Association of Maternal Smoking During Pregnancy With Childhood Blood Pressure and Hypertension in the ECHO Cohort

Lyndsey E Shorey-Kendrick^#¹, Christine Ladd-Acosta^#², Haozuo Zhao², Judy L Aschner³, Carrie V Breton⁴, Carlos A Camargo Jr⁵, Andrea E Cassidy-Bushrow^{6

7}, Elena Colicino⁸, Dana Dabelea⁹, Anne L Dunlop¹⁰, Shohreh F Farzan⁴, Assiamira Ferrara¹¹, James E Gern¹², Irva Hertz-Picciotto¹³, Margaret R Karagas¹⁴, Catherine J Karr¹⁵, Barry Lester¹⁶, Leslie D Leve¹⁷, Brianna F Moore⁹, Jenae M Neiderhiser¹⁸, Emily Oken¹⁹, T Michael O'Shea²⁰, Keia Sanderson²⁰, Joseph B Stanford²¹, Leonardo Trasande²², Scott T Weiss²³, Rosalind J Wright²⁴, Qi Zhao²⁵, Yeyi Zhu²⁶, Cindy T McEvoy²⁷, Eliot R Spindel¹; ECHO Cohort Consortium

Collaborators, Affiliations

Collaborators

ECHO Cohort Consortium:
P Brian Smith, L Kristin Newby, Linda Adair, Lisa P Jacobson, Diane Catellier, Monica McGrath, Christian Douglas, Priya Duggal, Emily Knapp, Amii Kress, Courtney K Blackwell, Maxwell A Mansolf, Jin-Shei Lai, Emily Ho, David Cella, Richard Gershon, Michelle L Macy, Suman R Das, Jane E Freedman, Simon A Mallal, John A McLean, Ravi V Shah, Meghan H Shilts, Akram N Alshawabkeh, Jose F Cordero, John Meeker, Leonardo Trasande, Carlos A Camargo, Kohei Hasegawa, Zhaozhong Zhu, Ashley F Sullivan, Dana Dabelea, Wei Perng, Traci A Bekelman, Greta Wilkening, Sheryl Magzamen, Brianna F Moore, Anne P Starling, Deborah J Rinehart, Daphne Koinis Mitchell, Viren D'Sa, Sean C L Deoni, Hans-Georg Mueller, Cristiane S Duarte, Catherine Monk, Glorisa Canino, Jonathan Posner, Tenneill Murray, Claudia Lugo-Candelas, Anne L Dunlop, Patricia A Brennan, Christine Hockett, Amy Elliott, Assiamira Ferrara, Lisa A Croen, Monique M Hedderson, John Ainsworth, Leonard B Bacharier, Casper G Bendixsen, James E Gern, Diane R Gold, Tina V Hartert, Daniel J Jackson, Christine C Johnson, Christine L M Joseph, Meyer Kattan, Gurjit K Khurana Hershey, Robert F Lemanske Jr, Susan V Lynch, Rachel L Miller, George T O'Connor, Carole Ober, Dennis Ownby, Katherine Rivera-Spoljaric, Patrick H Ryan, Christine M Seroogy, Anne Marie Singh, Robert A Wood, Edward M Zoratti, Rima Habre, Shohreh Farzan, Frank D Gilliland, Irva Hertz-Picciotto, Deborah H Bennett, Julie B Schweitzer, Rebecca J Schmidt, Janine M LaSalle, Alison E Hipwell, Catherine J Karr, Nicole R Bush, Kaja Z LeWinn, Sheela Sathyanarayana, Qi Zhao, Frances Tylavsky, Kecia N Carroll, Christine T Loftus, Leslie D Leve, Jody M Ganiban, Jenae M Neiderhiser, Scott T Weiss, Augusto A Litonjua, Cindy T McEvoy, Eliot R Spindel, Robert S Tepper, Craig J Newschaffer, Kristen Lyall, Heather E Volk, Rebecca Landa, Sally Ozonoff, Joseph Piven, Heather Hazlett, Juhi Pandey, Robert Schultz, Steven Dager, Kelly Botteron, Daniel