Association of Maternal Smoking During Pregnancy with Childhood Blood Pressure and Hypertension in the ECHO Cohort

Lyndsey E Shorey-Kendrick; Christine Ladd-Acosta; Haozuo Zhao; Judy L Aschner; Carrie V Breton; Carlos A Camargo, Jr; Andrea E Cassidy-Bushrow; Elena Colicino; Dana Dabelea; Anne L Dunlop; Shohreh F Farzan; Assiamira Ferrara; James E Gern; Irva Hertz-Picciotto; Margaret R Karagas; Catherine J Karr; Barry Lester; Leslie D Leve; Brianna F Moore; Jenae M Neiderhiser; Emily Oken; T Michael O’Shea; Keia Sanderson; Joseph B Stanford; Leonardo Trasande; Scott T Weiss; Rosalind J Wright; Qi Zhao; Yeyi Zhu; Cindy T McEvoy; Eliot R Spindel

doi:10.1161/CIRCULATIONAHA.125.076520

. Author manuscript; available in PMC: 2026 Feb 18.

Published in final edited form as: Circulation. 2026 Feb 16;153(7):536–539. doi: 10.1161/CIRCULATIONAHA.125.076520

Association of Maternal Smoking During Pregnancy with Childhood Blood Pressure and Hypertension in the ECHO Cohort

Lyndsey E Shorey-Kendrick ^1,^*, Christine Ladd-Acosta ^2,^*, Haozuo Zhao ³, Judy L Aschner ⁴, Carrie V Breton ⁵, Carlos A Camargo Jr ⁶, Andrea E Cassidy-Bushrow ^7,⁸, Elena Colicino ⁹, Dana Dabelea ¹⁰, Anne L Dunlop ¹¹, Shohreh F Farzan ¹², Assiamira Ferrara ¹³, James E Gern ¹⁴, Irva Hertz-Picciotto ¹⁵, Margaret R Karagas ¹⁶, Catherine J Karr ¹⁷, Barry Lester ^18,^19,²⁰, Leslie D Leve ²¹, Brianna F Moore ²², Jenae M Neiderhiser ²³, Emily Oken ²⁴, T Michael O’Shea ²⁵, Keia Sanderson ²⁶, Joseph B Stanford ²⁷, Leonardo Trasande ²⁸, Scott T Weiss ²⁹, Rosalind J Wright ³⁰, Qi Zhao ³¹, Yeyi Zhu ³², Cindy T McEvoy ³³, Eliot R Spindel ³⁴, for the ECHO Cohort Consortium

¹Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR.

²Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.

³Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.

⁴Center for Discovery and Innovation, Hackensack Meridian School of Medicine, Nutley, NJ.

⁵Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA.

⁶Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

⁷Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI.

⁸Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI.

⁹Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY.

¹⁰Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO.

¹¹Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA.

¹²Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA.

¹³Upstream Prevention of Adiposity and Diabetes Mellitus (UPSTREAM) Center, Division of Research, Kaiser Permanente Northern California, Oakland, CA.

¹⁴Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.

¹⁵Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA.

¹⁶Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH.

¹⁷Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA

¹⁸Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI.

¹⁹Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI.

²⁰Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI.

²¹Prevention Science Institute, University of Oregon, Eugene, OR.

²²Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO.

²³Department of Psychology, Penn State University, University Park, PA.

²⁴Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.

²⁵Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC.

²⁶Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC.

²⁷Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT.

²⁸Department of Pediatrics, New York University Grossman School of Medicine, New York, NY.

²⁹Channing Division of Network Medicine, Department of Medicine Brigham and Women’s Hospital and Harvard Medical School, Boston, MA.

³⁰Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY.

³¹Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.

³²Division of Research, Kaiser Permanente Northern California, Pleasanton, CA.

³³Department of Pediatrics, Oregon Health & Science University, Portland, OR.

³⁴Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR.

^*

These two authors made equal contributions.

^**

See Appendix for full list of collaborators.

