Pulmonary Effects of Maternal Smoking on the Fetus and Child: Effects on Lung Development, Respiratory Morbidities, and Life Long Lung Health

Paediatr Respir Rev. 2017 Jan;21:27-33. doi: 10.1016/j.prrv.2016.08.005. Epub 2016 Aug 19.


Maternal smoking during pregnancy is the largest preventable cause of abnormal in-utero lung development. Despite well known risks, rates of smoking during pregnancy have only slightly decreased over the last ten years, with rates varying from 5-40% worldwide resulting in tens of millions of fetal exposures. Despite multiple approaches to smoking cessation about 50% of smokers will continue to smoke during pregnancy. Maternal genotype plays an important role in the likelihood of continued smoking during pregnancy and the degree to which maternal smoking will affect the fetus. The primary effects of maternal smoking on offspring lung function and health are decreases in forced expiratory flows, decreased passive respiratory compliance, increased hospitalization for respiratory infections, and an increased prevalence of childhood wheeze and asthma. Nicotine appears to be the responsible component of tobacco smoke that affects lung development, and some of the effects of maternal smoking on lung development can be prevented by supplemental vitamin C. Because nicotine is the key agent for affecting lung development, e-cigarette usage during pregnancy is likely to be as dangerous to fetal lung development as is maternal smoking.

Keywords: Asthma; Forced expiratory flows; In-utero smoke; Lung development; Preterm birth; Wheeze.

Publication types

  • Review

MeSH terms

  • Animals
  • Antioxidants / therapeutic use
  • Ascorbic Acid / therapeutic use
  • Asthma / epidemiology
  • Asthma / etiology
  • Asthma / genetics
  • Asthma / prevention & control
  • Child
  • Disease Models, Animal
  • Epigenesis, Genetic
  • Female
  • Humans
  • Infant, Newborn
  • Lung / drug effects
  • Lung / embryology*
  • Lung / growth & development
  • Nicotine / pharmacology
  • Nicotinic Agonists / pharmacology
  • Pregnancy
  • Prenatal Exposure Delayed Effects / epidemiology*
  • Prenatal Exposure Delayed Effects / etiology
  • Prenatal Exposure Delayed Effects / genetics
  • Prenatal Exposure Delayed Effects / prevention & control
  • Respiratory Tract Diseases / epidemiology*
  • Respiratory Tract Diseases / etiology
  • Respiratory Tract Diseases / genetics
  • Respiratory Tract Diseases / prevention & control
  • Smoking / adverse effects
  • Smoking / epidemiology*
  • Tobacco Smoke Pollution / adverse effects
  • Tobacco Smoke Pollution / statistics & numerical data*


  • Antioxidants
  • Nicotinic Agonists
  • Tobacco Smoke Pollution
  • Nicotine
  • Ascorbic Acid