RESUMO
BACKGROUND: According to the INPES 2014 health barometer, the prevalence of smoking in pregnant women in France is the highest in Europe : 17.8% of expectant mothers who smoke continue to do so during pregnancy. Several epidemiological studies have confirmed multiple risks for tobacco-exposed infants (low birth weight; digestive, respiratory, neurological, and psychological disorders; obesity; type 1 diabetes). PURPOSE: This study compared a cohort of infants exposed to tobacco in utero (T+) with those unexposed (T-). Birth weight, diet, presence of colic (ROME III criteria) and regurgitations (Vandenplas scale) were specifically analyzed. METHODS: This observational, cross-sectional, and multicenter survey was conducted in France by pediatricians and general practitioners from September 2016 to February 2017. Infants with a chronic pathology and those with parents under 18 years of age were excluded. The data were collected by the physician and by the mother through a self-administered questionnaire. RESULTS: A total of 452 physicians recruited 759 T+ and 741 T- infants in the study. The mean birth weight of T+ infants was significantly lower (3.1±0.5 kg [WHO z-score -0.476±1.081]) than that of T- infants (3.3±0.5 kg [0.033±0.965]; P<0.001). At the time of leaving the maternity facility, 47.7% of T+ infants were breastfed by their mother compared with 70.1% of T- infants. The median reported duration of breastfeeding was 1 month vs. 2 months for T+ and T- infants, respectively. Colic was significantly more common in T+ than in T- infants: 25.6% vs. 12.3% according to the ROME III criteria, and 45.7% vs. 29.7% according to the doctor's opinion (P<0.001 for both). In the T+ group, cases of regurgitation (63.6% vs. 56.5%; P=0.005), respiratory disorder (6.3% vs. 2.4%, P<0.001), and bronchiolitis (6.5% vs. 3.0%; P=0.001) were also more frequent. CONCLUSION: This study confirms that maternal smoking during pregnancy is associated with health risks; exposed infants had significantly more digestive/respiratory symptoms and lower birth weight than unexposed infants. Preventive and educational actions need to be further strengthened in the face of this public health problem.
