Impact of Maternal Smoking Identified Through Prenatal Health Assessments on Offspring's Neurodevelopmental Disorders: Findings from a Korean Mother-Child Cohort Study

Category	Detail
Condition	Neurodevelopmental disorders including intellectual disability, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD)
Key Mechanisms	Maternal smoking exposes fetus to nicotine and neurotoxic tobacco components crossing the placenta, causing oxidative stress, chronic fetal hypoxia, altered neurotransmitter signaling, and epigenetic reprogramming
Target Population	Pregnant women and their offspring
Care Setting	Prenatal health assessments and population-based cohort monitoring

Maternal smoking is a modifiable prenatal risk factor associated with increased risk of neurodevelopmental disorders in offspring, particularly ADHD.
Large nationwide cohort (861,876 mother–child pairs) with prospectively collected maternal smoking data from health examinations within 2 years before delivery.
Dose–response relationship assessed using cumulative smoking exposure (pack-years) with adjustment for maternal and pregnancy-related confounders.

Use clinical validation and national registry data for accurate diagnosis of neurodevelopmental disorders in offspring.
Avoid reliance solely on parent-reported symptoms to improve diagnostic accuracy.

Implement targeted smoking cessation strategies for women of reproductive age before and during pregnancy.
Strengthen risk communication regarding the impact of maternal smoking on offspring neurodevelopment.

Monitor maternal smoking status through standardized prenatal health assessments.
Follow offspring longitudinally for early detection of neurodevelopmental disorders.

Maternal smoking increases risk of preterm birth, low birth weight, sudden infant death syndrome, and neurodevelopmental disorders.
Confounding factors such as maternal medical, psychiatric, and socioeconomic status should be considered.

Women of reproductive age undergoing prenatal health assessments

Smoking cessation interventions should be prioritized and tailored based on cumulative smoking exposure to reduce offspring neurodevelopmental risks.

Collect maternal smoking status prospectively using standardized questionnaires during prenatal health examinations.
Quantify cumulative smoking exposure (pack-years) to assess dose–response risk relationships.
Adjust for confounding maternal and pregnancy-related factors when evaluating neurodevelopmental outcomes.
Promote early and sustained smoking cessation efforts in women planning pregnancy or who are pregnant.
Use large, population-based cohorts and validated diagnostic data to inform clinical risk assessments.

Clinical Scorecard: Impact of Maternal Smoking Identified Through Prenatal Health Assessments on Offspring's Neurodevelopmental Disorders: Findings from a Korean Mother-Child Cohort Study