^✉

Address for Correspondence: Lyndsey Shorey-Kendrick, Oregon National Primate Research Center, Oregon Health & Science University, Division of Neuroscience, 505 NW 185th Avenue, Beaverton, OR 97006, shorey@ohsu.edu

PMCID: PMC12912780 NIHMSID: NIHMS2131451 PMID: 41697983

RESEARCH LETTER

Elevated blood pressure (BP) and hypertension in childhood are strongly related to hypertension in adulthood, a major risk factor for cardiovascular morbidity and mortality.¹ Previous studies suggest that maternal tobacco smoking during pregnancy (MSDP) is associated with increased childhood BP, but findings are inconsistent and mostly limited to systolic BP and self-reported MSDP.² This study examined the association of MSDP with childhood systolic and diastolic BP and hypertension using data from the Environmental influences on Child Health Outcomes (ECHO) Cohort. The study protocol was approved by the single ECHO institutional review board. Written informed consent, or child assent with parent’s/guardian’s permission, was obtained for participation in the ECHO Cohort Data and Biospecimen Collection Protocol. Select de-identified data are available through NICHD’s Data and Specimen Hub (DASH).³

We included children from singleton pregnancies with at least one BP measurement between 3–18 years and maternal self- or medical record report of any MSDP. We excluded cohorts with <10 children. We computed average systolic and diastolic BP Z-scores for each visit age adjusted for age, sex, and height.⁴ We utilized linear mixed models with random effects for individual participants nested within cohorts to test the association between MSDP and BP Z-scores, and Poisson regression models to test the association between MSDP and hypertension, defined as an average systolic and/or diastolic BP meeting or exceeding published thresholds [for children <13 y: ≥95th percentile, or ≥130/80 mm Hg (whichever is lower); for children ≥13y: ≥130/80] on ≥3 separate visits.¹ We implemented unadjusted models and models adjusted for potential confounders identified previously (child race [parent report], maternal age at delivery, maternal pre-pregnancy BMI category, prenatal alcohol [self- or medical report], maternal education [highest level of school completed] as a proxy for socioeconomic status, and child sex [hypertension models only]). We also implemented models with additional adjustment for preterm birth (< 37 weeks). Sex- and age (< vs. ≥ 6 years)- stratified analyses were also performed. Models for MSDP and hypertension were fit with and without an interaction term between MSDP and child sex. Covariates with <20% missing data were imputed at the cohort type level using multivariate imputation by chained equations algorithm. We additionally examined associations with active smoking in a subset with maternal urine cotinine measured during the index pregnancy (no exposure: ≤1.6 ng/mL; active smoking: ≥75 ng/mL)⁵ and with secondhand smoke exposure based on the question “Did anyone (excluding the mother) ever smoke in the mother’s home(s) or dwelling(s) during the child’s pregnancy?” Only 20 subjects reported exposure to e-cigarettes in addition to traditional cigarettes.

A total of 13120 children born between 1999–2020 from 52 cohorts met study criteria, with 9.3% prevalence of MSDP and nearly equal prevalence of each sex (52% male). Most reported race as White (58%), but others reported Black (18%), multiple (10%), Asian (5%), or other races (5%). The majority of children (7034) had BP data from one age; 3139 had measures at two ages, and 2947 had measures at ≥3 ages. The mean child age across measurement visits was 6.17 years. In the subset of children with BP measures at ≥3 visits (n=4158), 240 (5.8%; females, 82; males, 158) met criteria for hypertension.¹ In a subset of participants (n=2763; 10 cohorts), maternal urine cotinine was measured during pregnancy (median of 25 weeks gestation; range = 7–41), and we observed high concordance (>95%) between self-reported MSDP and pregnancy urine cotinine–derived categories.

Any MSDP was significantly associated with higher child diastolic BP (β=0.09 units; 95%CI: 0.04, 0.13; p<0.001) but not systolic BP (β=0.05 units; 95%CI: −0.01, 0.10; Figure 1). Any MSDP was also associated with a significant increase in the incidence rate ratio for hypertension (without interaction, 1.54; 95%CI: 1.04, 2.27). Cohort was removed from hypertension models to achieve convergence. Adding pre-term birth to models did not alter results (Figure 1). Results with sex-stratification or interaction suggest stronger effects among females compared to males (diastolic BP: females, 0.10; 95%CI: 0.03, 0.16; males, 0.08; 95%CI: 0.02, 0.15; hypertension interaction term, 0.31; 95%CI: 0.15, 0.66). Stratification at age 6 suggests weaker effect on diastolic BP in younger children (< 6 years, 0.07; 95%CI: 0.01, 0.13; ≥ 6years, 0.11; 95%CI: 0.06, 0.17), suggesting effects on BP may increase with age. Cotinine-determined active smoking exposure was associated with significantly higher diastolic and systolic BP Z-scores in crude models only and increased risk of hypertension before and after covariate adjustment. Secondhand smoke exposure only during pregnancy (1570 exposed vs 6017 unexposed) was not associated with increased BP Z-scores.