Messinger, Wendy Stone, Jennifer Ames, Thomas G O'Connor, Richard K Miller, Emily Oken, Michele R Hacker, Tamarra James-Todd, T Michael O'Shea, Rebecca C Fry, Jean A Frazier, Rachana Singh, Caitlin Rollins, Angela Montgomery, Ruben Vaidya, Robert M Joseph, Lisa K Washburn, Semsa Gogcu, Kelly Bear, Julie V Rollins, Stephen R Hooper, Genevieve Taylor, Wesley Jackson, Amanda Thompson, Julie Daniels, Michelle Hernandez, Kun Lu, Michael Msall, Madeleine Lenski, Rawad Obeid, Steven L Pastyrnak, Elizabeth Jensen, Christina Sakai, Hudson Santos, Jean M Kerver, Nigel Paneth, Charles J Barone, Michael R Elliott, Douglas M Ruden, Chris Fussman, Julie B Herbstman, Amy Margolis, Susan L Schantz, Sarah Dee Geiger, Andrea Aguiar, Karen Tabb, Rita Strakovsky, Tracey Woodruff, Rachel Morello-Frosch, Amy Padula, Joseph B Stanford, Christina A Porucznik, Angelo P Giardino, Rosalind J Wright, Robert O Wright, Brent Collett, Nicole Baumann-Blackmore, Ronald Gangnon, Daniel J Jackson, Chris G McKennan, Jo Wilson, Matt Altman, Judy L Aschner, Annemarie Stroustrup, Stephanie L Merhar, Paul E Moore, Gloria S Pryhuber, Mark Hudak, Ann Marie Reynolds Lyndaker, Andrea L Lampland, Burton Rochelson, Sophia Jan, Matthew J Blitz, Michelle W Katzow, Zenobia Brown, Codruta Chiuzan, Timothy Rafael, Dawnette Lewis, Natalie Meirowitz, Brenda Poindexter, Tebeb Gebretsadik, Sarah Osmundson, Jennifer K Straughen, Amy Eapen, Andrea Cassidy-Bushrow, Ganesa Wegienka, Alex Sitarik, Kim Woodcroft, Audrey Urquhart, Albert Levin, Tisa Johnson-Hooper, Brent Davidson, Tengfei Ma, Emily S Barrett, Martin J Blaser, Maria Gloria Dominguez-Bello, Daniel B Horton, Manuel Jimenez, Todd Rosen, Kristy Palomares, Lyndsay A Avalos, Yeyi Zhu, Kelly J Hunt, Roger B Newman, Michael S Bloom, Mallory H Alkis, James R Roberts, Sunni L Mumford, Heather H Burris, Sara B DeMauro, Lynn M Yee, Aaron Hamvas, Antonia F Olidipo, Andrew S Haddad, Lisa R Eiland, Nicole T Spillane, Kirin N Suri, Stephanie A Fisher, Jeffrey A Goldstein, Leena B Mithal, Raye-Ann O DeRegnier, Nathalie L Maitre, Ruby H N Nguyen, Meghan M JaKa, Abbey C Sidebottom, Michael J Paidas, JoNell E Potter, Natale Ruby, Lunthita Duthely, Arumugam Jayakumar, Karen Young, Isabel Maldonado, Meghan Miller, Jonathan L Slaughter, Sarah A Keim, Courtney D Lynch, Kartik K Venkatesh, Kristina W Whitworth, Elaine Symanski, Thomas F Northrup, Hector Mendez-Figueroa, Ricardo A Mosquera, Margaret R Karagas, Juliette C Madan, Debra M MacKenzie, Johnnye L Lewis, Brandon J Rennie, Bennett L Leventhal, Young Shin Kim, Somer Bishop, Sara S Nozadi, Li Luo, Barry M Lester, Carmen J Marsit, Todd Everson, Cynthia M Loncar, Elisabeth C McGowan, Stephen J Sheinkopf, Brian S Carter, Jennifer Check, Jennifer B Helderman, Charles R Neal, Lynne M Smith

