Advanced maternal age and nicotine consumption during pregnancy

Additive effects on new-born parameters


  • Robin Koger University of Vienna, Department of Evolutionary Anthropology
  • Katharina Syböck University of Vienna, Department of Evolutionary Anthropology
  • Emily Weinelt University of Vienna, Department of Evolutionary Anthropology
  • Beda Hartmann Medical University of Vienna, Department of Obstetrics and Gynecology
  • Sylvia Kirchengast University of Vienna, Department of Evolutionary Anthropology



advanced maternal age at first birth, maternal nicotine consumption, foetal growth, newborn size, birthweight, smoking



Nicotine consumption during pregnancy and advanced maternal age are well known independent risk factors for poor pregnancy outcome and therefore serious public health problems.


Considering the ongoing trend of delaying childbirth in our society, this study investigates potential additive effects of nicotine consumption during pregnancy and advanced maternal age on foetal growth.

Sample and Methods

In a medical record-based study, we analysed the impact of maternal age and smoking behaviour before and during pregnancy on newborn size among 4142 singleton births that took place in Vienna, Austria between 1990 and 1995.


Birth weight (H=82.176, p<0.001), birth length (H=91.525, p<0.001) and head circumference (H=42.097, p<0.001) differed significantly according to maternal smoking behaviour. For birth weight, the adjusted mean differences between smokers and non-smokers increased from 101.8g for the < 18-year-old mothers to 254.8g for >35 year olds, with the respective values for birth length being 0.6 cm to 0.7cm, for head circumference from 0.3 cm to 0.6 cm.


Increasing maternal age amplified the negative effects of smoking during pregnancy on newborn parameters. Our findings identify older smoking mothers as a high-risk group which should be of special interest for public health systems.


Aliyu, Muktar H./Salihu, Hamisu M./Wilson, Ronee E./Alio, Amina P./Kirby, Russell S. (2008). The risk of intrapartum stillbirth among smokers of advanced maternal age. Archives of Gynecology and Obstetrics 278 (1), 39–45.

Breton, C. V./Byun, H.-M./Wenten, M./Pan, F./Yang, A./Gilliland, F. D. (2009). Prenatal tobacco smoke exposure affects global and gene-specific DNA methylation. American journal of respiratory and critical care medicine 180 (5), 462–467.

Briggs, M. M./Hopman, W. M./Jamieson, M. A. (2007). Comparing Pregnancy in Adolescents and Adults: Obstetric Outcomes and Prevalence of Anemia. Journal of Obstetrics and Gynaecology Canada 29 (7), 546–555.

Casey, B. M./McIntire, D. D./Leveno, K. J. (2001). The continuing value of the Apgar score for the assessment of newborn infants. The New England Journal of Medicine 344 (7), 467–471.

Cleary-Goldman, J./Malone, F. D./Vidaver, J./Ball, R. H./Nyberg, D. A./Comstock, C. H./Saade, G. R./Eddleman, K. A./Klugman, S./Dugoff, L./Timor-Tritsch, I. E./Craigo, S. D./Carr, S. R./Wolfe, H. M./Bianchi, D. W./D'Alton, M. (2005). Impact of maternal age on obstetric outcome. Obstetrics and Gynecology 105 (5 Pt 1), 983–990.

Cnattingius, S. (1990). Does age potentiate the smoking-related risk of fetal growth retardation? Obstetrical & Gynecological Survey 45 (9), 606.

Cnattingius, S. (1997). Maternal age modifies the effect of maternal smoking on intrauterine growth retardation but not on late fetal death and placental abruption. American Journal of Epidemiology 145 (4), 319–323.

Cnattingius, S. (2004). The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine & Tobacco Research 6 Suppl 2, S125-40.

Cnattingius, S. M. D./Axelsson, O. M. D./Eklund, G./Lindmark, G. M. D. (1985). Smoking, maternal age, and fetal growth. Obstetrics & Gynecology 66 (4), 449–452.

Dulitzki, M. (1998). Effect of very advanced maternal age on pregnancy outcome and rate of cesarean delivery. Obstetrics and Gynecology 92 (6), 935–939.

Ekblad, M./Korkeila, J./Lehtonen, L. (2015). Smoking during pregnancy affects foetal brain development. Acta Paediatrica 104 (1), 12–18.

Fitzpatrick, K. E./Tuffnell, D./Kurinczuk, J. J./Knight, M. (2017). Pregnancy at very advanced maternal age: a UK population-based cohort study. BJOG : An International Journal of Obstetrics and Gynaecology 124 (7), 1097–1106.

Griebler, R./Winkler, P./Gaiswinkler, S./Delcour, J./Juraszovich, B./Nowotny, M./Pochobradsky, E./Schleicher, B./Schmutterer, I. (2017). Österreichischer Gesundheitsbericht 2016. Berichtszeitraum 2005–2014/2015. Bundesministerium für Gesundheit und Frauen. Wien.

