{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T23:21:03Z","timestamp":1777504863814,"version":"3.51.4"},"reference-count":44,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,8,1]]},"abstract":"<jats:p>OBJECTIVE. The causes of Legg-Calve\u0301-Perthes disease are largely unknown, but this pediatric disease seems to result from interruption of the blood supply to the proximal femur and is considered a vascular disease. Because maternal smoking during pregnancy influences fetal development and is associated with cardiovascular diseases in offspring, we hypothesized that this exposure is a risk for Legg-Calve\u0301-Perthes disease and also investigated other markers of impaired fetal development and early-life exposures.<\/jats:p>\n                  <jats:p>MATERIALS AND METHODS. The Swedish Inpatient Register identified 852 individuals with a diagnosis of Legg-Calve\u0301-Perthes disease from 1983 to 2005, individually matched by year of birth, age, sex, and region of residence with 4432 randomly selected control subjects. Linkage with the Swedish Medical Birth Register provided information on prenatal factors, including maternal smoking. Conditional logistic regression examined associations of maternal smoking during pregnancy and the other measures with the risk of Legg-Calve\u0301-Perthes disease in offspring, adjusted for socioeconomic index and other potential confounding factors.<\/jats:p>\n                  <jats:p>RESULTS. Maternal smoking during pregnancy was associated with an increased Legg-Calve\u0301-Perthes disease risk, and heavy smoking was associated with a risk increase of almost 100%. Very low birth weight and cesarean section were independently associated with \u223c240% and 36% increases in the risk of Legg-Calve\u0301-Perthes disease, respectively.<\/jats:p>\n                  <jats:p>CONCLUSION. Maternal smoking during pregnancy and other factors indicated by impaired fetal development may be associated with an increased risk of Legg-Calve\u0301-Perthes disease.<\/jats:p>","DOI":"10.1542\/peds.2008-0307","type":"journal-article","created":{"date-parts":[[2008,7,14]],"date-time":"2008-07-14T20:25:39Z","timestamp":1216067139000},"page":"e459-e464","source":"Crossref","is-referenced-by-count":55,"title":["Maternal Smoking During Pregnancy, Other Prenatal and Perinatal Factors, and the Risk of Legg-Calve\u0301-Perthes Disease"],"prefix":"10.1542","volume":"122","author":[{"given":"Shahram","family":"Bahmanyar","sequence":"first","affiliation":[{"name":"Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital"},{"name":"Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott M.","family":"Montgomery","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital"},{"name":"Clinical Research Centre, O\u0308rebro University Hospital, O\u0308rebro, Sweden"},{"name":"Department of Primary Care and Social Medicine, Charing Cross Hospital, Imperial College, London, United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ru\u0308diger J.","family":"Weiss","sequence":"additional","affiliation":[{"name":"Section of Orthopaedics and Sports Medicine, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anders","family":"Ekbom","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2008,8,1]]},"reference":[{"key":"2021120905590491700_R1","doi-asserted-by":"crossref","unstructured":"Axer A, Schiller MG. The pathogenesis of the early deformity of the capital femoral epiphysis in Legg-Calve\u0301-Perthes syndrome (L.C.P.S.). An arthrographic study. Clin Orthop Relat Res.