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Maternal Smoking, Breastfeeding, and Risk of Childhood Overweight: Findings from a National Cohort

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Abstract

To examine the association between exposure to tobacco compounds in breast milk and risk of childhood overweight, we used historical data for a subset of 21,063 mother–child pairs in the US Collaborative Perinatal Project. Based on self-reports, mothers were classified as non-smokers, light (1–9 cigarettes/day), moderate (10–19), or heavy (20+) smokers. Feeding type (exclusive breastfeeding or bottle-feeding) was observed during nursery stay after birth. We stratified children by maternal smoking and feeding type, and then fit interaction terms to isolate exposure to tobacco compounds via breast milk from exposure in uterus and in ambient air after birth. Using measured weight and height, overweight at age 7 was defined as a body mass index ≥85th percentile by sex and age. Among exclusively bottle-fed children, adjusted odds ratios (ORs) of overweight at age 7 were 1.24 (95 % confidence interval [CI], 1.12–1.38; vs. non-smoking) for light maternal smoking, 1.43 (95 % CI, 1.25–1.63) for moderate maternal smoking, and 1.46 (95 % CI, 1.28–1.66) for heavy maternal smoking. Among exclusively breastfed children, the corresponding ORs were 1.33 (95 % CI, 0.96–1.84) for light, 1.86 (95 % CI, 1.27–2.73) for moderate, and 2.22 (95 % CI, 1.53–3.20) for heavy maternal smoking. There was a modest positive interaction between breastfeeding and heavy maternal smoking on overweight risk at age 7. Tobacco compounds via breast milk of smoking mothers (significantly for heavy smokers) appear to be associated with a modest elevation in childhood overweight risk at 7 years of age. More aggressive intervention is needed to help pregnant and breastfeeding women to quit smoking.

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Acknowledgments

The authors appreciate the assistance of Dr. Michelle L. Rogers and Ms. Kathleen McGaffigan in data preparation. This analysis was supported by Flight Attendants Medical Research Institute and by grant R40MC03600-01-00 from the Maternal and Child Health Bureau, Department of Health and Human Services; National Institutes of Health (NIH) Transdisciplinary Tobacco Use Research Center (TTURC) Award (P50 CA084719) by the National Cancer Institute; the National Institute on Drug Abuse; and the Robert Wood Johnson Foundation. Dr. Paradis was supported by a National Research Service Award (grant number T32 MH17119) from the Harvard Training Program in Psychiatric Epidemiology and Biostatistics. Financial Disclosure: None reported.

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Authors and Affiliations

  1. Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA

    Xiaozhong Wen

  2. Maternal and Child Health Program, Department of Family Science, University of Maryland, 1142GG School of Public Health, College Park, MD, 20742, USA

    Edmond D. Shenassa

  3. Department of Epidemiology, Brown University, Providence, RI, USA

    Edmond D. Shenassa & Angela D. Paradis

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  1. Xiaozhong Wen
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  2. Edmond D. Shenassa
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Correspondence to Edmond D. Shenassa.

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Wen, X., Shenassa, E.D. & Paradis, A.D. Maternal Smoking, Breastfeeding, and Risk of Childhood Overweight: Findings from a National Cohort. Matern Child Health J 17, 746–755 (2013). https://doi.org/10.1007/s10995-012-1059-y

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