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Maternal smoking during pregnancy - Long-term health effects in the offspring

Mattsson, Kristina LU (2015) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2015:110.
Abstract (Swedish)
Popular Abstract in Swedish

Idag röker cirka 6% av alla gravida kvinnor i Sverige. I vissa regioner är andelen så hög som en av tio gravida kvinnor. Trots att det betyder att det har skett en kraftig nedgång sedan man började mäta utbredningen av graviditetsrökning i början på 80-talet, visar siffror att denna nedgång verkar ha avstannat.

Det är känt sedan länge att rökning under graviditeten är skadligt för barnet på kort sikt, med en ökad risk för bland annat för tidig födsel, låg födelsevikt och spontan abort. Däremot vet man fortfarande mycket lite om huruvida det kvarstår några negativa hälsoeffekter upp i vuxen ålder av att ha utsatts för tobaksrökning under fosterlivet. Detta är till stor del på grund av att... (More)
Popular Abstract in Swedish

Idag röker cirka 6% av alla gravida kvinnor i Sverige. I vissa regioner är andelen så hög som en av tio gravida kvinnor. Trots att det betyder att det har skett en kraftig nedgång sedan man började mäta utbredningen av graviditetsrökning i början på 80-talet, visar siffror att denna nedgång verkar ha avstannat.

Det är känt sedan länge att rökning under graviditeten är skadligt för barnet på kort sikt, med en ökad risk för bland annat för tidig födsel, låg födelsevikt och spontan abort. Däremot vet man fortfarande mycket lite om huruvida det kvarstår några negativa hälsoeffekter upp i vuxen ålder av att ha utsatts för tobaksrökning under fosterlivet. Detta är till stor del på grund av att det fram tills nu har saknats data som man kan använda för att undersöka samband som spänner över så lång tid.

I Sverige finns stora register som täcker hela befolkningen, som lämpar sig väl för att undersöka sådana frågeställningar, då många av dessa register är flera decennier gamla. Ett sådant register är det Medicinska Födelseregistret, som i princip täcker alla födslar i Sverige sedan 1973. Den huvudsakliga datan för detta projekt är hämtad från detta register.

Syftet med den här avhandlingen var att undersöka potentiella hälsoeffekter i det långa perspektivet av att ha utsatts för tobaksrökning under sitt fosterliv. Mer specifikt ville vi undersöka om en sådan exponering var relaterad till en högre risk för typ 1-diabetes hos barn, samt övervikt, graviditetsdiabetes och havandeskapsförgiftning hos vuxna kvinnor.

Eftersom denna forskning är baserad på självrapporterad registerdata om rökvanor, var ett ytterligare syfte även att undersöka kvaliteten på rökdatan i Medicinska Födelseregistret med hjälp av en biomarkör för nikotinexponering (kotinin).

Vi fann i våra studier att risken ökade för både övervikt, graviditetsdiabetes och typ 1-diabetes om man varit utsatt för tobaksrökning under fosterlivet. Möjligen kunde man också se en svag riskökning för havandeskapsförgiftning, men här var sambanden mindre robusta. Ett viktigt fynd ur metodologisk synvinkel var att kvaliteten på rökdatan i Medicinska Födelseregistret befanns vara hög, varför den går bra att använda i epidemiologisk forskning.

Sammanfattningsvis kan sägas att fosterexponering för tobaksrökning kan ha långtgående konsekvenser, så det finns goda skäl att fortsatt försöka hjälpa kvinnor att sluta röka när de blir gravida. (Less)
Abstract
Globally, around 10 % of women smoke during pregnancy today. It is known that pregnancy smoking increases the risk of adverse short-term health effects in the offspring, such as preterm birth, low birthweight and spontaneous abortion. Less is known about whether any adverse health effects persist until adulthood.

In Sweden, there are nationwide population-based health registers that are becoming intergenerational, which lend themselves well for the study of such associations. This thesis is primarily based on the Swedish Medical Birth Register, which covers almost all births in Sweden since 1973. Additional data sources include a perinatal quality register (Perinatal Revision South Register), a regional biobank (Malmö Maternity... (More)
Globally, around 10 % of women smoke during pregnancy today. It is known that pregnancy smoking increases the risk of adverse short-term health effects in the offspring, such as preterm birth, low birthweight and spontaneous abortion. Less is known about whether any adverse health effects persist until adulthood.

