In Utero Exposure to Smoking and Alcohol, and Passive Smoking during Childhood: Effect on the Retinal Nerve Fibre Layer in Young Adulthood

Samantha Sze Yee Lee, David A. Mackey, Paul G. Sanfilippo, Alex W. Hewitt, Jamie E. Craig, Seyhan Yazar

Research output: Contribution to journalArticlepeer-review


Purpose: In utero exposure to cigarette smoke has been suggested to result in thinner retinal nerve fibre layer (RNFL). However, the potential cofounding effects of in utero alcohol exposure and passive smoking during childhood had not been considered. We explored RNFL thickness in young adults in relation to these early life factors. Methods: In 1989–1991, pregnant women completed questionnaires on their current smoking and alcohol drinking patterns. Following the birth of their offspring, information on household smokers was obtained between the 1- and 13-year follow-ups. At the 20-year follow-up, these offspring underwent an eye examination including optical coherence tomography imaging of the RNFL. Results: Participants (n = 1,287) were 19–22 years old at time of eye examination. Most participants (77%) had no in utero exposure to cigarette smoke; 1.3% were initially exposed but not after 18 weeks’ gestation, while 21% had continual in utero smoking exposure. Half of the mothers never consumed alcohol or only consumed alcohol once during their pregnancies. After correcting for potential confounders, including in utero alcohel exposure and childhood passive smoking, participants who had continued in utero exposure to >10 cigarettes/day and ≤10 cigarettes/day had thinner RNFLs by 6.6 (95% confidence interval [CI] = 4.4–8.7) and 3.7 µm (95%[CI] = 2.3–5.5), respectively, than those with no exposure (p < .001). In utero alcohol exposure and childhood passive smoking were not significantly associated with RNFL thickness after accounting for in utero exposure to smoking. Conclusions: In utero exposure to cigarette smoke is associated with thinner RFNL in young adulthood, independent of other early life environmental factors.

Original languageEnglish
Number of pages8
JournalOphthalmic Epidemiology
Early online date5 Sep 2021
Publication statusE-pub ahead of print - 5 Sep 2021


  • maternal alcohol consumption
  • Maternal smoking
  • passive smoking
  • retinal nerve fibre layer
  • the raine study


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