title: Association of Maternal Smoking During Pregnancy and Birth Weight With Retinal Nerve Fiber Layer Thickness in Children Aged 11 or 12 Years: The Copenhagen Child Cohort 2000 Eye Study.
abstract: Both maternal smoking during pregnancy and low birth weight have been implicated in impaired development of the retina.
  
  
  
  To investigate the associations of maternal smoking during pregnancy and low birth weight with retinal nerve fiber layer (RNFL) thickness in preadolescent children.
  
  
  
  The Copenhagen Child Cohort 2000 Eye Study is a prospective, population-based, birth cohort study that included all children (n = 6090) born in 2000 in Copenhagen, Denmark. Maternal smoking data were collected through parental interviews. Birth weight, pregnancy, and medical history data were obtained from the Danish Medical Birth Registry. As a follow-up, the study performed eye examinations on 1406 of these children from May 1, 2011, to October 31, 2012, when the children were aged 11 or 12 years. The participants were predominantly (1296 [92.4%]) of European descent. Study data were analyzed from June 1, 2016, to October 1, 2016.
  
  
  
  Peripapillary RNFL thickness measured using optical coherence tomography at the 11- or 12-year examination.
  
  
  
  Of the 1406 children in the study, 1323 were included in the analysis (mean [SD] age was 11.7 [0.4] years; 633 [47.8%] were boys and 690 [52.2%] were girls). The mean (SD) RNFL thickness was 104 (9.6) μm. In 227 children whose mothers had smoked during pregnancy, the peripapillary RNFL was 5.7 μm (95% CI, 4.3-7.1 μm; P < .001) thinner than in children whose mothers had not smoked after correction for age, sex, birth weight, height, body weight, Tanner stage of pubertal development, axial length, and spherical equivalent refractive error. In low-birth-weight children (<2500 g), the RNFL was 3.5 μm (95% CI, 0.6-6.3 μm; P = .02) thinner than in normal-birth-weight children after adjustment for all variables.
  
  
  
  Exposure to maternal smoking during uterine life and low birth weight were independently associated with having a thinner RNFL at age 11 or 12 years. These observations support previous findings that intrauterine and perinatal factors can have long-lasting effects on the retina and the optic nerve. The results of this study add evidence to existing recommendations to avoid smoking during pregnancy and support measures that promote maternal and fetal health.
authors.affiliation: Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark2Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Håkan
authors.initials: H
authors.lastname: Ashina
authors.affiliation: Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Xiao Qiang
authors.initials: XQ
authors.lastname: Li
authors.affiliation: Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Else Marie
authors.initials: EM
authors.lastname: Olsen
authors.affiliation: Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark4National Institute of Public Health, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
authors.forename: Anne Mette
authors.initials: AM
authors.lastname: Skovgaard
authors.affiliation: Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark2Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Larsen
authors.affiliation: Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark5Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark.
authors.forename: Inger Christine
authors.initials: IC
authors.lastname: Munch
mesh_terms: D001724:Birth Weight; D002648:Child; D003718:Denmark; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D008297:Male; D008425:Maternal Behavior; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000175:diagnosis / Q000209:etiology*; D011446:Prospective Studies; D012164:Retinal Diseases / Q000175:diagnosis / Q000209:etiology*; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000523:psychology; D041623:Tomography, Optical Coherence / Q000379:methods; D014792:Visual Acuity