Prenatal smoking exposure and cardio-metabolic risk factors in adulthood: a general population study and a meta-analysis

Objective Prenatal smoking exposure is associated with obesity and other cardio-metabolic risk factors in children, but no previous meta-analysis has been conducted in adults. Methods We investigated the association of prenatal smoking exposure in the Danish General Suburban Population Study (GESUS) with BMI, waist circumference, total cholesterol, type 2 diabetes, gestational type 2 diabetes, and hypertension in adulthood. We subsequently performed a meta-analysis, adding published studies investigating the association between prenatal smoking and the risk of cardio-metabolic outcomes among individuals at least 18 years of age. Results We included 19 eligible observational studies with various cardio-metabolic outcomes ( N = 24,201–308,981 adults). In individuals exposed to prenatal smoking, the pooled random effects adjusted odds ratio were 1.35 (95% CI: 1.16–1.56) for being overweight, 1.46 (1.39–1.54) for being obese, 1.07 (0.89–1.29) for type 2 diabetes, 1.17 (0.92–1.48) for hypertension, and 1.38 (1.19–1.61) for gestational diabetes mellitus (GDM), compared with no exposure. The standardized means in waist circumference, total cholesterol, diastolic, and systolic blood pressure were not different in individuals exposed vs. not exposed to prenatal smoking. Heterogeneity was moderate to high (51%