Affiliations

¹ Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton (L.E.S.-K., E.R.S).
² Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (C.L.-A., H.Z.).
³ Center for Discovery and Innovation, Hackensack Meridian School of Medicine, Nutley, NJ (J.L.A.).
⁴ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles (C.V.B., S.F.F.).
⁵ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (C.A.C.).
⁶ Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI (A.E.C.-B.).
⁷ Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing (A.E.C.-B.).
⁸ Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY (E.C.).
⁹ Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora (D.D., B.F.M.).
¹⁰ Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA (A.L.D.).
¹¹ Upstream Prevention of Adiposity and Diabetes Mellitus Center, Division of Research, Kaiser Permanente Northern California, Oakland (A.F.).
¹² Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison (J.E.G.).
¹³ Department of Public Health Sciences, School of Medicine, University of California Davis (I.H.-P.).
¹⁴ Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH (M.R.K.).
¹⁵ Department of Environmental & Occupational Health Sciences, University of Washington, Seattle (C.J.K.).
¹⁶ Department of Pediatrics, Women & Infants Hospital, Brown Center for the Study of Children at Risk, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI (B.L.).
¹⁷ Prevention Science Institute, University of Oregon, Eugene (L.D.L.).
¹⁸ Department of Psychology, Penn State University, University Park (J.M.N.).
¹⁹ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (E.O.).
²⁰ Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill (T.M.O., K.S.).
²¹ Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City (J.B.S.).
²² Department of Pediatrics, New York University Grossman School of Medicine, New York, NY (L.T.).
²³ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.T.W.).
²⁴ Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.W.).
²⁵ Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (Q.Z.).
²⁶ Division of Research, Kaiser Permanente Northern California, Pleasanton (Y.Z.).
²⁷ Department of Pediatrics, Oregon Health & Science University, Portland (C.T.M.).

^# Contributed equally.

PMID: 41697983
PMCID: PMC12912780
DOI: 10.1161/CIRCULATIONAHA.125.076520

Association of Maternal Smoking During Pregnancy With Childhood Blood Pressure and Hypertension in the ECHO Cohort

Lyndsey E Shorey-Kendrick et al. Circulation. 2026.

. 2026 Feb 17;153(7):536-539.

doi: 10.1161/CIRCULATIONAHA.125.076520. Epub 2026 Feb 16.

