Perinatal tobacco smoke exposure in 12,405 mother-infant pairs findings from the EISL Phase 3 in South America
Main Article Content
Keywords
infant, newborn, maternal-child health, pregnancy, perinatal tobacco exposure, tobacco smoke pollution / adverse effects
Abstract
Objective: To determine the prevalence, risk factors for perinatal tobacco smoking, and the effects on infants’ respiratory health in 12,450 mother-infant pairs from South America.
Methods: Cross-sectional population-based study in eleven centres from six countries, using a standardised questionnaire completed by parents.
Results: The prevalence of smoking during pregnancy was 8.4%, ranging from 1.4% in Lima to 15.3% in Montevideo; current maternal smoking was 15.3%, from 5.4% in Lima to 34.4% in Santiago; and second-hand tobacco smoke (SHS) at home was 29.8%, from 13.7% in Lima to 50.7% in Santiago. SHS and current maternal smoking were strong and independent risk factors for smoking during pregnancy (p < 0.0001). Low maternal education and monthly household income were significant risk factors for perinatal tobacco exposure. The prevalence and severity of wheezing, admissions for wheezing, pneumonia diagnosis, and admissions for pneumonia were significantly higher (p < 0.0001) in infants exposed to tobacco smoke.
Conclusions: The prevalence of smoking during pregnancy, current maternal tobacco smoking, and SHS remain high in South America. Perinatal tobacco smoke exposure is strongly related to greater wheezing severity and a higher prevalence of admissions for wheezing and pneumonia during the first year of life. Low socioeconomic status and low maternal education were the most significant risk factors for smoking during pregnancy, as well as for current maternal smoking and the presence of SHS at home. Our results point to the urgent need to improve the quantity and quality of education against tobacco smoking in girls and families, starting very early in life.
References
1. WHO report on the global tobacco epidemic, 2025: warning about the dangers of tobacco. Available from: https://www.who.int/publications/i/item/9789240112063 (Accessed September 2025)
2. Reitsma MB, Flor LS, Mullany EC, Gupta V, Hay SI, Gakidou E. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and initiation among young people in 204 countries and territories, 1990–2019. Lancet Public Health. 2021;6(7):e472–e481. https://doi.org/10.1016/S2468-2667(21)00102-X
3. Lawder R, Whyte B, Wood R, Fischbacher C, Tappin DM. Impact of maternal smoking on early childhood health: a retrospective cohort linked dataset analysis of 697003 children born in Scotland 1997–2009. BMJ Open. 2019;9(3):e023213. https://doi.org/10.1136/bmjopen-2018-023213
4. Mallol J, Urrutia-Pereira M, Mallol-Simmonds MJ, Calderón-Rodríguez L, Osses-Vergara F, Matamala-Bezmalinovic A. Prevalence and determinants of tobacco smoking among low-income urban adolescents. Pediatr Allergy Immunol Pulmonol. 2021;34(2):60–67. https://doi.org/10.1089/ped.2021.0018
5. Urrutia-Pereira M, Oliano VJ, Aranda CS, Mallol J, Solé D. Prevalence and factors associated with smoking among adolescents. J Pediatr (Rio J). 2017;93(3):230–237. https://doi.org/10.1016/j.jped.2016.07.003
6. López Blázquez M, Pérez Moreno J, Vigil Vázquez S, Rodríguez Fernández R. Impact of passive smoking on lung function and asthma severity in children. Arch Bronconeumol. 2018;54(8):436–437. https://doi.org/10.1016/j.arbres.2017.10.016
7. Lajunen K, Kalliola S, Kotaniemi-Syrjänen A, Malmberg LP, Pelkonen AS, Mäkelä MJ. Environmental tobacco smoke affects lung function of preschoolers with asthma even after a decade. Am J Respir Crit Care Med. 2019;199(4):534–536. https://doi.org/10.1164/rccm.201809-1729LE
8. Leonardi-Bee J, Britton J, Venn A. Secondhand smoke and adverse fetal outcomes in nonsmoking pregnant women: a meta-analysis. Pediatrics. 2011;127(4):734–741. https://doi.org/10.1542/peds.2010-3041
9. Ma C, Heiland EG, Li Z, Zhao M, Liang Y, Xi B. Global trends in the prevalence of secondhand smoke exposure among adolescents aged 12–16 years from 1999 to 2018: an analysis of repeated cross-sectional surveys. Lancet Glob Health. 2021;9(12):e1667–78. https://doi.org/10.1016/S2214-109X(21)00365-X
10. Tarasi B, Cornuz J, Clair C, Baud D. Cigarette smoking during pregnancy and adverse perinatal outcomes: a cross-sectional study over 10 years. BMC Public Health. 2022;22(1):2403. https://doi.org /10.1186/s12889-022-14881-4.
