The influence of cigarette smoking on antenatal growth, birth size, and the insulin-like growth factor axis

Background: Maternal smoking during pregnancy is associated with a reduction in birth size. Very few studies have collated changes in fetal biometry, neonatal anthropometry, biochemical factors involved in fetal growth, and measures of uterine and umbilical blood flow. Methods: We related smoking status in 1650 low-risk, singleton Caucasian pregnancies delivering at term to measures of fetal growth, uterine and umbilical artery blood flow, placental appearance, birth size, and cord concentrations of IGF-I and - II and IGF binding protein (IGFBP)-3. Results: Mothers who smoked in pregnancy were younger ( P < 0.001) and shorter ( P = 0.03) and from lower socioeconomic groups ( P < 0.001). Mean umbilical artery blood flow at 20 wk gestation was not associated with smoking status but was significantly higher in smokers at 30 wk ( P = 0.006). Uterine artery blood flow was unaffected. Smoking was associated with an increase in the percentage of abnormal placentas in a dose-dependent manner and with a 3.1-fold increased risk ( odds ratio 3.1, 95% confidence interval 1.3 - 7.6) of abnormal umbilical artery blood flow ( P = 0.009). Smoking was associated with a reduction in fetal femur length ( P = 0.005) and abdominal circumference as well as birth weight, length, and head circumference but not skinfold thickness. Cord plasma concentrations of IGF-I and IGFBP-3 were lower in the babies of mothers who had smoked ( P = 0.02 and P = 0.01, respectively). Conclusion: We concluded that maternal smoking is associated with an altered placental appearance on ultrasonography, increased umbilical artery blood flow resistance, and a reduction in longitudinal and intraabdominal organ growth. Circulating concentrations of IGF-I and IGFBP-3 along with measures of birth size but not markers of body fat are reduced, suggesting smoking results in a reduction in organ size and function.