title: Fetal Smoke Exposure and Kidney Outcomes in School-Aged Children.
abstract: BACKGROUND
  Fetal smoke exposure may result in developmental adaptations that permanently affect the developing kidney. In this study, the associations of maternal and paternal smoking during pregnancy with childhood kidney size and function were assessed.
  
  
  METHODS
  Prospective cohort study from fetal life onward.
  
  
  METHODS
  This study was conducted in a group of 5,622 children in Rotterdam, the Netherlands.
  
  
  METHODS
  Maternal and paternal smoking were assessed during pregnancy by questionnaires.
  
  
  METHODS
  At a median age of 6.0 (5th-95th percentile, 5.6-7.9) years, we measured childhood kidney volumes, estimated glomerular filtration rate (eGFR), and albumin-creatinine ratio.
  
  
  RESULTS
  The confounder model, which included size at birth, shows that compared with children from mothers who did not smoke during pregnancy, those from mothers who continued smoking during pregnancy had smaller combined kidney volumes at the age of 6 years. The strongest effect estimate was observed for mothers who smoked 5 or more cigarettes per day during pregnancy (difference for combined kidney volume, -2.80 [95% CI, -5.15 to -0.45] cm(3)). Similarly, continued maternal smoking during pregnancy also was associated with a lower eGFR in childhood (difference, -2.25 [95% CI, -3.70 to -0.79] mL/min/1.73 m(2)). First-trimester-only smoking was associated with a higher risk of increased albumin-creatinine ratio (OR, 1.45; 95% CI, 1.05-2.01). Among mothers who did not smoke during pregnancy, paternal smoking was associated with smaller childhood combined kidney volume (difference, -1.78 [95% CI, -3.48 to -0.07] cm(3)), but not with childhood kidney function measures.
  
  
  CONCLUSIONS
  Smoking behavior was measured with questionnaires. Follow-up measurements were available for only 70% of the children.
  
  
  CONCLUSIONS
  Continued maternal smoking during pregnancy is associated with smaller combined kidney volume and lower eGFR in school-aged children. Stronger effect estimates for maternal versus paternal smoking suggest that intrauterine adaptive responses may play a role as underlying mechanisms.
authors: The Generation R Study Group, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Pediatrics, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands.
authors: Marjolein N
authors: MN
authors: Kooijman
authors: The Generation R Study Group, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Pediatrics, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands.
authors: Hanneke
authors: H
authors: Bakker
authors: Department of Epidemiology, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands.
authors: Oscar H
authors: OH
authors: Franco
authors: The Generation R Study Group, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands.
authors: Albert
authors: A
authors: Hofman
authors: The Generation R Study Group, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Pediatrics, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands.
authors: H Rob
authors: HR
authors: Taal
authors: The Generation R Study Group, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands; Department of Pediatrics, Erasmus University Medical Center, Rotterdam-Sophia's Children's Hospital, the Netherlands. Electronic address: v.jaddoe@erasmusmc.nl.
authors: Vincent W V
authors: VW
authors: Jaddoe
mesh_terms: D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D005260:Female; D005333:Fetus / Q000187:drug effects*; D006801:Humans; D007668:Kidney / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D018811:Maternal Exposure; D009929:Organ Size; D018812:Paternal Exposure; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000473:pathology* / Q000503:physiopathology*; D011446:Prospective Studies; D014028:Tobacco Smoke Pollution / Q000009:adverse effects / Q000706:statistics & numerical data*
chemical_list: D014028:Tobacco Smoke Pollution; D003404:Creatinine
keywords: Generation R Study; Maternal smoking; albumin-creatinine ratio (ACR); cigarette exposure; epidemiology; fetal influences; glomerular filtration rate (GFR); intrauterine development; kidney development; kidney size; kidney ultrasound; nephrogenesis; nephron number; paternal smoking; pregnancy; renal function; tobacco use