11. Upadhyaya P, Milillo C, Bruno A, Anaclerio F, Buccolini C, Dell'Elice A, et al. Nicotine-induced genetic and epigenetic modifications in primary human amniotic fluid stem cells. Curr Pharm Des. 2024;30(25):1995–2006. https://doi.org/10.2174/0113816128305232240607084420
12. Perret JL, Walters H, Johns D, Gurrin L, Burgess J, Lowe A, et al. Mother’s smoking and complex lung function of offspring in middle age: a cohort study from childhood. Respirology. 2016;21(5):911–9. https://doi.org/10.1111/resp.12750
13. Vlachou M, Kyrkou GA, Vivilaki V, Georgakopoulou VE, Katsaounou P, Kapetanaki A, et al. Tobacco smoke exposure and lactation. Cureus. 2024;16(11):e73651. https://doi.org/10.7759/cureus.73651
14. Itoh M, Kobayashi S, Nishihara S, Miyashita C, Yamazaki K, Tamura N, et al. Association between prenatal tobacco exposure and attention-deficit/hyperactivity disorder related characteristics at 6 and 8 years: a birth cohort in Japan. BMJ Open. 2024;14(12):e087406. https://doi.org/10.1136/bmjopen-2024-087406
15. Neuman Å, Hohmann C, Orsini N, Pershagen G, Eller E, Fomsgaard Kjaer H, et al. Maternal smoking in pregnancy and asthma in preschool children: a pooled analysis of eight birth cohorts. Am J Respir Crit Care Med. 2012;186(10):1037–43. https://doi.org/10.1164/rccm.201203-0501OC
16. Beckodro CK, Conteh V, Nsitou B, Das S, Sullivan K, Cowan LT. Tobacco smoking and postpartum depression symptoms in the Pregnancy Risk Assessment and Monitoring System (PRAMS) study.
J Affect Disord. 2025 Aug 15;383:222-27. https://doi.org/ 10.1016/j.jad.2025.04.147.
17. Hoang TT, Cosin-Tomas M, Lee Y, Monasso G, Xu Z, Shaobo Li S, et al. Prenatal smoking exposures and epigenome-wide methylation in newborn blood. Environ Health Perspect. 2025 Jun 6. https://doi.org/10.1289/EHP16303
18. McEvoy CT, Spindel ER. Pulmonary effects of maternal smoking on the fetus and child: effects on lung development, respiratory morbidities, and lifelong lung health. Paediatr Respir Rev. 2017;21:27–33. https://doi.org/10.1016/j.prrv.2016.08.005
19. Mallol J, García-Marcos L, Solé D, Brand P; EISL Study Group. International prevalence of recurrent wheezing during the first year of life: variability, treatment patterns and use of health resources. Thorax. 2010;65(11):1004–9. https://doi.org/10.1136/thx.2009.115188
20. Mallol J, Solé D, García-Marcos L, Rosario N, Aguirre V, Chong H, et al. Prevalence, severity, and treatment of recurrent wheezing during the first year of life: a cross-sectional study of 12,405 Latin American infants. Allergy Asthma Immunol Res. 2016;8(1):22–31. https://doi.org/10.4168/aair.2016.8.1.22
21. Lange S, Probst C, Rehm J, Popova S. National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysis. Lancet Glob Health. 2018;6(7):e769–76. https://doi.org/10.1016/S2214-109X(18)30223-7
22. Jafari A, Rajabi A, Gholian-Aval M, Peyman N, Mahdizadeh M, Tehrani H. National, regional, and global prevalence of cigarette smoking among women/females in the general population: a systematic review and meta-analysis. Environ Health Prev Med. 2021;26(1):5. https://doi.org/10.1186/s12199-020-00924-y.
