"Prenatal tobacco smoke exposure and neurological impairment at 10 years of age among extremely preterm children: a prospective cohort"

2021 
OBJECTIVE To determine the association between prenatal tobacco smoke exposure and neurological impairment at 10 years of age among children born extremely preterm (<28 weeks gestation). DESIGN The Extremely Low Gestational Age Newborn (ELGAN) Study, a prospective cohort SETTING: 10-year follow-up of extremely preterm infants born between 2002-2004 at 14 U.S. hospitals METHODS: Prenatal tobacco smoke exposure was defined as a mother's report at enrollment of active (i.e., maternal) and passive smoking during pregnancy. Poisson regression with generalized estimating equations was used. Models adjusted for mother's age, race/ethnicity, education, insurance, pre-pregnancy body mass index, U.S region, multiple gestation, and infant's sex; and in sensitivity analysis, gestational age at delivery and clinical subtype of preterm birth, given their classification as intermediate and non-confounding variables. MAIN OUTCOMES Neurological impairment at 10 years, epilepsy, cerebral palsy, and cognitive impairment. RESULTS Of 1,200 ELGAN study survivors, 856 were assessed at 10 years of age with neurological outcomes, of whom 14% (118/856) to active tobacco exposure during pregnancy and 24% (207/852) to passive tobacco exposure. Compared to children who were not exposed prenatally to tobacco, children exposed to active tobacco use during pregnancy had a higher risk of epilepsy (14% vs. 5%; aRR: 1.68, 95% CI: 1.45 to 1.92). This risk remained after adjustment for gestational age at delivery and clinical subtype of preterm birth. Prenatal tobacco smoke exposure was not associated with other assessed neurological outcomes, including cerebral palsy and multiple measures of cognitive impairment. CONCLUSIONS Among children born extremely preterm, prenatal active tobacco smoke exposure was associated with an increased risk of epilepsy at 10 years of life.
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