\u20081972;84:106\u2013115","DOI":"10.1097\/00003086-197205000-00020"},{"key":"2021120905590491700_R2","doi-asserted-by":"crossref","unstructured":"Catterall A. The natural history of Perthes\u2019 disease. J Bone Joint Surg Br.\u20081971;53(1):37\u201353","DOI":"10.1302\/0301-620X.53B1.37"},{"key":"2021120905590491700_R3","unstructured":"Catterall A. Legg-Calve\u0301-Perthes disease. Instr Course Lect.\u20081989;38:297\u2013303"},{"key":"2021120905590491700_R4","doi-asserted-by":"crossref","unstructured":"Wiig O, Terjesen T, Svenningsen S, Lie SA. The epidemiology and aetiology of Perthes\u2019 disease in Norway: a nationwide study of 425 patients. J Bone Joint Surg Br.\u20082006;88(9):1217\u20131223","DOI":"10.1302\/0301-620X.88B9.17400"},{"key":"2021120905590491700_R5","doi-asserted-by":"crossref","unstructured":"Molloy MK, MacMahon B. Incidence of Legg-Perthes disease (osteochondritis deformans). N Engl J Med.\u20081966;275(18):988\u2013990","DOI":"10.1056\/NEJM196611032751804"},{"key":"2021120905590491700_R6","doi-asserted-by":"crossref","unstructured":"Gray IM, Lowry RB, Renwick DH. Incidence and genetics of Legg-Perthes disease (osteochondritis deformans) in British Columbia: evidence of polygenic determination. J Med Genet.\u20081972;9(2):197\u2013202","DOI":"10.1136\/jmg.9.2.197"},{"key":"2021120905590491700_R7","doi-asserted-by":"crossref","unstructured":"Pillai A, Atiya S, Costigan PS. The incidence of Perthes\u2019 disease in Southwest Scotland. J Bone Joint Surg Br.\u20082005;87(11):1531\u20131535","DOI":"10.1302\/0301-620X.87B11.16744"},{"key":"2021120905590491700_R8","doi-asserted-by":"crossref","unstructured":"Rowe SM, Jung ST, Lee KB, Bae BH, Cheon SY, Kang KD. The incidence of Perthes\u2019 disease in Korea: a focus on differences among races. J Bone Joint Surg Br.\u20082005;87(12):1666\u20131668","DOI":"10.1302\/0301-620X.87B12.16808"},{"key":"2021120905590491700_R9","doi-asserted-by":"crossref","unstructured":"Moberg A, Rehnberg L. Incidence of Perthes\u2019 disease in Uppsala, Sweden. Acta Orthop Scand.\u20081992;63(2):157\u2013158","DOI":"10.3109\/17453679209154813"},{"key":"2021120905590491700_R10","doi-asserted-by":"crossref","unstructured":"Alpaslan AM, Aksoy MC, Yazici M. Interruption of the blood supply of femoral head: an experimental study on the pathogenesis of Legg-Calve\u0301-Perthes Disease. Arch Orthop Trauma Surg.\u20082007;127(6):485\u2013491","DOI":"10.1007\/s00402-007-0367-y"},{"key":"2021120905590491700_R11","doi-asserted-by":"crossref","unstructured":"de Camargo FP, de Godoy RM Jr, Tovo R. Angiography in Perthes\u2019 disease. Clin Orthop Relat Res.\u20081984(191):216\u2013220","DOI":"10.1097\/00003086-198412000-00028"},{"key":"2021120905590491700_R12","doi-asserted-by":"crossref","unstructured":"Green NE, Griffin PP. Intra-osseous venous pressure in Legg-Perthes disease. J Bone Joint Surg Am.\u20081982;64(5):666\u2013671","DOI":"10.2106\/00004623-198264050-00003"},{"key":"2021120905590491700_R13","doi-asserted-by":"crossref","unstructured":"Burwell RG, Dangerfield PH, Hall DJ, Vernon CL, Harrison MH. Perthes\u2019 disease. An anthropometric study revealing impaired and disproportionate growth. J Bone Joint Surg Br.