Figure 1. — Effect sizes and 95% confidence intervals are shown on the x-axis (• unadjusted; ▲ adjusted for child race, maternal age at delivery, maternal pre-pregnancy BMI category, prenatal alcohol exposure, maternal education level, and child sex [hypertension models only]; ■ additionally adjusted for preterm birth). The top panel represents the effects of any MSDP ascertained via self-reported questionnaire or medical record in the total study population. The middle panel represents the effects of any MSDP in the subset of subjects with cotinine data. The bottom panel represents the effects of active smoking based on urine cotinine measured during the index pregnancy (no exposure: ≤1.6 ng/mL vs. active smoking: ≥75 ng/mL).

Findings from this large multicohort US study support previous evidence that MSDP is a risk factor for increased childhood BP and hypertension. Our results extend previous studies of the relationship between MSDP and childhood BP to a large US population of children that included both males and females, a younger age group, and use of an objective biomarker of exposure.² Further, our results suggest that decreasing MSDP may reduce prevalence of hypertension in children and therefore among adults, improving overall health.

Acknowledgements

The authors wish to thank our ECHO Colleagues; the medical, nursing, and program staff; and the children and families participating in the ECHO cohort.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The sponsor, NIH, participated in the overall design and implementation of the ECHO Program, which was funded as a cooperative agreement between NIH and grant awardees. The sponsor approved the Steering Committee-developed ECHO protocol and its amendments including COVID-19 measures. The sponsor had no access to the central database, which was housed at the ECHO Data Analysis Center. Data management and site monitoring were performed by the ECHO Data Analysis Center and Coordinating Center. All analyses for scientific publication were performed by the study statistician, independently of the sponsor. The lead author wrote all drafts of the manuscript and made revisions based on co-authors and the ECHO Publication Committee (a subcommittee of the ECHO Operations Committee) feedback without input from the sponsor. The study sponsor did not review or approve the manuscript for submission to the journal.

Sources of Funding

Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, NIH, under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), U24OD023319 with co-funding from the Office of Behavioral and Social Science Research (Measurement Core), U24OD035523 (Lab Core), ES0266542 (HHEAR), U24ES026539 (HHEAR Barbara O’Brien), U2CES026533 (HHEAR Lisa Peterson), U2CES026542 (HHEAR Patrick Parsons, Kannan Kurunthacalam), U2CES030859 (HHEAR Manish Arora), U2CES030857 (HHEAR Timothy R. Fennell, Susan J. Sumner, Xiuxia Du), U2CES026555 (HHEAR Susan L. Teitelbaum), U2CES026561 (HHEAR Robert O. Wright), U2CES030851 (HHEAR Heather M. Stapleton, P. Lee Ferguson), UG3/UH3OD023251 (Akram Alshawabkeh), UH3OD023320 and UG3OD035546 (Judy Aschner), UH3OD023332 (Clancy Blair, Leonardo Trasande), UG3/UH3OD023253 (Carlos Camargo), UG3/UH3OD023248 and UG3OD035526 (Dana Dabelea), UG3/UH3OD023313 (Daphne Koinis Mitchell), UH3OD023328 (Cristiane Duarte), UH3OD023318 (Anne Dunlop), UG3/UH3OD023279 (Amy Elliott), UG3/UH3OD023289 (Assiamira Ferrara), UG3/UH3OD023282 (James Gern), UH3OD023287 (Carrie Breton), UG3/UH3OD023365 (Irva Hertz-Picciotto), UG3/UH3OD023244 (Alison Hipwell), UG3/UH3OD023275 (Margaret Karagas), UH3OD023271 and UG3OD035528 (Catherine Karr), UH3OD023347 (Barry Lester), UG3/UH3OD023389 (Leslie Leve), UG3/UH3OD023344 (Debra MacKenzie), UH3OD023268 (Scott T.Weiss), UG3/UH3OD023288 (Cynthia McEvoy), UG3/UH3OD023342 (Kristen Lyall), UG3/UH3OD023349 (Thomas O’Connor), UH3OD023286 and UG3OD035533 (Emily Oken), UG3/UH3OD023348 (Mike O’Shea), UG3/UH3OD023285 (Jean Kerver), UG3/UH3OD023290 (Julie Herbstman), UG3/UH3OD023272 (Susan Schantz), UG3/UH3OD023249 (Joseph Stanford), UG3/UH3OD023305 (Leonardo Trasande), UG3/UH3OD023337 (Rosalind Wright), UG3OD035508 (Sheela Sathyanarayana), UG3OD035509 (Anne Marie Singh), UG3OD035513 and UG3OD035532 (Annemarie Stroustrup), UG3OD035516 and UG3OD035517 (Tina Hartert), UG3OD035518 (Jennifer Straughen), UG3OD035519 (Qi Zhao), UG3OD035521 (Katherine Rivera-Spoljaric), UG3OD035527 (Emily S Barrett), UG3OD035540 (Monique Marie Hedderson), UG3OD035543 (Kelly J Hunt), UG3OD035537 (Sunni L Mumford), UG3OD035529 (Hong-Ngoc Nguyen), UG3OD035542 (Hudson Santos), UG3OD035550 (Rebecca Schmidt), UG3OD035536 (Jonathan Slaughter), UG3OD035544 (Kristina Whitworth). Additional support from the Oregon Clinical Translational Research Institute funded by the National Center for Advancing Translational Sciences (UL1TR000128) and the Oregon National Primate Research Center (P51 OD011092).