In Sweden, there are nationwide population-based health registers that are becoming intergenerational, which lend themselves well for the study of such associations. This thesis is primarily based on the Swedish Medical Birth Register, which covers almost all births in Sweden since 1973. Additional data sources include a perinatal quality register (Perinatal Revision South Register), a regional biobank (Malmö Maternity Unit Serum Biobank), and prospective clinical study cohorts including all children who developed type 1 diabetes in Skåne between 1999 and 2005 (The Diabetes Prediction in Skåne Cohort, The Skåne Study and Better Diabetes Diagnosis Study).

The aim of this thesis was to investigate if maternal smoking during pregnancy was associated with long-term health effects in her offspring, by specifically looking at the risk of childhood type 1 diabetes, as well as the risk of obesity, gestational diabetes and preeclampsia in adult women. We also investigated the validity of the self-reported smoking data in the Medical Birth Register, by the use of biomarker measurements.

We found a higher risk of both type 1 diabetes, obesity and gestational diabetes in those exposed to tobacco smoking prenatally, but less consistent associations with preeclampsia. The validity of the self-reported smoking data in the Medical Birth Register was found to be high.

In conclusion, our studies suggest that maternal pregnancy smoking could have long-term health effects for her children, so there is reason to continue to make efforts to help women quit smoking when they are pregnant. When performing research on pregnancy smoking, Swedish register-data are of good quality and can be used. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Almqvist-Malmros, Catarina, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Maternal smoking during pregnancy, Medical Birth Register, long-term health effects, register validation, biomarker
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2015:110
pages
95 pages
publisher
Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University
defense location
Belfragesalen, BMC (D:15), Klinikgatan 32, Lund
defense date
2015-11-20 13:00
ISSN
1652-8220
ISBN
978-91-7619-189-7
language
English
LU publication?
yes
id
82d6887b-edb8-42f8-8fb8-9ad3b873d994 (old id 8161245)
date added to LUP
2015-11-04 12:36:17
date last changed
2016-09-19 08:44:49
@phdthesis{82d6887b-edb8-42f8-8fb8-9ad3b873d994,
  abstract     = {Globally, around 10 % of women smoke during pregnancy today. It is known that pregnancy smoking increases the risk of adverse short-term health effects in the offspring, such as preterm birth, low birthweight and spontaneous abortion. Less is known about whether any adverse health effects persist until adulthood.<br/><br>
In Sweden, there are nationwide population-based health registers that are becoming intergenerational, which lend themselves well for the study of such associations. This thesis is primarily based on the Swedish Medical Birth Register, which covers almost all births in Sweden since 1973. Additional data sources include a perinatal quality register (Perinatal Revision South Register), a regional biobank (Malmö Maternity Unit Serum Biobank), and prospective clinical study cohorts including all children who developed type 1 diabetes in Skåne between 1999 and 2005 (The Diabetes Prediction in Skåne Cohort, The Skåne Study and Better Diabetes Diagnosis Study).<br/><br>
The aim of this thesis was to investigate if maternal smoking during pregnancy was associated with long-term health effects in her offspring, by specifically looking at the risk of childhood type 1 diabetes, as well as the risk of obesity, gestational diabetes and preeclampsia in adult women. We also investigated the validity of the self-reported smoking data in the Medical Birth Register, by the use of biomarker measurements.<br/><br>
We found a higher risk of both type 1 diabetes, obesity and gestational diabetes in those exposed to tobacco smoking prenatally, but less consistent associations with preeclampsia. The validity of the self-reported smoking data in the Medical Birth Register was found to be high.<br/><br>
In conclusion, our studies suggest that maternal pregnancy smoking could have long-term health effects for her children, so there is reason to continue to make efforts to help women quit smoking when they are pregnant. When performing research on pregnancy smoking, Swedish register-data are of good quality and can be used.},
  author       = {Mattsson, Kristina},
  isbn         = {978-91-7619-189-7},
  issn         = {1652-8220},
  keyword      = {Maternal smoking during pregnancy,Medical Birth Register,long-term health effects,register validation,biomarker},
  language     = {eng},
  pages        = {95},
  publisher    = {Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {Maternal smoking during pregnancy - Long-term health effects in the offspring},
  volume       = {2015:110},
  year         = {2015},
}