Authors

Collaborators

ECHO Cohort Consortium:
P Brian Smith, L Kristin Newby, Linda Adair, Lisa P Jacobson, Diane Catellier, Monica McGrath, Christian Douglas, Priya Duggal, Emily Knapp, Amii Kress, Courtney K Blackwell, Maxwell A Mansolf, Jin-Shei Lai, Emily Ho, David Cella, Richard Gershon, Michelle L Macy, Suman R Das, Jane E Freedman, Simon A Mallal, John A McLean, Ravi V Shah, Meghan H Shilts, Akram N Alshawabkeh, Jose F Cordero, John Meeker, Leonardo Trasande, Carlos A Camargo, Kohei Hasegawa, Zhaozhong Zhu, Ashley F Sullivan, Dana Dabelea, Wei Perng, Traci A Bekelman, Greta Wilkening, Sheryl Magzamen, Brianna F Moore, Anne P Starling, Deborah J Rinehart, Daphne Koinis Mitchell, Viren D'Sa, Sean C L Deoni, Hans-Georg Mueller, Cristiane S Duarte, Catherine Monk, Glorisa Canino, Jonathan Posner, Tenneill Murray, Claudia Lugo-Candelas, Anne L Dunlop, Patricia A Brennan, Christine Hockett, Amy Elliott, Assiamira Ferrara, Lisa A Croen, Monique M Hedderson, John Ainsworth, Leonard B Bacharier, Casper G Bendixsen, James E Gern, Diane R Gold, Tina V Hartert, Daniel J Jackson, Christine C Johnson, Christine L M Joseph, Meyer Kattan, Gurjit K Khurana Hershey, Robert F Lemanske Jr, Susan V Lynch, Rachel L Miller, George T O'Connor, Carole Ober, Dennis Ownby, Katherine Rivera-Spoljaric, Patrick H Ryan, Christine M Seroogy, Anne Marie Singh, Robert A Wood, Edward M Zoratti, Rima Habre, Shohreh Farzan, Frank D Gilliland, Irva Hertz-Picciotto, Deborah H Bennett, Julie B Schweitzer, Rebecca J Schmidt, Janine M LaSalle, Alison E Hipwell, Catherine J Karr, Nicole R Bush, Kaja Z LeWinn, Sheela Sathyanarayana, Qi Zhao, Frances Tylavsky, Kecia N Carroll, Christine T Loftus, Leslie D Leve, Jody M Ganiban, Jenae M Neiderhiser, Scott T Weiss, Augusto A Litonjua, Cindy T McEvoy, Eliot R Spindel, Robert S Tepper, Craig J Newschaffer, Kristen Lyall, Heather E Volk, Rebecca Landa, Sally Ozonoff, Joseph Piven, Heather Hazlett, Juhi Pandey, Robert Schultz, Steven Dager, Kelly Botteron, Daniel Messinger, Wendy Stone, Jennifer Ames, Thomas G O'Connor, Richard K Miller, Emily Oken, Michele R Hacker, Tamarra James-Todd, T Michael O'Shea, Rebecca C Fry, Jean A Frazier, Rachana Singh, Caitlin Rollins, Angela Montgomery, Ruben Vaidya, Robert M Joseph, Lisa K Washburn, Semsa Gogcu, Kelly Bear, Julie V Rollins, Stephen R Hooper, Genevieve Taylor, Wesley Jackson, Amanda Thompson, Julie Daniels, Michelle Hernandez, Kun Lu, Michael Msall, Madeleine Lenski, Rawad Obeid, Steven L Pastyrnak, Elizabeth Jensen, Christina Sakai, Hudson Santos, Jean M Kerver, Nigel Paneth, Charles J Barone, Michael R Elliott, Douglas M Ruden, Chris Fussman, Julie B Herbstman, Amy Margolis, Susan L Schantz, Sarah Dee Geiger, Andrea Aguiar, Karen Tabb, Rita Strakovsky, Tracey Woodruff, Rachel Morello-Frosch, Amy Padula, Joseph B Stanford, Christina A Porucznik, Angelo P Giardino, Rosalind J Wright, Robert O Wright, Brent Collett, Nicole Baumann-Blackmore, Ronald Gangnon, Daniel J Jackson, Chris G McKennan, Jo Wilson, Matt Altman, Judy L Aschner, Annemarie Stroustrup, Stephanie L Merhar, Paul E Moore, Gloria S Pryhuber, Mark Hudak, Ann Marie Reynolds Lyndaker, Andrea L Lampland, Burton Rochelson, Sophia Jan, Matthew J Blitz, Michelle W Katzow, Zenobia Brown, Codruta Chiuzan, Timothy Rafael, Dawnette Lewis, Natalie Meirowitz, Brenda Poindexter, Tebeb Gebretsadik, Sarah Osmundson, Jennifer K Straughen, Amy Eapen, Andrea Cassidy-Bushrow, Ganesa Wegienka, Alex Sitarik, Kim Woodcroft, Audrey Urquhart, Albert Levin, Tisa Johnson-Hooper, Brent Davidson, Tengfei Ma, Emily S Barrett, Martin J Blaser, Maria Gloria Dominguez-Bello, Daniel B Horton, Manuel Jimenez, Todd Rosen, Kristy Palomares, Lyndsay A Avalos, Yeyi Zhu, Kelly J Hunt, Roger B Newman, Michael S Bloom, Mallory H Alkis, James R Roberts, Sunni L Mumford, Heather H Burris, Sara B DeMauro, Lynn M Yee, Aaron Hamvas, Antonia F Olidipo, Andrew S Haddad, Lisa R Eiland, Nicole T Spillane, Kirin N Suri, Stephanie A Fisher, Jeffrey A Goldstein, Leena B Mithal, Raye-Ann O DeRegnier, Nathalie L Maitre, Ruby H N Nguyen, Meghan M JaKa, Abbey C Sidebottom, Michael J Paidas, JoNell E Potter, Natale Ruby, Lunthita Duthely, Arumugam Jayakumar, Karen Young, Isabel Maldonado, Meghan Miller, Jonathan L Slaughter, Sarah A Keim, Courtney D Lynch, Kartik K Venkatesh, Kristina W Whitworth, Elaine Symanski, Thomas F Northrup, Hector Mendez-Figueroa, Ricardo A Mosquera, Margaret R Karagas, Juliette C Madan, Debra M MacKenzie, Johnnye L Lewis, Brandon J Rennie, Bennett L Leventhal, Young Shin Kim, Somer Bishop, Sara S Nozadi, Li Luo, Barry M Lester, Carmen J Marsit, Todd Everson, Cynthia M Loncar, Elisabeth C McGowan, Stephen J Sheinkopf, Brian S Carter, Jennifer Check, Jennifer B Helderman, Charles R Neal, Lynne M Smith