Non-standard Abbreviations and Acronyms

BP: blood pressure
SBP: systolic blood pressure
DBP: diastolic blood pressure
MSDP: maternal tobacco smoking during pregnancy
ECHO: Environmental influences on Child Health Outcomes
BMI: body mass index
DASH: Data and Specimen Hub

ECHO Collaborator Appendix

P Brian Smith

L Kristin Newby

Linda Adair

Lisa P. Jacobson

Diane Catellier

Monica McGrath

Christian Douglas

Priya Duggal

Emily Knapp

Amii Kress

Courtney K. Blackwell

Maxwell A. Mansolf

Jin-Shei Lai

Emily Ho

David Cella

Richard Gershon

Michelle L. Macy

Suman R. Das

Jane E. Freedman

Simon A. Mallal

John A. McLean

Ravi V. Shah

Meghan H. Shilts

Akram N. Alshawabkeh

Jose F. Cordero

John Meeker

Leonardo Trasande

Carlos A. Camargo

Kohei Hasegawa

Zhaozhong Zhu

Ashley F. Sullivan

Dana Dabelea

Wei Perng

Traci A. Bekelman

Greta Wilkening

Sheryl Magzamen

Brianna F. Moore

Anne P. Starling

Deborah J. Rinehart

Daphne Koinis Mitchell

Viren D’Sa

Sean C.L. Deoni

Hans-Georg Mueller

Cristiane S. Duarte

Catherine Monk

Glorisa Canino

Jonathan Posner

Tenneill Murray

Claudia Lugo-Candelas

Anne L. Dunlop

Patricia A. Brennan

Christine Hockett

Amy Elliott

Assiamira Ferrara

Lisa A. Croen

Monique M. Hedderson

John Ainsworth

Leonard B. Bacharier

Casper G. Bendixsen

James E. Gern

Diane R. Gold

Tina V. Hartert

Daniel J. Jackson

Christine C. Johnson

Christine L.M. Joseph

Meyer Kattan

Gurjit K. Khurana Hershey

Robert F. Lemanske, Jr.

