Journal of Respiratory and Critical Care Medicine, 2022. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35943859
120. Hu L, Wu S, Zhang Y, Xia X, Shu Y, et al. Associations of maternal and personal smoking with all-cause and cause-specific mortality risk and life expectancy: a prospective cohort study. Public Health, 2024; 229:144-50. Available from: https://www.ncbi.nlm.nih.gov/pubmed/38442596
121. Jiang W, Lei Q, Gao W, Sun X, Qiao C, et al. Maternal smoking during pregnancy could accelerate aging in the adulthood: evidence from a perspective study in UK Biobank. Sci Total Environ, 2024; 951:175150. Available from: https://www.ncbi.nlm.nih.gov/pubmed/39089379
122. Li Z, Wang Z, Yu S, Zhang X, and Zhu Y. Early-life exposure to tobacco smoke increase risk of frailty in adulthood: evidence from a large prospective cohort study. Journal of Translational Medicine, 2025; 23(1):1098. Available from: https://www.ncbi.nlm.nih.gov/pubmed/41088435
123. Xu X, Li J, Fu Y, Li J, Shen W, et al. Early-life exposure to tobacco smoke and chronic liver disease incidence in adulthood. Annals of Hepatology, 2025:102168. Available from: https://www.ncbi.nlm.nih.gov/pubmed/41314390
124. Zhang K, Wang Y, Shu Z, Huang Y, Feng L, et al. The Impact of Maternal Smoking During Pregnancy on Depressive and Anxiety Behaviors in Offspring: A Meta-analysis. Depression and Anxiety, 2025; 2025:2168791. Available from: https://www.ncbi.nlm.nih.gov/pubmed/40904630
125. Duko B, Ayano G, Pereira G, Betts K, and Alati R. Prenatal tobacco use and the risk of mood disorders in offspring: a systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 2020. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32895729
126. Banderali G, Martelli A, Landi M, Moretti F, Betti F, et al. Short and long term health effects of parental tobacco smoking during pregnancy and lactation: a descriptive review. Journal of Translational Medicine, 2015; 13(1):327. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26472248
127. Napierala M, Mazela J, Merritt TA, and Florek E. Tobacco smoking and breastfeeding: Effect on the lactation process, breast milk composition and infant development. A critical review. Environmental Research, 2016; 151:321-38. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27522570
128. Llaquet H, Pichini S, Joya X, Papaseit E, Vall O, et al. Biological matrices for the evaluation of exposure to environmental tobacco smoke during prenatal life and childhood. Analytical and Bioanalytical Chemistry, 2010; 396(1):379-99. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19466395
129. Mascola MA, Van Vunakis H, Tager IB, Speizer FE, and Hanrahan JP. Exposure of young infants to environmental tobacco smoke: breast-feeding among smoking mothers. American Journal of Public Health, 1998; 88(6):893-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/9618615
130. Macchi M, Bambini L, Franceschini S, Alexa ID, and Agostoni C. The effect of tobacco smoking during pregnancy and breastfeeding on human milk composition-a systematic review. European Journal of Clinical Nutrition, 2021; 75(5):736-47. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33087893
131. Mennella JA, Yourshaw LM, and Morgan LK. Breastfeeding and smoking: short-term effects on infant feeding and sleep. Pediatrics, 2007; 120(3):497-502. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17766521
132. Chatzimichael A, Tsalkidis A, Cassimos D, Gardikis S, Tripsianis G, et al. The role of breastfeeding and passive smoking on the development of severe bronchiolitis in infants. Minerva Pediatrica, 2007; 59(3):199-206. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17519864
133. Dorea JG. Maternal smoking and infant feeding: breastfeeding is better and safer. Maternal and Child Health Journal, 2007; 11(3):287-91. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17226091
134. Yilmaz G, Hizli S, Karacan C, Yurdakök K, Coşkun T, et al. Effect of passive smoking on growth and infection rates of breast-fed and non-breast-fed infants. Pediatrics International 2009; 51(3):352–8. Available from: https://pubmed.ncbi.nlm.nih.gov/19400822/
135. Guedes HT and Souza LS. Exposure to maternal smoking in the first year of life interferes in breast-feeding protective effect against the onset of respiratory allergy from birth to 5 yr. Pediatric Allergy and Immunology, 2009; 20(1):30-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18208466
136. Primo CC, Ruela PB, Brotto LD, Garcia TR, and Lima Ede F. Effects of maternal nicotine on breastfeeding infants. Rev Paul Pediatr, 2013; 31(3):392-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24142324
137. Nidey N, Groh K, Agnoli A, Wilder C, Froehlich TE, et al. Breastfeeding Initiation and Continuation Among Women with Substance and Tobacco Use During Pregnancy: Findings from the Pregnancy Risk Assessment Monitoring System 2016-2018. Breastfeeding Medicine, 2022. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35475630
138. Jenkins TG, James ER, Alonso DF, Hoidal JR, Murphy PJ, et al. Cigarette smoking significantly alters sperm DNA methylation patterns. Andrology, 2017; 5(6):1089-99. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28950428
139. Esakky P and Moley KH. Paternal smoking and germ cell death: A mechanistic link to the effects of cigarette smoke on spermatogenesis and possible long-term sequelae in offspring. Molecular and Cellular Endocrinology, 2016; 435:85-93. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27424142
140. Morkve Knudsen GT, Rezwan FI, Johannessen A, Skulstad SM, Bertelsen RJ, et al. Epigenome-wide association of father's smoking with offspring DNA methylation: a hypothesis-generating study. Environ Epigenet, 2019; 5(4):dvz023. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31827900
