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9
Parental smoking and spirometric indices in children
Department of Public Health Sciences, St George's
Hospital Medical School, Cranmer Terrace, London SW17 0RE
Correspondence to: Dr D G Cook.
BACKGROUND
A systematic quantitative review was
conducted of the evidence relating parental smoking to spirometric
indices in children.
METHODSAn electronic search of the Embase and
Medline databases was completed in April 1997 and identified 692 articles from which we included four studies in neonates, 42 cross-sectional studies in school aged children (22 were included in a
meta-analysis), and six longitudinal studies of lung function development.
RESULTSIn a pooled analyses of 21 surveys of
school aged children the percentage reduction in forced expiratory
volume in one second (FEV1) in children exposed to parental
smoking compared with those not exposed was 1.4% (95% CI 1.0 to 1.9).
Effects were greater on mid expiratory flow rates (5.0% reduction,
95% CI 3.3 to 6.6) and end expiratory flow rates (4.3% reduction,
95% CI 3.1 to 5.5). Adjustment for potential confounding variables had
little effect on the estimates. A number of studies reported clear
evidence of exposure response. Where exposure was explicitly identified it was usually maternal smoking. Two studies in neonates have reported
effects of prenatal exposure to maternal smoking. Of five cross
sectional studies that compared effects of perinatal exposure
(retrospectively assessed) with current exposure to maternal smoking in
later childhood, the three largest concluded that the major effect was
in utero or neonatal exposure. Longitudinal studies suggest a small
effect of current exposure on growth in lung function, but with some
heterogeneity between studies.
CONCLUSIONSMaternal smoking is associated with
small but statistically significant deficits in FEV1 and
other spirometric indices in school aged children. This is almost
certainly a causal relationship. Much of the effect may be due to
maternal smoking during pregnancy.
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