Low birthweight and maternal smoking as predictors of infant lung function from a South African birth cohort within low socioeconomic communities

Main Article Content

S Muttoo
P M Jeena
M Röösli
A C Olin
H K Carlson
K Asharam
A A Mtiku
R N Naidoo


Background. Early assessment of infant lung function (ILF) is necessary to improve our understanding of factors that determine long- term respiratory health.

Objective. To identify predictors of lung function among infants aged 6 weeks, 6, 12 and 24 months, from low socioeconomic settings, enrolled within the Mother and Child in the Environment (MACE) study.

Methods. ILF tests were performed assessing multiple breath washout and tidal breathing during spontaneous sleep. Several risk factors, relating to infant growth, maternal and environmental exposures, were assessed cross-sectionally against the lung function parameters in multivariable models for each age group.

Results. Maternal smoking during pregnancy affected the ratio of time to peak expiratory flow, showing a decline across the age groups, while being statistically significant (β (95% confidence interval (CI)) at 6 weeks (–24.6% (–43.92 - –4.59)) and 12 months (−12.68 (−25.25 - −0.11)). Low birthweight was associated with a lower tidal volume at 6 weeks (−5.99 mL (–9.59 - –2.39)), 6 months (−15.02 mL (−22.48 - −7.57)) and 12 months (−23.7 mL (−35.55 - −11.85)), compared with those with normal birthweight. This was further observed for minute ventilation at 6 weeks (−157.78 mL/min (−338.95 - 23.38)), 6 months (−325.57 mL/min (–619.06 - −32.08)) and 12 months (−527.58 mL/min (−947.85 - −107.32)), though less evident at 24 months.

Conclusion. Low birthweight was the main predictor for low tidal volumes and minute ventilation at 6 weeks, with smaller differences observed at 12 and 24 months. Lung function development early in life is primarily driven by infant size and postnatal growth factors, consistent with other studies.

Article Details

How to Cite
Low birthweight and maternal smoking as predictors of infant lung function from a South African birth cohort within low socioeconomic communities. (2023). South African Journal of Child Health, 17(4), 174-180. https://doi.org/10.7196/SAJCH.2023.v17i4.1957

How to Cite

Low birthweight and maternal smoking as predictors of infant lung function from a South African birth cohort within low socioeconomic communities. (2023). South African Journal of Child Health, 17(4), 174-180. https://doi.org/10.7196/SAJCH.2023.v17i4.1957


Hoo A-F, Stocks J, Lum S, et al. Development of lung function in early life: Influence of birth weight in infants of nonsmokers. Am J Respir Crit Care Med 2004;170(5):527-533. https://doi.org/10.1164/rccm.200311-1552OC

Goldizen FC, Sly PD, Knibbs LD. Respiratory effects of air pollution on children. Pediatr Pulmonol 2016;51(1):94-108. https://doi.org/10.1002/ppul.23262

Korten I, Ramsey K, Latzin P. Air pollution during pregnancy and lung development in the child. Paediatr Respir Rev 2017;21(1):38-46. https://doi. org/10.1016/j.prrv.2016.08.008

Gray D, Willemse L, Visagie A, et al. Determinants of early-life lung function in African infants. Thorax 2017;72(5):445-450. https://doi.org/10.1136/ thoraxjnl-2015-207401.

Horsley A. Lung clearance index in the assessment of airways disease. Respir Med 2009;103(6):793-799. https://doi.org/10.1016/j.rmed.2009.01.025

Macleod KA, Horsley AR, Bell NJ, Greening AP, Innes JA, Cunningham S. Ventilation heterogeneity in children with well controlled asthma with normal spirometry indicates residual airways disease. Thorax 2009;64(1):33-37. https:// doi.org/10.1136/thx.2007.095018

Horsley AR, Gustafsson PM, Macleod KA, et al. Lung clearance index is a sensitive, repeatable and practical measure of airways disease in adults with cystic fibrosis. Thorax 2008;63(2):135-140. https://doi.org/10.1136/thx.2007.082628

Aurora P, Bush A, Gustafsson P, et al. Multiple-breath washout as a marker of lung disease in preschool children with cystic fibrosis. Am J Respir Crit Care Med 2005;171(3):249-256. https://doi.org/10.1164/rccm.200407-895OC