Gueri, M./Jutsum, P./Sorhaindo, B. (1982). Anthropometric assessment of nutritional status in pregnant women: a reference table of weight-for-height by week of pregnancy. The American Journal of Clinical Nutrition 35 (3), 609–616.

Hoffman, M. C./Jeffers, S./Carter, J./Duthely, L./Cotter, A./González-Quintero, V. H. (2007). Pregnancy at or beyond age 40 years is associated with an increased risk of fetal death and other adverse outcomes. American Journal of Obstetrics and Gynecology 196 (5), e11-3.

Huang, L./Sauve, R./Birkett, N./Fergusson, D./van Walraven, C. (2008). Maternal age and risk of stillbirth: a systematic review. CMAJ : Canadian Medical Association Journal 178 (2), 165–172.

Jacobsson, B./Ladfors, L./Milsom, I. (2004). Advanced maternal age and adverse perinatal outcome. Obstetrics and Gynecology 104 (4), 727–733.

Jaddoe, V. W. V./Bakker, R./Hofman, A./Mackenbach, J. P./Moll, H. A./Steegers, E. A. P./Witteman, J. C. M. (2007a). Moderate alcohol consumption during pregnancy and the risk of low birth weight and preterm birth: the generation R study. Annals of Epidemiology 17 (10), 834–840.

Jaddoe, V. W. V./Troe, E.-J. W. M./Hofman, A./Mackenbach, J. P./Moll, H. A./Steegers, E. A. P./Witteman, J. C. M. (2008). Active and passive maternal smoking during pregnancy and the risks of low birthweight and preterm birth: the Generation R Study. Paediatric and Perinatal Epidemiology 22 (2), 162–171.

Jaddoe, V. W. V./Verburg, B. O./Ridder, M. A. J. de/Hofman, A./Mackenbach, J. P./Moll, H. A./Steegers, E. A. P./Witteman, J. C. M. (2007b). Maternal smoking and fetal growth characteristics in different periods of pregnancy: the generation R study. American Journal of Epidemiology 165 (10), 1207–1215.

Jolly, M./Sebire, N./Harris, J./Robinson, S./Regan, L. (2000). The risks associated with pregnancy in women aged 35 years or older. Human Reproduction 15 (11), 2433–2437.

Kahveci, B./Melekoglu, R./Evruke, I. C./Cetin, C. (2018). The effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancies. BMC Pregnancy and Childbirth 18 (1), 343.

Kenny, L. C./Lavender, T./McNamee, R./O'Neill, S. M./Mills, T./Khashan, A. S. (2013). Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PloS One 8 (2), e56583.

Kharkova, O./Odland, J. (2019). Effect of smoking behaviour before and during pregnancy on low head circumference at birth. European Journal of Public Health 29 (Supplement 4).

Kim, D./Saada, A. (2013). The social determinants of infant mortality and birth outcomes in Western developed nations: a cross-country systematic review. International Journal of Environmental Research and Public Health 10 (6), 2296–2335.

Kim, M. K./Lee, S. M./Bae, S.-H./Kim, H. J./Lim, N. G./Yoon, S.-J./Lee, J. Y./Jo, M.-W. (2018). Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system. International Journal for Equity in Health 17 (1), 2.

Kirchengast, S./Hartmann, B. (2003). Nicotine consumption before and during pregnancy affects not only newborn size but also birth modus. Journal of Biosocial Science 35 (2), 175–188.

Kirchweger, F./Kirchengast, S./Hafner, E./Stümpflein, I./Hartmann, B. (2018). The impact of maternal age on foetal growth patterns and newborn size. Anthropological Review 81 (2), 111–129.

Knopik, V. S./Maccani, M. A./Francazio, S./McGeary, J. E. (2012). The epigenetics of maternal cigarette smoking during pregnancy and effects on child development. Development and Psychopathology 24 (4), 1377–1390.

Knußmann, R. (1988). Somatometrie. In: R. Knußmann (Ed.). Anthropologie. Handbuch der vergleichenden Biologie des Menschen ; zugleich 4. Auflage des Lehrbuchs der Anthropologie, begründet von Rudolf Martin. Stuttgart/Jena/New York, G. Fischer.

Lamminpää, R./Vehviläinen-Julkunen, K./Gissler, M./Heinonen, S. (2013). Smoking among older childbearing women - a marker of risky health behaviour a registry-based study in Finland. BMC Public Health 13, 1179.

Lu, Y./Tong, S./Oldenburg, B. (2001). Determinants of smoking and cessation during and after pregnancy. Health Promotion International 16 (4), 355–365.

Mook-Kanamori, D. O./Steegers, E. A. P./Eilers, P. H./Raat, H./Hofman, A./Jaddoe, V. W. V. (2010). Risk factors and outcomes associated with first-trimester fetal growth restriction. JAMA 303 (6), 527–534.