23. The Tobacco Atlas. Prevalence [Internet]. Available from: https://tobaccoatlas.org/challenges/prevalence/#:~:text=Although%20global%20smoking%20prevalence%20has,were%20current%20smokers%20in%202019
24. Sharma T, Khapre M. Exposure of second hand smoke in women and children: a narrative review. J Family Med Prim Care. 2021;10(5):1804–7. https://doi.org/10.4103/jfmpc.jfmpc_1397_20
25. Wang X, Gao X, Chen D, Chen X, Li Q, Ding J, et al. The effect of active and passive smoking during pregnancy on birth outcomes: a cohort study in Shanghai. Tob Induc Dis. 2024;22. https://doi.org/10.18332/tid/188866
26. Gibbs K, Collaco JM, McGrath-Morrow SA. Impact of tobacco smoke and nicotine exposure on lung development. Chest. 2016;149(2):552–61. https://doi.org/10.1378/chest.15-1858
27. Miller RL, Lawrence J. Understanding root causes of asthma: perinatal environmental exposures and epigenetic regulation. Ann Am Thorac Soc. 2018;15(Suppl 2):S103–8. https://doi.org/10.1513/AnnalsATS.201706-514MG
28. Accordini S, Calciano L, Johannessen A, Benediktsdóttir B, Bertelsen RJ, Bråbäcket L, et al. Prenatal and prepubertal exposures to tobacco smoke in men may cause lower lung function in future offspring: a three-generation study using a causal modelling approach. Eur Respir J. 2021;58(4):2002791. https://doi.org/10.1183/13993003.02791-2020
29. Miyake K, Kushima M, Shinohara R, Horiuchi S, Otawa S, Akiyama Y, et al. Maternal smoking status before and during pregnancy and bronchial asthma at 3 years of age: a prospective cohort study. Sci Rep. 2023;13(1):3234. https://doi.org/10.1038/s41598-023-30304-9
30. Suzuki D, Wariki WMV, Suto M, Yamaji N, Takemoto Y, Rahman M, et al. Secondhand smoke exposure during pregnancy and mothers' subsequent breastfeeding outcomes: a systematic review and meta-analysis. Sci Rep. 2019;9(1):8535. https://doi.org/10.1038/s41598-019-44786-z
31. Yasuda S, Fukuda T, Toba N, Kamo N, Imaizumi K, Yokochi M, et al. Risk factors for discontinuation of exclusive breastfeeding within 1 month: a retrospective cohort study in Japan. Int Breastfeed J. 2022;17(1):20. https://doi.org/10.1186/s13006-022-00449-w
32. Garcia-Marcos L, Mallol J, Solé D, Brand PL; EISL Study Group. International study of wheezing in infants: risk factors in affluent and non-affluent countries during the first year of life. Pediatr Allergy Immunol. 2010;21(5):878–88. https://doi.org/10.1111/j.1399-3038.2010.01035.x
33. Fernández-Plata R, Rojas-Martínez R, Martínez-Briseño D, García-Sancho C, Pérez-Padilla R. Effect of passive smoking on the growth of pulmonary function and respiratory symptoms in schoolchildren. Rev Invest Clin. 2016 May–Jun;68(3):119–27.
