In spite of the well-known harmful effects on the fetus, many women continue smoking during pregnancy. Smoking as an important source of toxic chemicals may contribute to the developmental origin of ...diseases.
The aim of this work was to pursue the possible association between maternal smoking and cancer in early life. Specifically, we wanted to identify the associated early life cancer types, and to quantify the associations.
In a systematic literature search 825 articles were identified in PubMed and Web of Science, and 55 more through the reference lists. Of these 62 fulfilled the criteria for inclusion in meta-analyses. Using Mantel-Haenszel or DerSimonian and Laird method, depending on heterogeneity of the studies, pooled estimates and 95% confidence intervals for eight cancer types were calculated.
Smoking during pregnancy was associated with an increased risk for for brain and central nervous system tumors (OR = 1.09; 95% CI = 1.02-1.17). Although the risk for lymphoma was also associated (OR = 1.21; 95% CI = 1.05-1.34), it did not hold up in subgroup analyses. Leukemia was not found to be associated with maternal smoking. Five other cancer types (bone, soft tissue, renal, hepatic, and germ cell cancer) were also examined, but the number of studies was too limited to exclude the possibility of maternal smoking as a risk factor for cancer in offspring.
According to our meta-analyses, maternal smoking is associated with nervous system cancers, but not with leukemia in early life. Confirming or rejecting associations of maternal smoking with lymphoma and the five other cancer types requires further studies.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Traditional risk factors and environmental exposures only explain less than half of the disease burden. The developmental origin of the health and disease (DOHaD) concept proposes that prenatal and ...early postnatal exposures increase disease susceptibility throughout life. The aim of this work is to demonstrate the application of the DOHaD concept in a chained risk assessment and to provide an estimate of later in life burden of disease related to maternal smoking. We conducted three systematic literature searches for meta-analysis and reviewed the literature reporting meta-analyses of long-term health outcomes associated with maternal smoking and intermediate risk factors (preterm birth, low birth weight, childhood overweight). In the chained model the three selected risk factors explained an additional 2% (34,000 DALY) of the total non-communicable disease burden (1.4 million DALY) in 2017. Being overweight in childhood was the most important risk factor (28,000 DALY). Maternal smoking was directly associated with 170 DALY and indirectly via the three intermediate risk factors 1000 DALY (1200 DALY in total). The results confirm the potential to explain a previously unattributed part of the non-communicable diseases by the DOHAD concept. It is likely that relevant outcomes are missing, resulting in an underestimation of disease burden.
Aims: In Finland, smoking rates in the general population are decreasing due to increased awareness of the adverse effects and tightened tobacco legislation. However, previous studies have shown that ...smoking in pregnant Finnish women remained as high as in the general Finnish female population at around 15% in 2010. Our aim was to describe temporal and spatial trends in smoking behaviour, and determinants of changes in smoking behaviour between first and second pregnancy. Methods: Self-reported smoking from the Finnish Medical Birth Register covered the years 1991–2015 (N=1,435,009). The association of maternal age and socioeconomic status with smoking rate was analysed. Spatial trends were assessed at municipality level. Results: The overall smoking rate during early pregnancy remained fairly stable at around 15% from 1991 to 2015, but increased in teenage and young women below 25 years of age. The mean smoking rate (36%) was higher in these age groups than in older pregnant women (11%). Through the study period the smoking rate remained higher in blue collar workers compared with higher socioeconomic groups. Between the first and second child, on average only 4% of women started to smoke and 41% quitted. Smoking rates developed less favourably in Eastern Finland. Conclusions: The observed increase in smoking rate during pregnancy in teenage and young women is concerning. Pregnancy is a trigger point for smoking cessation in a big fraction of pregnant women. More studies are needed to explain the opposite trends of smoking rates in Northern and Western Finland compared with Eastern Finland.