\u20081978;60-B(4):461\u2013477","DOI":"10.1302\/0301-620X.60B4.711791"},{"key":"2021120905590491700_R14","doi-asserted-by":"crossref","unstructured":"Molloy MK, Macmahon B. Birth weight and Legg-Perthes disease. J Bone Joint Surg Am.\u20081967;49(3):498\u2013506","DOI":"10.2106\/00004623-196749030-00008"},{"key":"2021120905590491700_R15","doi-asserted-by":"crossref","unstructured":"Lappin K, Kealey D, Cosgrove A, Graham K. Does low birthweight predispose to Perthes\u2019 disease? Perthes\u2019 disease in twins. J Pediatr Orthop B.\u20082003;12(5):307\u2013310","DOI":"10.1097\/01202412-200309000-00003"},{"key":"2021120905590491700_R16","doi-asserted-by":"crossref","unstructured":"Harrison MH, Turner MH, Jacobs P. Skeletal immaturity in Perthes\u2019 disease. J Bone Joint Surg Br.\u20081976;58(1):37\u201340","DOI":"10.1302\/0301-620X.58B1.178665"},{"key":"2021120905590491700_R17","doi-asserted-by":"crossref","unstructured":"Weiner DS, O'Dell HW. Legg-Calve\u0301-Perthes disease: observations on skeletal maturation. Clin Orthop Relat Res.\u20081970;68:44\u201349","DOI":"10.1097\/00003086-197001000-00007"},{"key":"2021120905590491700_R18","doi-asserted-by":"crossref","unstructured":"Neidel J, Boddenberg B, Zander D, Schicha H, Rutt J, Hackenbroch MH. Thyroid function in Legg-Calve\u0301-Perthes disease: cross-sectional and longitudinal study. J Pediatr Orthop.\u20081993;13(5):592\u2013597","DOI":"10.1097\/01241398-199309000-00007"},{"key":"2021120905590491700_R19","doi-asserted-by":"crossref","unstructured":"Roy DR. Perthes\u2019-like changes caused by acquired hypothyroidism. Orthopedics.\u20081991;14(8):901\u2013904","DOI":"10.3928\/0147-7447-19910801-16"},{"key":"2021120905590491700_R20","doi-asserted-by":"crossref","unstructured":"Neidel J, Zander D, Hackenbroch MH. No physiologic age-related increase of circulating somatomedin-C during early stage of Perthes\u2019 disease: a longitudinal study in 21 boys. Arch Orthop Trauma Surg.\u20081992;111(3):171\u2013173","DOI":"10.1007\/BF00388093"},{"key":"2021120905590491700_R21","doi-asserted-by":"crossref","unstructured":"Rayner PH, Schwalbe SL, Hall DJ. An assessment of endocrine function in boys with Perthes\u2019 disease. Clin Orthop Relat Res.\u20081986(209):124\u2013128","DOI":"10.1097\/00003086-198608000-00016"},{"key":"2021120905590491700_R22","doi-asserted-by":"crossref","unstructured":"Tanaka H, Tamura K, Takano K, et al. Serum somatomedin A in Perthes\u2019 disease. Acta Orthop Scand.\u20081984;55(2):135\u2013140","DOI":"10.3109\/17453678408992324"},{"key":"2021120905590491700_R23","doi-asserted-by":"crossref","unstructured":"Barker DJ, Dixon E, Taylor JF. Perthes\u2019 disease of the hip in three regions of England. J Bone Joint Surg Br.\u20081978;60-B(4):478\u2013480","DOI":"10.1302\/0301-620X.60B4.711792"},{"key":"2021120905590491700_R24","doi-asserted-by":"crossref","unstructured":"Hall AJ, Barker DJ. Perthes\u2019 disease in Yorkshire. J Bone Joint Surg Br.\u20081989;71(2):229\u2013233","DOI":"10.1302\/0301-620X.71B2.2925740"},{"key":"2021120905590491700_R25","doi-asserted-by":"crossref","unstructured":"Kealey WD, Moore AJ, Cook S, Cosgrove AP. Deprivation, urbanisation and Perthes\u2019 disease in Northern Ireland. J Bone Joint Surg Br.\u20082000;82(2):167\u2013171","DOI":"10.1302\/0301-620X.82B2.0820167"},{"key":"2021120905590491700_R26","doi-asserted-by":"crossref","unstructured":"Hall AJ, Barker DJ, Dangerfield PH, Taylor JF. Perthes\u2019 disease of the hip in Liverpool. Br Med J (Clin Res Ed).