JMIR Publications

ABSTRACT

Background:

Maternal smoking during pregnancy (MSDP) is a known risk factor for offspring developing chronic obstructive pulmonary disease (COPD). However, the underlying mechanism remains unclear.

Objective:

This study aimed to explore whether the increased COPD risk associated with MSDP could be attributed to tobacco dependence (TD).

Methods:

This case-control study utilized data from the nationwide cross-sectional China Pulmonary Health (CPH) study, with controls matched for age, gender, and smoking status. TD was defined as smoking within 30 minutes of waking, and severity of TD assessed using the Fagerstrom Test for Nicotine Dependence (FTND). COPD was diagnosed when FEV1/FVC was < 0.7 in a post-bronchodilator pulmonary function test according to 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Logistic regression was employed to investigate the association between MSDP and COPD. Mediation analysis examined TD as a potential mediator in the link between MSDP and COPD risk. The significance of the indirect effect was assessed through 1000 iterations of the "bootstrap" method.

Results:

The study included 5943 participants (2991 with COPD, 2952 controls). COPD participants' mothers had higher pregnancy smoking rates (COPD: 10.20%, controls: 7.10%, P < 0.001). TD was more prevalent in the COPD group (COPD: 40.40%, controls: 33.90%, P < 0.001). After adjusting for covariates, MSDP had a significant effect on COPD (β = 0.081, P < 0.001). Mediation analysis of TD in the MSDP-COPD relationship showed significant direct and indirect effects (direct: β = 0.077, P < 0.001; indirect: β = 0.004, P = 0.038).

Conclusions:

MSDP, mediated through TD, exerts both direct and indirect effects on the risk of COPD in offspring during adulthood.