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Smoking in pregnancy, cord blood cotinine and risk of celiac disease diagnosis in offspring

Research output: Contribution to journalArticle

  • Karl Mårild
  • German Tapia
  • Øivind Midttun
  • Per M Ueland
  • Maria C Magnus
  • Marian Rewers
  • Lars C Stene
  • Ketil Størdal
Original languageEnglish
Pages (from-to)637-649
Number of pages13
JournalEuropean Journal of Epidemiology
Issue number7
Early online date29 Apr 2019
DateAccepted/In press - 20 Apr 2019
DateE-pub ahead of print - 29 Apr 2019
DatePublished (current) - 15 Jul 2019


Ecological observations suggest an inverse relationship between smoking in pregnancy and celiac disease (CD) in offspring. While individual-level analyses have been inconsistent, they have mostly lacked statistical power or refined assessments of exposure. To examine the association between pregnancy-related smoking and CD in the offspring, as well as its consistency across data sets, we analyzed: (1) The Norwegian Mother and Child Cohort (MoBa) of 94,019 children, followed from birth (2000-2009) through 2016, with 1035 developing CD; (2) a subsample from MoBa (381 with CD and 529 controls) with biomarkers; and (3) a register-based cohort of 536,861 Norwegian children, followed from birth (2004-2012) through 2014, with 1919 developing CD. Smoking behaviors were obtained from pregnancy questionnaires and antenatal visits, or, in the MoBa-subsample, defined by measurement of cord blood cotinine. CD and potential confounders were identified through nationwide registers and comprehensive parental questionnaires. Sustained smoking during pregnancy, both self-reported and cotinine-determined, was inversely associated with CD in MoBa (multivariable-adjusted [a] OR = 0.61 [95%CI, 0.46-0.82] and aOR = 0.55 [95%CI, 0.31-0.98], respectively); an inverse association was also found with the intensity of smoking. These findings differed from those of our register-based cohort, which revealed no association with sustained smoking during pregnancy (aOR = 0.97 [95%CI, 0.80-1.18]). In MoBa, neither maternal smoking before or after pregnancy, nor maternal or paternal smoking in only early pregnancy predicted CD. In a carefully followed pregnancy cohort, a more-detailed smoking assessment than oft-used register-based data, revealed that sustained smoking during pregnancy, rather than any smoking exposure, predicts decreased likelihood of childhood-diagnosed CD.

    Structured keywords

  • Bristol Population Health Science Institute

    Research areas

  • Celiac disease, cohort studies, environmental tabacco smoke, Human Leukocyte Antigen, smoking cessation, registries

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