By midlife, individuals exposed to maternal smoking while in the womb or to environmental tobacco smoke in childhood and adolescence are at greater risk for high blood pressure and diabetes by middle age, suggests a study funded by the National Institutes of Health.
The study was conducted by Zhongzheng Niu, Ph.D., and Xiaozhong Wen, Ph.D., of the State University of New York at Buffalo, and colleagues. It appears in the Journal of Developmental Origins of Health and Disease. NIH funding was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Center for Advancing Translational Science. Additional funding was provided by the Health Resource Services Administration.
Background
Heart and blood vessel disease, stroke and diabetes—known collectively as cardiometabolic diseases—tend to occur later in life, but previous older studies suggest they may have their origins in fetal life. Early life exposure to tobacco smoke is known to increase the risk of arterial disease in children. However, there are few long-term studies linking cardiometabolic diseases in adulthood to early life tobacco smoke exposure.
Results
For the current study, researchers analyzed data from a study 
that collected information on maternal smoking during pregnancy in the 1960s and a follow-up study that collected information in the 2000s on cardiometabolic disease among the adult offspring from those pregnancies. A total of 1,623 adult offspring at an average age of 39 years participated.
Risk of high blood pressure was 29% higher for those exposed to tobacco smoke in the second trimester, 11% higher for those exposed in childhood, and 22% higher for those exposed through adolescence. Dual exposure to tobacco smoke in the uterus and early childhood increased risk for diabetes by 23% and exposure from fetal development through adolescence increased diabetes risk by 47%. Risks were higher for males than for females. For example, females born to parents who smoked in the second trimester had a 3% higher risk for hypertension, while males had a 55% higher risk.
Significance
The authors concluded that exposure to tobacco smoke in the womb and in childhood and adolescence might increase the risk of high blood pressure and diabetes in midlife.
Next Steps
The authors called for future studies to verify their findings. They noted that less than 5% of participants pregnant in the 1960s changed their smoking behavior during pregnancy. They added that there is a need for more current studies in which pregnant smokers are more likely to quit during pregnancy to examine whether there are intervals during pregnancy in which the fetus is particularly sensitive to the effects of tobacco exposure.
Reference
Niu, Z, et al. Involuntary tobacco smoke exposures from conception to 18 years increase midlife cardiometabolic disease risk: a 40-year longitudinal study. Journal of Developmental Origins of Health and Disease. 2024.
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