Nafstad, P./Botten, G./Hagen, J. (1996). Partner's smoking: a major determinant for changes in women's smoking behaviour during and after pregnancy. Public Health 110 (6), 379–385.

Ogawa, K./Urayama, K. Y./Tanigaki, S./Sago, H./Sato, S./Saito, S./Morisaki, N. (2017). Association between very advanced maternal age and adverse pregnancy outcomes: a cross sectional Japanese study. BMC Pregnancy and Childbirth 17 (1), 349.

Phung, H./Bauman, A./Nguyen, T. V./Young, L./Tran, M./Hillman, K. (2003). Risk factors for low birth weight in a socio-economically disadvantaged population: parity, marital status, ethnicity and cigarette smoking. European Journal of Epidemiology 18 (3), 235–243.

Pölzlberger, E./Hartmann, B./Hafner, E./Stümpflein, I./Kirchengast, S. (2017). Maternal height and pre-pregnancy weight status are associated with fetal growth patterns and newborn size. Journal of Biosocial Science 49 (3), 392–407.

Prabhu, N./Smith, N./Campbell, D./Craig, L. C./Seaton, A./Helms, P. J./Devereux, G./Turner, S. W. (2010). First trimester maternal tobacco smoking habits and fetal growth. Thorax 65 (3), 235–240.

Radoń-Pokracka, M./Adrianowicz, B./Płonka, M./Danił, P./Nowak, M./Huras, H. (2019). Evaluation of pregnancy outcomes at advanced maternal age. Open Access Macedonian Journal of Medical Sciences 7 (12), 1951–1956.

Salem Yaniv, S./Levy, A./Wiznitzer, A./Holcberg, G./Mazor, M./Sheiner, E. (2011). A significant linear association exists between advanced maternal age and adverse perinatal outcome. Archives of Gynecology and Obstetrics 283 (4), 755–759.

Shan, D./Qiu, P.-Y./Wu, Y.-X./Chen, Q./Li, A.-L./Ramadoss, S./Wang, R.-R./Hu, Y.-Y. (2018). Pregnancy outcomes in women of advanced maternal age: a retrospective cohort study from China. Scientific Reports 8 (1), 12239.

Statistik Austria (Hrsg.) (2019). Statistisches Jahrbuch 2019.

Toledo-Rodriguez, M/Lotfipour, S./Leonard, G./Perron, M./Richer, L./Veillette, S./Pausova, Z./Paus, T. (2010). Maternal smoking during pregnancy is associated with epigenetic modifications of the brain-derived neurotrophic factor-6 exon in adolescent offspring. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics : The Official Publication of the International Society of Psychiatric Genetics 153B (7), 1350–1354.

Tromp, M./Ravelli, A. C. J./Reitsma, J. B./Bonsel, G. J./Mol, B. W. (2011). Increasing maternal age at first pregnancy planning: health outcomes and associated costs. Journal of Epidemiology and Community Health 65 (12), 1083–1090.

Tsakiridis, I./Mamopoulos, A./Papazisis, G./Petousis, S./Liozidou, A./Athanasiadis, A./Dagklis, T. (2018). Prevalence of smoking during pregnancy and associated risk factors: a cross-sectional study in Northern Greece. European Journal of Public Health 28 (2), 321–325.

Voigt, M./Briese, V./Jorch, G./Henrich, W./Schneider, K. T. M./Straube, S. (2009). The influence of smoking during pregnancy on fetal growth: considering daily cigarette consumption and the SGA rate according to length of gestation. Zeitschrift fur Geburtshilfe und Neonatologie 213 (5), 194–200.

Wilkie, J. R. (1981). The trend toward delayed parenthood. Journal of Marriage and the Family 43 (3), 583.

Wolff, M. G. de/Backhausen, M. G./Iversen, M. L./Bendix, J. M./Rom, A. L./Hegaard, H. K. (2019). Prevalence and predictors of maternal smoking prior to and during pregnancy in a regional Danish population: a cross-sectional study. Reproductive Health 16 (1), 82.

Zdravkovic, T./Genbacev, O./McMaster, M. T./Fisher, S. J. (2005). The adverse effects of maternal smoking on the human placenta: a review. Placenta 26 Suppl A, S81-6.

Zheng, W./Suzuki, K./Tanaka, T./Kohama, M./Yamagata, Z. (2016). Association between maternal smoking during pregnancy and low birthweight: effects by maternal age. PloS One 11 (1), e0146241.




How to Cite

Koger, R., Syböck, K., Weinelt, E., Hartmann, B., & Kirchengast, S. (2021). Advanced maternal age and nicotine consumption during pregnancy: Additive effects on new-born parameters. Human Biology and Public Health, 1.