Susan V. Lynch

Rachel L. Miller

George T. O’Connor

Carole Ober

Dennis Ownby

Katherine Rivera-Spoljaric

Patrick H. Ryan

Christine M. Seroogy

Anne Marie Singh

Robert A. Wood

Edward M. Zoratti

Rima Habre

Shohreh Farzan

Frank D. Gilliland

Irva Hertz-Picciotto

Deborah H. Bennett

Julie B. Schweitzer

Rebecca J. Schmidt

Janine M. LaSalle

Alison E. Hipwell

Catherine J. Karr

Nicole R. Bush

Kaja Z. LeWinn

Sheela Sathyanarayana

Qi Zhao

Frances Tylavsky

Kecia N. Carroll

Christine T. Loftus

Leslie D. Leve

Jody M. Ganiban

Jenae M. Neiderhiser

Scott T. Weiss

Augusto A. Litonjua

Cindy T. McEvoy

Eliot R. Spindel

Robert S. Tepper

Craig J. Newschaffer

Kristen Lyall

Heather E. Volk

Rebecca Landa

Sally Ozonoff

Joseph Piven

Heather Hazlett

Juhi Pandey

Robert Schultz

Steven Dager

Kelly Botteron

Daniel Messinger

Wendy Stone

Jennifer Ames

Thomas G. O’Connor

Richard K. Miller

Emily Oken

Michele R. Hacker

Tamarra James-Todd

T. Michael O’Shea

Rebecca C. Fry

Jean A. Frazier

Rachana Singh

Caitlin Rollins

Angela Montgomery

Ruben Vaidya

Robert M. Joseph

Lisa K. Washburn

Semsa Gogcu

Kelly Bear

Julie V. Rollins

Stephen R. Hooper

Genevieve Taylor

Wesley Jackson

Amanda Thompson

Julie Daniels

Michelle Hernandez

Kun Lu

Michael Msall

Madeleine Lenski

Rawad Obeid

Steven L. Pastyrnak

Elizabeth Jensen

Christina Sakai

Hudson Santos

Jean M. Kerver

Nigel Paneth

Charles J. Barone

Michael R. Elliott

Douglas M. Ruden

Chris Fussman

Julie B. Herbstman

Amy Margolis

Susan L. Schantz

Sarah Dee Geiger

Andrea Aguiar

Karen Tabb

Rita Strakovsky

Tracey Woodruff

Rachel Morello-Frosch

Amy Padula

Joseph B. Stanford

Christina A. Porucznik

Angelo P. Giardino

Rosalind J. Wright

Robert O. Wright

Brent Collett

Nicole Baumann-Blackmore

Ronald Gangnon

Daniel J. Jackson

Chris G. McKennan

Jo Wilson

Matt Altman

Judy L. Aschner

Annemarie Stroustrup

Stephanie L. Merhar

Paul E. Moore

Gloria S. Pryhuber

Mark Hudak

Ann Marie Reynolds Lyndaker

Andrea L. Lampland

Burton Rochelson

Sophia Jan

Matthew J. Blitz

Michelle W. Katzow

Zenobia Brown

Codruta Chiuzan

Timothy Rafael

Dawnette Lewis

Natalie Meirowitz

Brenda Poindexter

Tebeb Gebretsadik

Sarah Osmundson

Jennifer K. Straughen

Amy Eapen

Andrea Cassidy-Bushrow

Ganesa Wegienka

Alex Sitarik

Kim Woodcroft

Audrey Urquhart

Albert Levin

Tisa Johnson-Hooper

Brent Davidson

Tengfei Ma

Emily S. Barrett

Martin J. Blaser

Maria Gloria Dominguez-Bello

Daniel B. Horton

Manuel Jimenez

Todd Rosen

Kristy Palomares

Lyndsay A. Avalos

Yeyi Zhu

Kelly J. Hunt

Roger B. Newman

Michael S. Bloom

Mallory H. Alkis

James R. Roberts

Sunni L. Mumford

Heather H. Burris

Sara B. DeMauro

Lynn M. Yee

Aaron Hamvas

Antonia F. Olidipo

Andrew S. Haddad

Lisa R. Eiland

Nicole T. Spillane

Kirin N. Suri

Stephanie A. Fisher

Jeffrey A. Goldstein

Leena B. Mithal

Raye-Ann O. DeRegnier

Nathalie L. Maitre

Ruby H.N. Nguyen

Meghan M. JaKa

Abbey C. Sidebottom

Michael J. Paidas

JoNell E. Potter

Natale Ruby

Lunthita Duthely

Arumugam Jayakumar

Karen Young

Isabel Maldonado

Meghan Miller

Jonathan L. Slaughter

Sarah A. Keim

Courtney D. Lynch

Kartik K. Venkatesh

Kristina W.Whitworth

Elaine Symanski

Thomas F. Northrup

Hector Mendez-Figueroa

Ricardo A. Mosquera

Margaret R.Karagas

Juliette C. Madan

Debra M. MacKenzie

Johnnye L. Lewis

Brandon J. Rennie

Bennett L. Leventhal

Young Shin Kim

Somer Bishop

Sara S. Nozadi

Li Luo

Barry M. Lester

Carmen J. Marsit

Todd Everson

Cynthia M. Loncar

Elisabeth C. McGowan

Stephen J. Sheinkopf

Brian S. Carter

Jennifer Check

Jennifer B. Helderman

Charles R. Neal

Lynne M. Smith

Footnotes

Disclosures: Dr. Ladd-Acosta reports consulting fees from the University of Iowa for providing expertise on autism epigenetics, outside the scope of this work. Dr. Weiss reports honoraria from UpToDate and is on the Board of Histolix, a digital pathology company. All other co-authors declare that they have no competing interests.

