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Maternal cigarette smoking during pregnancy. A risk factor for childhood strabismus
1Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Md.
Insights
Maternal smoking throughout pregnancy is linked to childhood esotropia, a type of strabismus. This risk is highest for infants with very low or very high birth weights.
Area of Science:
- Ophthalmology
- Pediatrics
- Epidemiology
Background:
- Strabismus is a common childhood eye condition that can lead to vision impairment.
- Prenatal risk factors are being investigated for their role in childhood strabismus development.
Purpose of the Study:
- To examine the association between prenatal risk factors, specifically maternal smoking, and the development of childhood strabismus.
- To investigate if birth weight and gestational age modify the effect of maternal smoking on strabismus risk.
Main Methods:
- A population-based case-control study involving 377 children diagnosed with strabismus and 377 controls.
- Data collected through maternal interviews and review of obstetric and neonatal records.
- Analysis focused on maternal smoking habits during pregnancy and specific types of strabismus (esotropia, exotropia).
Main Results:
- Maternal smoking throughout pregnancy was associated with an increased risk of esotropia (OR, 1.8).
- No increased risk was observed for exotropia, or for mothers who quit smoking before or during pregnancy.
- The association between maternal smoking and esotropia was strongest in infants with birth weights <2500g (OR, 8.2) and >=3500g (OR, 5.6).
- Exposure to secondhand smoke increased strabismus risk only if the mother also smoked.
Conclusions:
- Maternal smoking throughout pregnancy is a significant risk factor for childhood esotropia.
- Birth weight appears to modify the risk of esotropia associated with maternal smoking.
- Quitting smoking before or during pregnancy mitigates the risk of strabismus.
Abstract:
Strabismus is a common ophthalmologic disorder in children that can result in permanent visual loss. A population-based case-control study was conducted to investigate the association between childhood strabismus and prenatal risk factors including maternal smoking. All incident cases of strabismus diagnosed during a 21-month period, from January 1, 1985, to September 30, 1986, in nine metropolitan area pediatric ophthalmology centers were selected for study (n = 377). Controls were children born on the same day and in the same hospital as the cases (n = 377). Data collection included an interview with the biologic mother and abstraction of obstetric and neonatal birth records. Cigarette smoking was associated with esotropia and but not exotropia for those women who smoked throughout pregnancy (odds ratio, 1.8, 95% confidence interval, 1.1 to 2.8, and odds ratio, 1.4, 95% confidence interval, 0.6 to 3.1, respectively). The relative risk for strabismus was not elevated for women who quit smoking before pregnancy or during pregnancy, nor was there evidence of a dose response. The effect of maternal smoking on risk of esotropia was modified by birth weight and gestational age. The association of maternal smoking throughout pregnancy and esotropia was strongest for children who weighed less than 2500 g (odds ratio, 8.2, 95% confidence interval, 1.1 to 62.7) and 3500 g or more at birth (odds ratio, 5.6, 95% confidence interval, 2.1 to 15.4). Exposure to secondary smoke during pregnancy increased the risk of strabismus only when the mother smoked.