34. Mudau R, Voyi K, Shirinde J. Prevalence of wheezing and its association with environmental tobacco smoke exposure among rural and urban preschool children in Mpumalanga Province, South Africa. Int J Environ Res Public Health. 2024;21(4):469. https://doi.org/10.3390/ijerph21040469
35. Zacharasiewicz A. Maternal smoking in pregnancy and its influence on childhood asthma. ERJ Open Res. 2016;2(3):00042–2016. https://doi.org/10.1183/23120541.00042-2016
36. Mendoza-Berjano R, León-Larios F, Corrales-Gutiérrez I, Gómez-Baya D, Medero-Canela R, Baena-Antequera F. High prevalence of tobacco consumption among pregnant women in a southern European city (Seville): a challenge for the health system. Toxics. 2024;12(10):728. https://doi.org/10.3390/toxics12100728
37. Nur N. Association of risk factors with smoking during pregnancy among women of childbearing age: an epidemiological field study in Turkey. Sao Paulo Med J. 2017;135(2):100–6. https://doi.org/10.1590/1516-3180.2016.021921102016
38. Bonello K, Figoni H, Blanchard E, Vignier N, Avenin G, Melchior M, et al. Prevalence of smoking during pregnancy and associated social inequalities in developed countries over the 1995–2020 period: a systematic review. Paediatr Perinat Epidemiol. 2023;37(6):555–65. https://doi.org/10.1111/ppe.12989
39. Pilehvari A, Chipoletti A, Krukowski R, Little M. Unveiling socioeconomic disparities in maternal smoking during pregnancy: a comprehensive analysis of rural and Appalachian areas in Virginia utilizing the multi-dimensional YOST index. BMC Pregnancy Childbirth. 2024;24(1):828. https://doi.org/10.1186/s12884-024-07032-7.
40. Bianca AC, Wandalsen GF, Miyagi K, Camargo L, Cezarin D, Mallol J, Solé D. International Study of Wheezing in Infants (EISL): validation of written questionnaire for children aged below 3 years. J Investig Allergol Clin Immunol. 2009;19(1):35–42.
41. Chong Neto HJ, Rosario N, Dela Bianca AC, Solé D, Mallol J. Validation of a questionnaire for epidemiologic studies of wheezing in infants. Pediatr Allergy Immunol. 2007;18(1):86–7. https://doi.org/10.1111/j.1399-3038.2006.00488.x
42. Mallol J, García-Marcos L, Aguirre V, Martinez-Torres A, Perez-Fernández V, Gallardo A, et al. The International Study of Wheezing in Infants: questionnaire validation. Int Arch Allergy Immunol. 2007;144(1):44–50. https://doi.org/10.1159/000102613
2. Reitsma MB, Flor LS, Mullany EC, Gupta V, Hay SI, Gakidou E. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and initiation among young people in 204 countries and territories, 1990–2019. Lancet Public Health. 2021;6(7):e472–e481. https://doi.org/10.1016/S2468-2667(21)00102-X
3. Lawder R, Whyte B, Wood R, Fischbacher C, Tappin DM. Impact of maternal smoking on early childhood health: a retrospective cohort linked dataset analysis of 697003 children born in Scotland 1997–2009. BMJ Open. 2019;9(3):e023213. https://doi.org/10.1136/bmjopen-2018-023213
4. Mallol J, Urrutia-Pereira M, Mallol-Simmonds MJ, Calderón-Rodríguez L, Osses-Vergara F, Matamala-Bezmalinovic A. Prevalence and determinants of tobacco smoking among low-income urban adolescents. Pediatr Allergy Immunol Pulmonol. 2021;34(2):60–67. https://doi.org/10.1089/ped.2021.0018
5. Urrutia-Pereira M, Oliano VJ, Aranda CS, Mallol J, Solé D. Prevalence and factors associated with smoking among adolescents. J Pediatr (Rio J). 2017;93(3):230–237. https://doi.org/10.1016/j.jped.2016.07.003
6. López Blázquez M, Pérez Moreno J, Vigil Vázquez S, Rodríguez Fernández R. Impact of passive smoking on lung function and asthma severity in children. Arch Bronconeumol. 2018;54(8):436–437. https://doi.org/10.1016/j.arbres.2017.10.016
7. Lajunen K, Kalliola S, Kotaniemi-Syrjänen A, Malmberg LP, Pelkonen AS, Mäkelä MJ. Environmental tobacco smoke affects lung function of preschoolers with asthma even after a decade. Am J Respir Crit Care Med. 2019;199(4):534–536. https://doi.org/10.1164/rccm.201809-1729LE
8. Leonardi-Bee J, Britton J, Venn A. Secondhand smoke and adverse fetal outcomes in nonsmoking pregnant women: a meta-analysis. Pediatrics. 2011;127(4):734–741. https://doi.org/10.1542/peds.2010-3041
9. Ma C, Heiland EG, Li Z, Zhao M, Liang Y, Xi B. Global trends in the prevalence of secondhand smoke exposure among adolescents aged 12–16 years from 1999 to 2018: an analysis of repeated cross-sectional surveys. Lancet Glob Health. 2021;9(12):e1667–78. https://doi.org/10.1016/S2214-109X(21)00365-X
10. Tarasi B, Cornuz J, Clair C, Baud D. Cigarette smoking during pregnancy and adverse perinatal outcomes: a cross-sectional study over 10 years. BMC Public Health. 2022;22(1):2403. https://doi.org /10.1186/s12889-022-14881-4.
