Genetic and Epigenetic Alterations Associated With Human Prenatal Tobacco and Environmental Tobacco Smoke Exposure: Protocol for a Systematic Evidence Map

Abstract

Objectives: This protocol outlines the development of a systematic evidence map (SEM) on genetic and epigenetic alterations associated with human prenatal tobacco exposure. The SEM will identify and synthetize epidemiological data on periconceptional and prenatal tobacco exposure associated with genetic (e.g., DNA damage) and epigenetic (e.g., DNA methylation) outcomes. Furthermore, it will describe the available evidence, highlight knowledge clusters, and identify gaps for future research.

Methods: Bibliographic databases and grey literature sources will be searched, complemented by reference mining. Predefined inclusion and exclusion criteria will guide study inclusion. Data extraction will include population, exposure, comparator, outcome, funding, study design, confounding factors, and statistical methods. Summarization will include a narrative review, graphical visualization, and an interactive, queryable and open-access table.

Results: A pilot study assessed the protocol's feasibility, testing key components, including screening, data extraction, and eligibility criteria. Findings confirmed that the methodology is workable and reliable.

Conclusion: This protocol supports a rigorous, reproducible, transparent SEM, aligned with international standards. The comprehensive mapping will support research prioritization and inform public health policies targeting maternal and child health.

Keywords: environmental tobacco smoke; epigenetics; genotoxicity; human prenatal exposure; tobacco.

FIGURE 1

Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flow diagram (adapted from Page et al. [61]; Worldwide, 2023).