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Maternal Smoking During Pregnancy and Risk of Autism Spectrum Disorder in Offspring: A Systematic Review and
Afroditi Peltekidi1, Vaidas Jotautis2, Maria Tzitiridou-Chatzopoulou3
1Department of Midwifery, School of Health & Care Sciences, University of West Attica, Egaleo,12243 Athens, Greece.
Insights
Maternal smoking during pregnancy does not increase autism spectrum disorder (ASD) risk in children. However, quitting smoking is crucial for overall fetal health due to other known risks.
Area of Science:
- Neurodevelopmental disorders
- Prenatal environmental exposures
- Autism Spectrum Disorder (ASD) etiology
Background:
- Autism spectrum disorder (ASD) is a complex neurodevelopmental condition with known genetic influences.
- Prenatal environmental factors are increasingly recognized as potential contributors to ASD.
- The association between maternal smoking during pregnancy and ASD risk is not well-established.
Purpose of the Study:
- To systematically review and meta-analyze existing observational studies on maternal smoking during pregnancy and ASD.
- To quantify the risk of ASD in offspring exposed to maternal smoking in utero.
- To provide evidence-based conclusions regarding this potential environmental risk factor.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA 2020 guidelines.
- Comprehensive literature search across multiple major scientific databases up to September 2025.
- Pooled relative risks (RR) using a random-effects model for studies evaluating maternal active smoking and ASD diagnosis.
Main Results:
- Twenty-one studies comprising millions of mother-child pairs were included.
- The overall pooled relative risk for ASD associated with maternal smoking was 1.01 (95% CI: 0.95-1.08), indicating no statistically significant association.
- Subgroup analyses, sensitivity analyses, and publication bias assessments confirmed the robustness of these findings.
Conclusions:
- Maternal smoking during pregnancy is not associated with an increased risk of autism spectrum disorder in offspring.
- Despite this finding, smoking cessation during pregnancy is strongly recommended due to other significant, established adverse fetal effects.
- Further research may explore other prenatal exposures and their complex interplay with genetic factors in ASD development.
Abstract:
Background/Objectives: Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition characterized by persistent social-communication deficits and repetitive behaviors. While genetic factors play a major role, prenatal environmental exposures may also contribute. Maternal smoking during pregnancy is a known risk factor for adverse perinatal outcomes, but its association with ASD remains unclear. Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. A comprehensive literature search was performed in PubMed, Embase, Web of Science, Scopus, PsycINFO, and Google Scholar up to September 2025. Eligible observational studies evaluated maternal active smoking during pregnancy and ASD diagnosis in offspring. Effect estimates were pooled using a random-effects model and expressed as relative risks (RR) with 95% confidence intervals (CI). Heterogeneity was quantified using I2, with subgroup and sensitivity analyses performed. Results: Twenty-one studies including several million mother-child pairs met the inclusion criteria. The pooled RR for ASD associated with maternal smoking was 1.01 (95% CI: 0.95-1.08), indicating no significant association. Subgroup and sensitivity analyses confirmed the robustness of the findings, with no evidence of publication bias. Conclusions: Maternal smoking during pregnancy does not appear to increase ASD risk in offspring. Nevertheless, smoking cessation remains critical due to established adverse fetal effects.
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