11. Upadhyaya P, Milillo C, Bruno A, Anaclerio F, Buccolini C, Dell'Elice A, et al. Nicotine-induced genetic and epigenetic modifications in primary human amniotic fluid stem cells. Curr Pharm Des. 2024;30(25):1995–2006. https://doi.org/10.2174/0113816128305232240607084420
12. Perret JL, Walters H, Johns D, Gurrin L, Burgess J, Lowe A, et al. Mother’s smoking and complex lung function of offspring in middle age: a cohort study from childhood. Respirology. 2016;21(5):911–9. https://doi.org/10.1111/resp.12750
13. Vlachou M, Kyrkou GA, Vivilaki V, Georgakopoulou VE, Katsaounou P, Kapetanaki A, et al. Tobacco smoke exposure and lactation. Cureus. 2024;16(11):e73651. https://doi.org/10.7759/cureus.73651
14. Itoh M, Kobayashi S, Nishihara S, Miyashita C, Yamazaki K, Tamura N, et al. Association between prenatal tobacco exposure and attention-deficit/hyperactivity disorder related characteristics at 6 and 8 years: a birth cohort in Japan. BMJ Open. 2024;14(12):e087406. https://doi.org/10.1136/bmjopen-2024-087406
15. Neuman Å, Hohmann C, Orsini N, Pershagen G, Eller E, Fomsgaard Kjaer H, et al. Maternal smoking in pregnancy and asthma in preschool children: a pooled analysis of eight birth cohorts. Am J Respir Crit Care Med. 2012;186(10):1037–43. https://doi.org/10.1164/rccm.201203-0501OC
16. Beckodro CK, Conteh V, Nsitou B, Das S, Sullivan K, Cowan LT. Tobacco smoking and postpartum depression symptoms in the Pregnancy Risk Assessment and Monitoring System (PRAMS) study.
J Affect Disord. 2025 Aug 15;383:222-27. https://doi.org/ 10.1016/j.jad.2025.04.147.
17. Hoang TT, Cosin-Tomas M, Lee Y, Monasso G, Xu Z, Shaobo Li S, et al. Prenatal smoking exposures and epigenome-wide methylation in newborn blood. Environ Health Perspect. 2025 Jun 6. https://doi.org/10.1289/EHP16303
18. McEvoy CT, Spindel ER. Pulmonary effects of maternal smoking on the fetus and child: effects on lung development, respiratory morbidities, and lifelong lung health. Paediatr Respir Rev. 2017;21:27–33. https://doi.org/10.1016/j.prrv.2016.08.005
19. Mallol J, García-Marcos L, Solé D, Brand P; EISL Study Group. International prevalence of recurrent wheezing during the first year of life: variability, treatment patterns and use of health resources. Thorax. 2010;65(11):1004–9. https://doi.org/10.1136/thx.2009.115188
20. Mallol J, Solé D, García-Marcos L, Rosario N, Aguirre V, Chong H, et al. Prevalence, severity, and treatment of recurrent wheezing during the first year of life: a cross-sectional study of 12,405 Latin American infants. Allergy Asthma Immunol Res. 2016;8(1):22–31. https://doi.org/10.4168/aair.2016.8.1.22
21. Lange S, Probst C, Rehm J, Popova S. National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysis. Lancet Glob Health. 2018;6(7):e769–76. https://doi.org/10.1016/S2214-109X(18)30223-7
22. Jafari A, Rajabi A, Gholian-Aval M, Peyman N, Mahdizadeh M, Tehrani H. National, regional, and global prevalence of cigarette smoking among women/females in the general population: a systematic review and meta-analysis. Environ Health Prev Med. 2021;26(1):5. https://doi.org/10.1186/s12199-020-00924-y.
