Prenatal Tobacco Exposure and the Risk of Tobacco Smoking and Dependence in Offspring: a Systematic Review and Meta-Analysis.

Abstract Background There is some compelling, though not comprehensive, epidemiological evidence which suggests an association between prenatal tobacco exposure and tobacco smoking/dependence in offspring. We conducted a systematic review and meta-analysis to identify the magnitude and consistency of associations reported between prenatal tobacco exposure and subsequent tobacco smoking/dependence in offspring. Methods Using the PRISMA guideline, we systematically searched PubMed, SCOPUS, EMBASE and Psych-INFO to identify relevant studies. The methodological quality of all identified studies was checked by the Newcastle-Ottawa Scale. Inverse variance weighted random effects meta-analysis was used to estimate pooled risk ratio (RR) and 95 % confidence intervals (CI). We stratified outcomes by tobacco smoking initiation, lifetime tobacco smoking, current tobacco smoking and tobacco dependence. We further performed subgroup and leave-one-out sensitivity analyses. The protocol of this review was registered in the PROSPERO. Results Twenty-six cohort and one case-control study were included in the final meta-analysis. We found elevated pooled risks of tobacco smoking initiation [RR = 2.08, (95 % CI: 1.18–3.68)], ever tobacco smoking [RR = 1.21, (95 % CI: 1.05–1.38)], current tobacco smoking [RR = 1.70, (95 % CI: 1.48–1.95)] and tobacco dependence [RR = 1.50, (95 % CI: 1.31–1.73)] in offspring exposed to maternal prenatal tobacco use compared to non-exposed. We also noted higher risk estimate of current tobacco smoking in offspring exposed to heavy prenatal tobacco smoking [RR = 1.68, (95 % CI: 1.26–2.23)] when compared to prenatal exposure to lighter tobacco use [RR = 1.39, (95 % CI: 1.09–1.78)]. There was no association observed between paternal smoking during pregnancy and tobacco smoking in offspring. Conclusion Offspring exposed to maternal prenatal tobacco smoking are at an increased risk of tobacco smoking/dependence, indicating that tobacco smoking cessation during gestation may be imperative to reduce these risks in offspring.