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The Influence of Cigarette Smoking on Antenatal Growth, Birth Size, and the Insulin-Like Growth Factor Axis

Centre for Human Growth and Maturation at the London Centre for Paediatric Endocrinology and Metabolism (P.J.P., S.K.-K., P.C.H.) and Department of Obstetrics and Gynaecology (C.H.R.), University College London, London W1T 3AA, United Kingdom; Department of Obstetrics and Gynaecology (M.P.P.G.), Rotunda Hospital, Dublin 1, Ireland; and Program in Development and Fetal Health (J.C.P.K.), Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Toronto M5G 1X5, Canada

Address all correspondence and requests for reprints to: Dr. P. C. Hindmarsh, Centre for Human Growth and Maturation, Cobbold Laboratories, Middlesex Hospital, Mortimer Street, London W1T 3AA, United Kingdom. E-mail: p.hindmarsh{at}ucl.ac.uk.

Background: Maternal smoking during pregnancy is associated with a reduction in birth size. Very few studies have collated changes in fetal biometry, neonatal anthropometry, biochemical factors involved in fetal growth, and measures of uterine and umbilical blood flow.

Methods: We related smoking status in 1650 low-risk, singleton Caucasian pregnancies delivering at term to measures of fetal growth, uterine and umbilical artery blood flow, placental appearance, birth size, and cord concentrations of IGF-I and -II and IGF binding protein (IGFBP)-3.

Results: Mothers who smoked in pregnancy were younger (P < 0.001) and shorter (P = 0.03) and from lower socioeconomic groups (P < 0.001). Mean umbilical artery blood flow at 20 wk gestation was not associated with smoking status but was significantly higher in smokers at 30 wk (P = 0.006). Uterine artery blood flow was unaffected. Smoking was associated with an increase in the percentage of abnormal placentas in a dose-dependent manner and with a 3.1-fold increased risk (odds ratio 3.1, 95% confidence interval 1.3–7.6) of abnormal umbilical artery blood flow (P = 0.009). Smoking was associated with a reduction in fetal femur length (P = 0.005) and abdominal circumference as well as birth weight, length, and head circumference but not skinfold thickness. Cord plasma concentrations of IGF-I and IGFBP-3 were lower in the babies of mothers who had smoked (P = 0.02 and P = 0.01, respectively).

Conclusion: We concluded that maternal smoking is associated with an altered placental appearance on ultrasonography, increased umbilical artery blood flow resistance, and a reduction in longitudinal and intraabdominal organ growth. Circulating concentrations of IGF-I and IGFBP-3 along with measures of birth size but not markers of body fat are reduced, suggesting smoking results in a reduction in organ size and function.

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