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BFBNIB, NMLJ, NUK, OILJ, PNG, SAZU, UKNU, UL, UM, UPUK
Health effect estimates depend on the methods of evaluating exposures. Due to non-linearities in the exposure-response relationships, both the predicted mean exposures as well as its spatial ...variability are significant. The aim of this work is to systematically quantify the impact of the spatial resolution on population-weighted mean concentration (PWC), its variance, and mortality attributable to fine particulate matter (PM
2.5
) exposure in Finland in 2015. The atmospheric chemical transport model SILAM was used to estimate the ambient air PM
2.5
concentrations at 0.02° longitudinal × 0.01° latitudinal resolution (ca. 1 km), including both the national PM
2.5
emissions and the long-range transport. The decision-support model FRES source-receptor matrices applied at 250-m resolution was used to model the ambient air concentrations of primary fine particulate matter (PPM
2.5
) from local and regional sources up to 10 km and 20 km distances. Numerical averaging of population and concentrations was used to produce the results for coarser resolutions. Population-weighted PM
2.5
concentration was 11% lower at a resolution of 50 km, compared with the corresponding computations at a resolution of 1 km. However, considering only the national emissions, the influences of spatial averaging were substantially larger. The average population-weighted local PPM
2.5
concentration originated from Finnish sources was 70% lower at a resolution of 50 km, compared with the corresponding result obtained using a resolution of 250 m. The sensitivity to spatial averaging, between the finest 250-m and the coarsest 50-km resolution, was highest for the emissions of PPM
2.5
originated from national vehicular traffic (about 80% decrease) and lowest for the national residential combustion (60% decrease). Exposure estimates in urban areas were more sensitive to the changes of model resolution (14% and 74% decrease for PM
2.5
and local PPM
2.5
, respectively), compared with estimates in rural areas (2% decrease for PM
2.5
and 36% decrease for PPM
2.5
). We conclude that for the evaluation of the health impacts of air pollution, the resolution of the model computations is an important factor, which can potentially influence the predicted health impacts by tens of percent or more, especially when assessing the impacts of national emissions.
ObjectivesThe aim of our work was to analyse the effect of maternal smoking on body size and body proportions of newborns when the mother had smoked only during the first trimester, in comparison ...with continued smoking after the first trimester. Furthermore, we have evaluated how growth restriction associated with maternal smoking contributes to changes in body proportions.DesignRegister-based cohort studySettingMaternal Exposure (MATEX) cohort identified from the Finnish Medical Birth Register.ParticipantsSingleton births without congenital anomalies and missing data (1.38 million) from 1 January 1991 to 31 December 2016.MethodsLogistic regression was used to quantify the effect of maternal smoking, stratified by the maternal smoking status.Outcome measuresBody proportions indicated by low brain-to-body ratio (defined as <10th percentile); high ponderal index and high head-to-length ratio (defined as >90th percentile); small body size for gestational age at birth (defined as weight, length or head circumference <10th percentile) and preterm birth (<37 weeks) and low birth weight (2500 g).ResultsContinued smoking after the first trimester was associated with high ponderal index (OR 1.26, 95% CI 1.23 to 1.28), low brain-to-body ratio (1.11, 1.07–1.15) and high head-to-length ratio (1.22, 1.19–1.26), corresponding with absolute risks of 22%, 10% and 19%, respectively). The effects were slightly lower when smoking had been quit during the first trimester. Similar effects were seen for the body size variables and low birth weight. Preterm birth was not associated with smoking only during first trimester.ConclusionsMaternal smoking, independent of smoking duration during pregnancy, was associated with abnormal body proportions resulting from larger reduction of length and head circumference in comparison to weight. The effects of having quit smoking during the first trimester and having continued smoking after the first trimester were similar, suggesting the importance of early pregnancy as a sensitive exposure window.