Affiliations

¹ Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton (L.E.S.-K., E.R.S).
² Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (C.L.-A., H.Z.).
³ Center for Discovery and Innovation, Hackensack Meridian School of Medicine, Nutley, NJ (J.L.A.).
⁴ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles (C.V.B., S.F.F.).
⁵ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (C.A.C.).
⁶ Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI (A.E.C.-B.).
⁷ Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing (A.E.C.-B.).
⁸ Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY (E.C.).
⁹ Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora (D.D., B.F.M.).
¹⁰ Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA (A.L.D.).
¹¹ Upstream Prevention of Adiposity and Diabetes Mellitus Center, Division of Research, Kaiser Permanente Northern California, Oakland (A.F.).
¹² Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison (J.E.G.).
¹³ Department of Public Health Sciences, School of Medicine, University of California Davis (I.H.-P.).
¹⁴ Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH (M.R.K.).
¹⁵ Department of Environmental & Occupational Health Sciences, University of Washington, Seattle (C.J.K.).
¹⁶ Department of Pediatrics, Women & Infants Hospital, Brown Center for the Study of Children at Risk, Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI (B.L.).
¹⁷ Prevention Science Institute, University of Oregon, Eugene (L.D.L.).
¹⁸ Department of Psychology, Penn State University, University Park (J.M.N.).
¹⁹ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (E.O.).
²⁰ Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill (T.M.O., K.S.).
²¹ Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City (J.B.S.).
²² Department of Pediatrics, New York University Grossman School of Medicine, New York, NY (L.T.).
²³ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.T.W.).
²⁴ Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY (R.J.W.).
²⁵ Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (Q.Z.).
²⁶ Division of Research, Kaiser Permanente Northern California, Pleasanton (Y.Z.).
²⁷ Department of Pediatrics, Oregon Health & Science University, Portland (C.T.M.).

^# Contributed equally.

PMID: 41697983
PMCID: PMC12912780
DOI: 10.1161/CIRCULATIONAHA.125.076520

No abstract available

Keywords: blood pressure; hypertension; maternal smoking in pregnancy.

PubMed Disclaimer

Conflict of interest statement

Dr Ladd-Acosta reports consulting fees from the University of Iowa for providing expertise on autism epigenetics, outside the scope of this work. Dr Weiss reports honoraria from UpToDate and is on the board of Histolix, a digital pathology company. The other authors report no conflicts.

Figures

**Figure 1.. Summary of association of MSDP with childhood blood pressure (BP: both systolic [SBP] and diastolic [DBP]) or hypertension in the ECHO Cohort.**
Effect sizes and 95% confidence intervals are shown on the x-axis (• unadjusted; ▲ adjusted for child race, maternal age at delivery, maternal pre-pregnancy BMI category, prenatal alcohol exposure, maternal education level, and child sex [hypertension models only]; ■ additionally adjusted for preterm birth). The top panel represents the effects of any MSDP ascertained via self-reported questionnaire or medical record in the total study population. The middle panel represents the effects of any MSDP in the subset of subjects with cotinine data. The bottom panel represents the effects of active smoking based on urine cotinine measured during the index pregnancy (no exposure: ≤1.6 ng/mL vs. active smoking: ≥75 ng/mL).

See this image and copyright information in PMC

References

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Association of Maternal Smoking During Pregnancy With Childhood Blood Pressure and Hypertension in the ECHO Cohort

Collaborators

Affiliations

Association of Maternal Smoking During Pregnancy With Childhood Blood Pressure and Hypertension in the ECHO Cohort

Authors

Collaborators

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Conflict of interest statement

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