Smoking During Pregnancy Linked With Long-Term Ophthalmic Morbidity Risk

Doctor using ophthalmoscope to examine health of babys retina and vitreous humor
Doctor using ophthalmoscope to examine health of babys retina and vitreous humor (Photo by Universal Images Group via Getty Images)
Researchers say tobacco use during pregnancy is an independent risk factor for long-term ophthalmic morbidity of the offspring.

Maternal smoking during pregnancy is linked with increased risk of long-term ophthalmic morbidity of the offspring, researchers in Israel found in a study published in Early Human Development.

Previous research has shown that smoking damages ocular health, but limited research has been conducted regarding the impact a mother’s smoking has on the fetus’ long-term ophthalmic health. The investigators reviewed 23 years of data to analyze the affect smoking during pregnancy has on the risk of ocular morbidity until adulthood.

All mothers who delivered single babies at the Soroka University Medical Center in southern Israel between 1991 and 2014 (n=243,680) were included in the study. Perinatal mortality cases and fetuses with congenital malformations or chromosomal abnormalities were not included. The researchers compared the rate of hospitalization that involved an ophthalmic morbidity for 2965 children whose mothers reported smoking during pregnancy and 240,715 children whose mothers did not report smoking during pregnancy.

There was a higher rate of ophthalmic-related hospitalizations among offspring of smoking mothers compared with those of nonsmoking mothers (1.4% vs 1%, P <.01). Ocular infections were higher among smoking mothers compared with their nonsmoking peers (0.9% vs 0.6%, P =.05).

Kaplan-Meier curve indicated children of mothers who reported smoking had higher cumulative incidence of hospitalizations for ophthalmic morbidity compared with children born of nonsmoking mothers (P <.001).

Adjusting for maternal age, ethnicity, birthweight, maternal hypertensive disorders of pregnancy, diabetes, preterm delivery, and mode of delivery, multivariate Cox regression modeling indicated smoking during pregnancy was a significant, independent risk factor for long-term risk of ophthalmic-related hospitalization of children (adjusted HR 1.51 95% CI 1.11-2.04).

Retinopathy of prematurity, and visual disturbances were higher among children born of mothers who reported smoking during pregnancy compared with their peers, but the difference was not statistically significant.

Mean gestational age at birth and birthweight were comparable between the groups.

“The implications of successfully reducing maternal smoking could be far reaching both for the health of individuals and both for the health system and the economy,” the study says. “Like so many other studies before, this study too highlights the perils of smoking during pregnancy and reinforces the current recommendations regarding smoking cessation. Since while smoking during pregnancy bears risks for not only the mother herself but also for her infant, this could be a useful intervention point for us as health professionals to exploit in order to encourage smoking cessation.”

Limitations of the study included challenges for generalization due to recruitment from 1 location, effect of any secondhand smoking and exposure to smoking after pregnancy, self-reporting of smoking status, lack of data on mothers’ smoking habits prior to pregnancy, and inability to establish causation.


Tsumi E, Lavy Y, Wainstock T, et al. Maternal smoking during pregnancy and long-term ophthalmic morbidity of the offspring. Early Human Development. Published online October 16, 2021. doi:10.1016/j.earlhumdev.2021.105489