Gustafsson PM, Aurora P, Lindblad A. Evaluation of ventilation maldistribution as an early indicator of lung disease in children with cystic fibrosis. Eur Respir J 2003;22(6):972-979. https://doi.org/10.1183/09031936.03.00049502

Hülskamp G , Pillow JJ, Dinger J, Stocks J. Lung function tests in neonates and infants with chronic lung disease of infancy: Functional residual capacity. Pediatr Pulmonol 2006;41(1):1-22. https://doi.org/10.1002/ppul.20318

Hülskamp G, Lum S, Stocks J, et al. Association of prematurity, lung disease and body size with lung volume and ventilation inhomogeneity in unsedated neonates: A multicentre study. Thorax 2009;64(3):240-245. https://doi. org/10.1136/thx.2008.101758

Latzin P, Roosli M, Huss A, Kuehni CE, Frey U. Air pollution during pregnancy and lung function in newborns: A birth cohort study. Eur Respir J 2009;33(3):594- 603. https://dx.doi.org/10.1183/09031936.00084008

Jeena PM, Asharam K, Mitku AA, Naidoo P, Naidoo RN. Maternal demographic and antenatal factors, low birth weight and preterm birth: Findings from the Mother and Child in the Environment (MACE) birth cohort, Durban, South Africa. BMC Pregnancy Childbirth 2020;20(1):628. https://doi.org/10.1186/ s12884-020-03328-6

World Health Organization. Child growth standards. WHO Multicentre Growth Reference Study Group. https://www.who.int/tools/child-growth-standards/ who-multicentre-growth-reference-study (accessed 29 September 2023).

Bates J, Schmalisch G, Filbrun D, Stocks J. Tidal breath analysis for infant pulmonary function testing. ERS/ATS Task Force on Standards for Infant Respiratory Function Testing. European Respiratory Society/American Thoracic Society. Eur Respir J 2000;16(6):1180-1192. https://doi.org/10.1034/j.1399- 3003.2000.16f26.x

Robinson PD, Latzin P, Verbanck S, et al. Consensus statement for inert gas washout measurement using multiple- and single- breath tests. Eur Respir J 2013;41:507-522. https://doi.org/10.1183/09031936.00069712

Gray D, Willemse L, Visagie A, et al. Lung function and exhaled nitric oxide in healthy unsedated African infants. Respirology 2015;20(7):1108-1114. https:// doi.org/10.1111/resp.12579

World Health Organization. Global Nutrition Targets 2025: Low Birth Weight Policy Brief. Geneva: WHO, 2014.

Lodrup Carlsen K, Jaakkola J, Nafstad P, Carlsen K. In utero exposure to cigarette smoking influences lung function at birth. Eur Respir J 1997;10(8):1774-1779. https://doi.org/10.1183/09031936.97.10081774

Dezateux C, Lum S, Hoo AF, Hawdon J, Costeloe K, Stocks J. Low birth weight for gestation and airway function in infancy: Exploring the fetal origins hypothesis. Thorax 2004;59(1):60-66. https://doi.org/10.1136/thx.2003.awjan

Yuksel B, Greenough A, Giffin F, Nicolaides KH. Tidal breathing parameters in the first week of life and subsequent cough and wheeze. Thorax 1996;51(8):815- 818. https://doi.org/10.1136/thx.51.8.815

Young S, Arnott J, O’Keeffe P, le Souef P, Landau L. The association between early life lung function and wheezing during the first 2 years of life. Eur Respir J 2000;15(1):151-157. https:// doi.org/10.1183/09031936.00.15115100

Dezateux C, Stocks J, Dundas I, Fletcher ME. Impaired airway function and wheezing in infancy. Am J Respir Crit Care Med 1999;159(2):403-410. https:// doi.org/10.1164/ajrccm.159.2.9712029

Fuchs O, Latzin P, Thamrin C, et al. Normative data for lung function and exhaled nitric oxide in unsedated healthy infants. Eur Respir J 2011;37(5):1208- 1216. https:// doi.org/10.1183/09031936.00125510

Gray DM, Turkovic L, Willemse L, et al. Lung function in African infants in the Drakenstein Child Health Study: Impact of lower respiratory tract illness. Am J Respir Crit Care Med 2017;195(2):212-220. https://doi.org/10.1164/ rccm.201601-0188OC

Similar Articles

You may also start an advanced similarity search for this article.