Contributor Information

Lyndsey E. Shorey-Kendrick, Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR..

Christine Ladd-Acosta, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD..

Haozuo Zhao, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD..

Judy L. Aschner, Center for Discovery and Innovation, Hackensack Meridian School of Medicine, Nutley, NJ..

Carrie V. Breton, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA..

Carlos A. Camargo, Jr., Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA..

Andrea E. Cassidy-Bushrow, Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI.; Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI.

Elena Colicino, Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, NY..

Dana Dabelea, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO..

Anne L. Dunlop, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA..

Shohreh F. Farzan, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA..

Assiamira Ferrara, Upstream Prevention of Adiposity and Diabetes Mellitus (UPSTREAM) Center, Division of Research, Kaiser Permanente Northern California, Oakland, CA..

James E. Gern, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI..

Irva Hertz-Picciotto, Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA..

Margaret R. Karagas, Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, NH..

Catherine J. Karr, Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA.

Barry Lester, Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI.; Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI. Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI.

Leslie D. Leve, Prevention Science Institute, University of Oregon, Eugene, OR..

Brianna F. Moore, Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO..

Jenae M. Neiderhiser, Department of Psychology, Penn State University, University Park, PA..

Emily Oken, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA..

T. Michael O’Shea, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC..

Keia Sanderson, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC..

Joseph B. Stanford, Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT..

Leonardo Trasande, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY..

Scott T. Weiss, Channing Division of Network Medicine, Department of Medicine Brigham and Women’s Hospital and Harvard Medical School, Boston, MA..

Rosalind J. Wright, Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY..

Qi Zhao, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN..

Yeyi Zhu, Division of Research, Kaiser Permanente Northern California, Pleasanton, CA..

Cindy T. McEvoy, Department of Pediatrics, Oregon Health & Science University, Portland, OR..

Eliot R. Spindel, Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR..

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PERMALINK

Association of Maternal Smoking During Pregnancy with Childhood Blood Pressure and Hypertension in the ECHO Cohort

Lyndsey E Shorey-Kendrick, PhD

Christine Ladd-Acosta, PhD

Haozuo Zhao, MS

Judy L Aschner, MD

Carrie V Breton, ScD

Carlos A Camargo Jr, MD, DrPH

Andrea E Cassidy-Bushrow, PhD

Elena Colicino, PhD

Dana Dabelea, MD

Anne L Dunlop, MD, MPH

Shohreh F Farzan, PhD

Assiamira Ferrara, MD, PhD

James E Gern, MD

Irva Hertz-Picciotto, PhD, MPH

Margaret R Karagas, PhD

Catherine J Karr, PhD

Barry Lester, PhD

Leslie D Leve, PhD

Brianna F Moore, PhD

Jenae M Neiderhiser, PhD

Emily Oken, MD, MPH

T Michael O’Shea, MD, MPH

Keia Sanderson, MD, MSCR

Joseph B Stanford, MD, MSPH

Leonardo Trasande, MD, MPP

Scott T Weiss, MD, MS

Rosalind J Wright, MD, MPH

Qi Zhao, MD, PhD

Yeyi Zhu, PhD, MS

Cindy T McEvoy, MD, MCR

Eliot R Spindel, MD, PhD

RESEARCH LETTER

Figure 1. Summary of association of MSDP with childhood blood pressure (BP: both systolic [SBP] and diastolic [DBP]) or hypertension in the ECHO Cohort.

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