23. The Tobacco Atlas. Prevalence [Internet]. Available from: https://tobaccoatlas.org/challenges/prevalence/#:~:text=Although%20global%20smoking%20prevalence%20has,were%20current%20smokers%20in%202019
24. Sharma T, Khapre M. Exposure of second hand smoke in women and children: a narrative review. J Family Med Prim Care. 2021;10(5):1804–7. https://doi.org/10.4103/jfmpc.jfmpc_1397_20
25. Wang X, Gao X, Chen D, Chen X, Li Q, Ding J, et al. The effect of active and passive smoking during pregnancy on birth outcomes: a cohort study in Shanghai. Tob Induc Dis. 2024;22. https://doi.org/10.18332/tid/188866
26. Gibbs K, Collaco JM, McGrath-Morrow SA. Impact of tobacco smoke and nicotine exposure on lung development. Chest. 2016;149(2):552–61. https://doi.org/10.1378/chest.15-1858
27. Miller RL, Lawrence J. Understanding root causes of asthma: perinatal environmental exposures and epigenetic regulation. Ann Am Thorac Soc. 2018;15(Suppl 2):S103–8. https://doi.org/10.1513/AnnalsATS.201706-514MG
28. Accordini S, Calciano L, Johannessen A, Benediktsdóttir B, Bertelsen RJ, Bråbäcket L, et al. Prenatal and prepubertal exposures to tobacco smoke in men may cause lower lung function in future offspring: a three-generation study using a causal modelling approach. Eur Respir J. 2021;58(4):2002791. https://doi.org/10.1183/13993003.02791-2020
29. Miyake K, Kushima M, Shinohara R, Horiuchi S, Otawa S, Akiyama Y, et al. Maternal smoking status before and during pregnancy and bronchial asthma at 3 years of age: a prospective cohort study. Sci Rep. 2023;13(1):3234. https://doi.org/10.1038/s41598-023-30304-9
30. Suzuki D, Wariki WMV, Suto M, Yamaji N, Takemoto Y, Rahman M, et al. Secondhand smoke exposure during pregnancy and mothers' subsequent breastfeeding outcomes: a systematic review and meta-analysis. Sci Rep. 2019;9(1):8535. https://doi.org/10.1038/s41598-019-44786-z
31. Yasuda S, Fukuda T, Toba N, Kamo N, Imaizumi K, Yokochi M, et al. Risk factors for discontinuation of exclusive breastfeeding within 1 month: a retrospective cohort study in Japan. Int Breastfeed J. 2022;17(1):20. https://doi.org/10.1186/s13006-022-00449-w
32. Garcia-Marcos L, Mallol J, Solé D, Brand PL; EISL Study Group. International study of wheezing in infants: risk factors in affluent and non-affluent countries during the first year of life. Pediatr Allergy Immunol. 2010;21(5):878–88. https://doi.org/10.1111/j.1399-3038.2010.01035.x
33. Fernández-Plata R, Rojas-Martínez R, Martínez-Briseño D, García-Sancho C, Pérez-Padilla R. Effect of passive smoking on the growth of pulmonary function and respiratory symptoms in schoolchildren. Rev Invest Clin. 2016 May–Jun;68(3):119–27.
