Exposure to environmental tobacco smoke during pregnancy and infancy increased the risk of upper respiratory tract infections in infants: A birth cohort study in Wuhan, China

We aimed to evaluate the association of the exposure to environmental tobacco smoke (ETS) during pregnancy and infancy with the risk of upper respiratory tract infections (URTI) in infants based on a Chinese birth cohort study. Among 4178 infants who constituted the final study population, 46.8% experienced URTI in their first year of life. The hazard ratios (HR) and 95% confidence intervals (CI) for the risk of URTI were assessed using Cox regression models. Compared with no ETS during pregnancy, continued ETS during pregnancy was independently associated with a higher risk of URTI (HR: 1.36, 95% CI: 1.13, 1.63) after adjustment for potential confounders and also associated with earlier occurrence of URTI (log-rank P = .002). The association remained consistent across the strata defined according to maternal age, number of siblings, sex, and breastfeeding. Exposure to ETS during infancy was associated with URTI only among infants who were breastfed for less than 12 months (P for interaction < 0.05).Furthermore, infants exposed to ETS during both pregnancy and infancy showed the highest HR of 1.46 (95% CI: 1.16, 1.85) for URTI. Efforts should be made to protect pregnant women and infants from the adverse effects of indoor and outdoor ETS.

Automated summary

Exposure to environmental tobacco smoke (ETS) during pregnancy and infancy is associated with an increased risk of upper respiratory tract infections (URTI) in infants, particularly continued ETS exposure during pregnancy. Infants breastfed for less than 12 months are more susceptible to developing URTI when exposed to ETS during infancy.