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This review presents findings of latent and persistent metabolic effects in offspring of smoking mothers like those observed in studies of maternal undernutrition during pregnancy. The phenotype of offspring of smoking mothers is like that associated with maternal undernutrition. Born smaller than offspring of nonsmokers, these children have increased risk of being overweight or obese later. Plausible mechanisms include in utero hypoxia, nicotine\u2010induced reductions in uteroplacental blood flow, placental toxicity, or toxic growth restriction from the many toxicants in tobacco smoke. Studies have reported increased risk of insulin resistance, type 2 diabetes and hypertension although the evidence here is weaker than for overweight\/obesity. Altered DNA methylation has been consistently documented in smoking mothers' offspring, and these epigenetic alterations are extensive and postnatally durable. A causal link between altered DNA methylation and the phenotypic changes observed in offspring remains to be firmly established, yet the association is strong, and mediation analyses suggest a causal link. Studies examining expression patterns of affected genes during childhood development and associated health outcomes should be instructive in this regard. The adverse effects of exposure to tobacco smoke during pregnancy now clearly include permanent metabolic derangements in offspring that can adversely affect life\u2010long health.<\/jats:p>","DOI":"10.1002\/bdr2.1550","type":"journal-article","created":{"date-parts":[[2019,7,17]],"date-time":"2019-07-17T06:05:26Z","timestamp":1563343526000},"page":"1259-1269","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":108,"title":["Smoking and pregnancy: Epigenetics and developmental origins of the metabolic syndrome"],"prefix":"10.1002","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5881-1768","authenticated-orcid":false,"given":"John M.","family":"Rogers","sequence":"first","affiliation":[{"name":"Toxicity Assessment Division, National Health and Environmental Effects Research Laboratory, Office of Research and Development United States Environmental Protection Agency, Research Triangle Park  North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,7,16]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"593","article-title":"Smoking during pregnancy: A review of effects on growth and development of offspring","volume":"52","author":"Abel E. 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