141. Beal MA, Yauk CL, and Marchetti F. From sperm to offspring: Assessing the heritable genetic consequences of paternal smoking and potential public health impacts. Mutat Res Rev Mutat Res, 2017; 773:26-50. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28927533
142. Cao Y, Lu J, and Lu J. Paternal Smoking Before Conception and During Pregnancy Is Associated With an Increased Risk of Childhood Acute Lymphoblastic Leukemia: A Systematic Review and Meta-Analysis of 17 Case-Control Studies. Journal of Pediatric Hematology/Oncology, 2020; 42(1):32-40. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31743318
143. Bailey HD, Lacour B, Guerrini-Rousseau L, Bertozzi AI, Leblond P, et al. Parental smoking, maternal alcohol, coffee and tea consumption and the risk of childhood brain tumours: the ESTELLE and ESCALE studies (SFCE, France). Cancer Causes and Control, 2017; 28(7):719-32. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28477209
144. Axelsson J, Sabra S, Rylander L, Rignell-Hydbom A, Lindh CH, et al. Association between paternal smoking at the time of pregnancy and the semen quality in sons. PLoS ONE, 2018; 13(11):e0207221. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30462692
145. Biederman J, Fitzgerald M, Spencer TJ, Bhide PG, McCarthy DM, et al. Is Paternal Smoking at Conception a Risk for ADHD? A Controlled Study in Youth With and Without ADHD. Journal of Attention Disorders, 2020; 24(11):1493-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28152645
146. Northstone K, Golding J, Davey Smith G, Miller LL, and Pembrey M. Prepubertal start of father's smoking and increased body fat in his sons: further characterisation of paternal transgenerational responses. European Journal of Human Genetics, 2014; 22(12):1382-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24690679
147. Carslake D, Pinger PR, Romundstad P, and Davey Smith G. Early-Onset Paternal Smoking and Offspring Adiposity: Further Investigation of a Potential Intergenerational Effect Using the HUNT Study. PLoS ONE, 2016; 11(12):e0166952. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27911909
148. Accordini S, Calciano L, Johannessen A, Portas L, Benediktsdottir B, et al. A three-generation study on the association of tobacco smoking with asthma. International Journal of Epidemiology, 2018; 47(4):1106-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29534228
149. Luo R, Zhang H, Mukherjee N, Karmaus W, Patil V, et al. Association of grandmaternal smoking during pregnancy with DNA methylation of grandchildren: the Isle of Wight study. Epigenomics, 2021; 13(18):1473-83. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34596434
150. Lodge CJ, Braback L, Lowe AJ, Dharmage SC, Olsson D, et al. Grandmaternal smoking increases asthma risk in grandchildren: A nationwide Swedish cohort. Clinical and Experimental Allergy, 2018; 48(2):167-74. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28925522
151. Li YF, Langholz B, Salam MT, and Gilliland FD. Maternal and grandmaternal smoking patterns are associated with early childhood asthma. Chest, 2005; 127(4):1232-41. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15821200
152. Magnus MC, Haberg SE, Karlstad O, Nafstad P, London SJ, et al. Grandmother's smoking when pregnant with the mother and asthma in the grandchild: the Norwegian Mother and Child Cohort Study. Thorax, 2015; 70(3):237-43. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25572596
153. Mahon GM, Koppelman GH, and Vonk JM. Grandmaternal smoking, asthma and lung function in the offspring: the Lifelines cohort study. Thorax, 2021. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33542091
154. Golding J, Tunstall H, Gregory S, Granell R, Dodd JW, et al. A history of asthma may be associated with grandparents' exposures to stress and cigarette smoking. Front Toxicol, 2023; 5:1253442. Available from: https://www.ncbi.nlm.nih.gov/pubmed/37808180
155. Golding J, Northstone K, Gregory S, Miller LL, and Pembrey M. The anthropometry of children and adolescents may be influenced by the prenatal smoking habits of their grandmothers: a longitudinal cohort study. Am J Hum Biol, 2014; 26(6):731-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25130101
156. Miller LL, Pembrey M, Davey Smith G, Northstone K, and Golding J. Is the growth of the fetus of a non-smoking mother influenced by the smoking of either grandmother while pregnant? PLoS ONE, 2014; 9(2):e86781. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24504157
157. Rillamas-Sun E, Harlow SD, and Randolph JF, Jr. Grandmothers' smoking in pregnancy and grandchildren's birth weight: comparisons by grandmother birth cohort. Maternal and Child Health Journal, 2014; 18(7):1691-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24337862
158. Rumrich IK, Hanninen O, Viluksela M, and Vahakangas K. Effect of Grandmaternal Smoking on Body Size and Proportions at Birth. International Journal of Environmental Research and Public Health, 2021; 18(9). Available from: https://www.ncbi.nlm.nih.gov/pubmed/34067158
159. Mustakim, Ishikuro M, Kawaguchi C, Shinoda G, Noda A, et al. Small for gestational age by grandmaternal smoking during pregnancy: Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. J Dev Orig Health Dis, 2025; 16:e46. Available from: https://www.ncbi.nlm.nih.gov/pubmed/41392872
160. Villamor E, Miglin AK, and Cnattingius S. Multigenerational smoking during pregnancy and risk of stillbirth: A population-based three-generation cohort study. American Journal of Obstetrics and Gynecology, 2025. Available from: https://www.ncbi.nlm.nih.gov/pubmed/41297780
161. Yim G, Roberts A, Ascherio A, Wypij D, Kioumourtzoglou MA, et al. Smoking During Pregnancy and Risk of Attention-Deficit/Hyperactivity Disorder in the Third Generation. Epidemiology, 2022. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35213510