The prevalence of chronic diseases, such as immune, neurobehavioral, and metabolic disorders has increased in recent decades. According to the concept of Developmental Origin of Health and Disease ...(DOHaD), developmental factors associated with environmental exposures and maternal lifestyle choices may partly explain the observed increase. Register-based epidemiology is a prime tool to investigate the effects of prenatal exposures over the whole life course. Our aim is to establish a Finnish register-based birth cohort, which can be used to investigate various (prenatal) exposures and their effects during the whole life course with first analyses focusing on maternal smoking and air pollution. In this paper we (i) review previous studies to identify knowledge gaps and overlaps available for cross-validation, (ii) lay out the MATEX study plan for register linkages, and (iii) analyse the study power of the baseline MATEX cohort for selected endpoints identified from the international literature.
The MATEX cohort is a fully register-based cohort identified from the Finnish Medical Birth Register (MBR) (1987-2015). Information from the MBR will be linked with other Finnish health registers and the population register to link the cohort with air quality data. Epidemiological analyses will be conducted for maternal smoking and air pollution and a range of health endpoints.
The MATEX cohort consists of 1.75 million mother-child pairs with a maximum follow up time of 29 years. This makes the cohort big enough to reach sufficient statistical power to investigate rare outcomes, such as birth anomalies, childhood cancers, and sudden infant death syndrome (SIDS). The linkage between different registers allows for an extension of the scope of the cohort and a follow up from the prenatal period to decades later in life.
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To quantify the reduction potential of asthma in Finland achievable by adjusting exposures to selected environmental factors.
A life table model for the Finnish population for 1986-2040 was developed ...and Years Lived with Disability caused by asthma and attributable to the following selected exposures were estimated: tobacco smoke (smoking and second hand tobacco smoke), ambient fine particles, indoor dampness and mould, and pets.
At baseline (2011) about 25% of the total asthma burden was attributable to the selected exposures. Banning tobacco was the most efficient mitigation action, leading to 6% reduction of the asthma burden. A 50% reduction in exposure to dampness and mould as well as a doubling in exposure to pets lead each to a 2% reduction. Ban of urban small scale wood combustion, chosen as a mitigation action to reduce exposure to fine particles, leads to a reduction of less than 1% of the total asthma burden. Combination of the most efficient mitigation actions reduces the total asthma burden by 10%. A more feasible combination of mitigation actions leads to 6% reduction of the asthma burden.
The adjustment of environmental exposures can reduce the asthma burden in Finland by up to 10%.
Ambient air pollution is a leading environmental risk factor causing substantial losses of life and significant morbidity. Concentration-response (CR) functions used globally to estimate such effects ...are largely based on ambient epidemiology, using centrally monitored outdoor air quality as an exposure indicator and various indices of population health as an outcome. Similar common understanding is mostly missing regarding indoor exposures. Less studied are health impact modifying factors such as particle size, infiltration, time-activity and population differences. In this discussion paper we aim at looking at one of these, infiltration.
The sensitivity of overall personal exposure to indoor exposures was quantified by a simple probabilistic time-activity model to calculate fractional exposures for indoor, outdoor and in traffic time-activity. To demonstrate the potential regional differences in epidemiological C-R relationships we re-analysed the ESCAPE results for natural-cause mortality, focusing on geographical grouping of the cohorts: pooled estimates were calculated for the Nordic, Central European and Southern European cohorts.
When comparing the relative differences in the regional hazard ratio increments, the Central European value (7%) is 1.75 times higher than the Nordic one, and Southern European value (12%) 3 times higher, respectively. While towards the expected direction when aiming to explain these differences at least partly with differences in PM2.5 infiltration, the differences are not statistically significant and only the Central European and the all cohorts combined estimates reach borderline statistical significance. As the analysis of PM2.5 infiltration factors by similar regions yielded only 10–15% differences, it seems possible that that the available data could also accommodate other regional factors, such as those originating from regional differences in population and contribution of indoor sources of PM, time-activity, behaviour, or compositional differences in the particulate matter.
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•Potential regional differences in particle C-R functions are only partly explained by building stocks in Europe.•Impact of toxicity of particles or aerosol properties such as particle size distribution cannot be ruled out.•Confidence intervals of cohort studies are largely overlapping and thus minor differences in toxicity are also difficult to be confirmed.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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