Parental smoking during pregnancy and the risk of gestational diabetes in the daughter

Abstract

Background: Fetal exposure to parental smoking may have long-term impact on the development of disease in adulthood. We examined the association of parental smoking during pregnancy with risk of gestational diabetes mellitus (GDM) in the daughter.

Methods: We included 15,665 singleton pregnancies from 10,152 women in the Nurses' Health Study II cohort whose mothers participated in the Nurses' Mothers' Cohort Study. Data on maternal and paternal smoking during pregnancy and associated covariates were recalled by the mothers. GDM diagnosis was self-reported by the daughters and was validated by medical record review in a previous study. We used log-binomial models with generalized estimating equations to estimate relative risks (RRs) and 95% confidence intervals (CIs).

Results: We observed a positive association between maternal heavy smoking during pregnancy and risk of GDM in the daughter. The multivariable-adjusted RRs (95% CIs) of GDM among women whose mothers did not smoke during pregnancy, continued smoking 1-14, 15-24, and ≥ 25 cigarettes/day were 1.00 (reference), 1.05 (0.81-1.35), 1.27 (0.95-1.70) and 1.98 (1.18-3.30), respectively (P for trend = 0.01). Further adjustment for the women's perinatal variables, adult-life characteristics and body mass index during various periods of life modestly attenuated the association. No association was observed between paternal smoking during the pregnancy period and risk of GDM in the daughter.

Conclusions: Maternal heavy smoking (≥ 25 cigarettes/day) during pregnancy was associated with higher risk of gestational diabetes in the daughter. Further studies are warranted to confirm our findings and to elucidate the underlying mechanisms.

Keywords: Gestational diabetes mellitus; maternal smoking during pregnancy.

Figure 1

The flowchart of study participants. Exclusion criteria are not mutually exclusive and individual reasons may not total the number of excluded participants. GDM denotes gestational diabetes mellitus; NHSII, Nurses’ Health Study II; NMS, Nurses’ Mothers’ Cohort Study; T2DM, type 2 diabetes mellitus.

Figure 2

Joint effect of maternal smoking during pregnancy and the daughter’s smoking during adulthood on the risk of GDM in the daughter. The symbol ‘+’ indicates smoking ≥ 15 cigarettes/day, ‘-’ indicates no smoking or smoking < 15 cigarettes/day. The symbol before and after the ‘/’ denotes smoking status of the mothers and the daughters, respectively. Covariates included the daughters’ age, maternal and paternal age at time of the daughter’s birth, maternal pre-pregnancy body mass index, paternal body mass index, maternal weight gain during pregnancy, maternal pregnancy complications (gestational diabetes, preeclampsia), maternal consumption of alcoholic beverages during pregnancy, paternal smoking during pregnancy, daughter’s race/ethnicity, gestational age at birth, breastfeeding status, birth eight, parity, family history of diabetes, physical activity, total energy intake, overall diet quality (i.e. Alternate Healthy Eating Index), BMI at 18 years old and updated adulthood BMI.