34. Mudau R, Voyi K, Shirinde J. Prevalence of wheezing and its association with environmental tobacco smoke exposure among rural and urban preschool children in Mpumalanga Province, South Africa. Int J Environ Res Public Health. 2024;21(4):469. https://doi.org/10.3390/ijerph21040469
35. Zacharasiewicz A. Maternal smoking in pregnancy and its influence on childhood asthma. ERJ Open Res. 2016;2(3):00042–2016. https://doi.org/10.1183/23120541.00042-2016
36. Mendoza-Berjano R, León-Larios F, Corrales-Gutiérrez I, Gómez-Baya D, Medero-Canela R, Baena-Antequera F. High prevalence of tobacco consumption among pregnant women in a southern European city (Seville): a challenge for the health system. Toxics. 2024;12(10):728. https://doi.org/10.3390/toxics12100728
37. Nur N. Association of risk factors with smoking during pregnancy among women of childbearing age: an epidemiological field study in Turkey. Sao Paulo Med J. 2017;135(2):100–6. https://doi.org/10.1590/1516-3180.2016.021921102016
38. Bonello K, Figoni H, Blanchard E, Vignier N, Avenin G, Melchior M, et al. Prevalence of smoking during pregnancy and associated social inequalities in developed countries over the 1995–2020 period: a systematic review. Paediatr Perinat Epidemiol. 2023;37(6):555–65. https://doi.org/10.1111/ppe.12989
39. Pilehvari A, Chipoletti A, Krukowski R, Little M. Unveiling socioeconomic disparities in maternal smoking during pregnancy: a comprehensive analysis of rural and Appalachian areas in Virginia utilizing the multi-dimensional YOST index. BMC Pregnancy Childbirth. 2024;24(1):828. https://doi.org/10.1186/s12884-024-07032-7.
40. Bianca AC, Wandalsen GF, Miyagi K, Camargo L, Cezarin D, Mallol J, Solé D. International Study of Wheezing in Infants (EISL): validation of written questionnaire for children aged below 3 years. J Investig Allergol Clin Immunol. 2009;19(1):35–42.
41. Chong Neto HJ, Rosario N, Dela Bianca AC, Solé D, Mallol J. Validation of a questionnaire for epidemiologic studies of wheezing in infants. Pediatr Allergy Immunol. 2007;18(1):86–7. https://doi.org/10.1111/j.1399-3038.2006.00488.x
42. Mallol J, García-Marcos L, Aguirre V, Martinez-Torres A, Perez-Fernández V, Gallardo A, et al. The International Study of Wheezing in Infants: questionnaire validation. Int Arch Allergy Immunol. 2007;144(1):44–50. https://doi.org/10.1159/000102613
Article Sidebar
Published
Mar 1, 2026
Article Details
How to Cite
Mallol, J., Solé, D., Aguirre, V., Aranda, C. S., Garcia-Marcos, L., Chong-Neto, H., Rosario, N., Urrutia-Pereira, M., Szulman, G., Niederbacher, J., Arruda-Chavez, E., Toledo, E., Sánchez, L. S., Pinchak, C., & The EISL South American Group. (2026). Perinatal tobacco smoke exposure in 12,405 mother-infant pairs: findings from the EISL Phase 3 in South America. Allergologia Et Immunopathologia, 54(2), 125–134. https://doi.org/10.15586/aei.v54i2.1647
Section
Original Articles
How to Cite
Mallol, J., Solé, D., Aguirre, V., Aranda, C. S., Garcia-Marcos, L., Chong-Neto, H., Rosario, N., Urrutia-Pereira, M., Szulman, G., Niederbacher, J., Arruda-Chavez, E., Toledo, E., Sánchez, L. S., Pinchak, C., & The EISL South American Group. (2026). Perinatal tobacco smoke exposure in 12,405 mother-infant pairs: findings from the EISL Phase 3 in South America. Allergologia Et Immunopathologia, 54(2), 125–134. https://doi.org/10.15586/aei.v54i2.1647