Smoking during pregnancy may increase the risk of obesity through programming, resulting in lifelong metabolic dysregulation, possibly due to fetal malnutrition or toxicity. Following data from the British National Child Development Study (NCDS), the adjusted odds ratios (and 95% confidence intervals) for obesity associated with maternal smoking during pregnancy were 1.34 (1.07 to 1.69), 1.35 (0.95 to 1.92), and 1.38 (1.06 to 1.79), with a statistically significant trend (p 0.003) for medium, variable, and heavy smokers, respectively. Of note, non-diabetic cohort members who smoked at age 16 did not have an increased risk of obesity [79]. Similar results were obtained in a different analysis of the same data set [80]. Data from German school entry health examinations [81] show the same association of maternal smoking before or throughout pregnancy with obesity of the child. The highest prevalence of overweight and obesity was observed in children of mothers who had smoked throughout pregnancy. In children whose mothers claimed to have abandoned smoking in pregnancy, however, the prevalence of overweight and obesity was only slightly lower. This contrasts with the prevalence in children of mothers who had taken up smoking after pregnancy only, which was similar to that in children of non-smoking mothers [82]. Longterm effects of nicotine exposure on neurobehavioral impulse control has been shown in animal models and human studies [83–85]. Since smoking in women of childbearing age has increased during the last decades, smoking during pregnancy might contribute to the causes accounting for the present epidemic of adiposity in children.
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