Maternal smoking during pregnancy is linked to fetal growth restriction and lower birth weight. This study evaluates the impact of maternal smoking on fractures in offspring during different stages of development.

This is a national register-based birth cohort study with a sibling comparison design set in Sweden. The study included 1,680,307 people born in Sweden between 1983 and 2000 to women who smoked (377,367) and did not smoke (1,302,940). The follow-up was until 31 December 2014, with the primary outcome measure being fractured by attained age up to 32 years.

A total of 377,970 fractures were found in the median follow-up of 21.1 years. The association between maternal smoking and fractures differed by retained age. Maternal smoking was associated with a higher risk of features in offspring before one year of age. The rate of fractures was also linked to the dose of tobacco. Maternal smoking during pregnancy was also related to an increased fracture incidence in offspring from age 5 to 32 years.

The research concluded that prenatal exposure to maternal smoking is associated with an increased fracture rate during one year of life. Still, it doesn’t seem to have a lasting influence later in childhood and adulthood.