\u20081983;287(6407):1757\u20131759","DOI":"10.1136\/bmj.287.6407.1757"},{"key":"2021120905590491700_R27","doi-asserted-by":"crossref","unstructured":"Barker DJ, Hall AJ. The epidemiology of Perthes\u2019 disease. Clin Orthop Relat Res.\u20081986(209):89\u201394","DOI":"10.1097\/00003086-198608000-00012"},{"key":"2021120905590491700_R28","doi-asserted-by":"crossref","unstructured":"Glueck CJ, Freiberg RA, Crawford A, et al. Secondhand smoke, hypofibrinolysis, and Legg-Perthes disease. Clin Orthop Relat Res.\u20081998(352):159\u2013167","DOI":"10.1097\/00003086-199807000-00019"},{"key":"2021120905590491700_R29","doi-asserted-by":"crossref","unstructured":"Gordon JE, Schoenecker PL, Osland JD, Dobbs MB, Szymanski DA, Luhmann SJ. Smoking and socio-economic status in the etiology and severity of Legg-Calve\u0301-Perthes\u2019 disease. J Pediatr Orthop B.\u20082004;13(6):367\u2013370","DOI":"10.1097\/01202412-200411000-00003"},{"key":"2021120905590491700_R30","doi-asserted-by":"crossref","unstructured":"Mata SG, Aicua EA, Ovejero AH, Grande MM. Legg-Calve\u0301-Perthes disease and passive smoking. J Pediatr Orthop.\u20082000;20(3):326\u2013330","DOI":"10.1097\/01241398-200005000-00011"},{"key":"2021120905590491700_R31","doi-asserted-by":"crossref","unstructured":"Gunes T, Koklu E, Yikilmaz A, et al. Influence of maternal smoking on neonatal aortic intima-media thickness, serum IGF-I and IGFBP-3 levels. Eur J Pediatr.\u20082007;166(10):1039\u20131044","DOI":"10.1007\/s00431-006-0376-9"},{"key":"2021120905590491700_R32","doi-asserted-by":"crossref","unstructured":"Jaddoe VW, Verburg BO, de Ridder MA, et al. Maternal smoking and fetal growth characteristics in different periods of pregnancy: the generation R study. Am J Epidemiol.\u20082007;165(10):1207\u20131215","DOI":"10.1093\/aje\/kwm014"},{"key":"2021120905590491700_R33","doi-asserted-by":"crossref","unstructured":"Vielwerth SE, Jensen RB, Larsen T, Greisen G. The impact of maternal smoking on fetal and infant growth. Early Hum Dev.\u20082007;83(8):491\u2013495","DOI":"10.1016\/j.earlhumdev.2006.09.010"},{"key":"2021120905590491700_R34","doi-asserted-by":"crossref","unstructured":"Lindmark G, Cnattingius S. The scientific basis of antenatal care: report from a state-of-the-art conference. Acta Obstet Gynecol Scand.\u20081991;70(2):105\u2013109","DOI":"10.3109\/00016349109006190"},{"key":"2021120905590491700_R35","doi-asserted-by":"crossref","unstructured":"Shiverick KT, Salafia C. Cigarette smoking and pregnancy I: ovarian, uterine and placental effects. Placenta.\u20081999;20(4):265\u2013272","DOI":"10.1053\/plac.1998.0377"},{"key":"2021120905590491700_R36","doi-asserted-by":"crossref","unstructured":"Salafia C, Shiverick K. Cigarette smoking and pregnancy II: vascular effects. Placenta.\u20081999;20(4):273\u2013279","DOI":"10.1053\/plac.1998.0378"},{"key":"2021120905590491700_R37","doi-asserted-by":"crossref","unstructured":"Aycicek A, Ipek A. Maternal active or passive smoking causes oxidative stress in cord blood. Eur J Pediatr.\u20082008;167(1):81\u201385","DOI":"10.1007\/s00431-007-0433-z"},{"key":"2021120905590491700_R38","doi-asserted-by":"crossref","unstructured":"Janson C, Kunzli N, de Marco R, et al. Changes in active and passive smoking in the European Community Respiratory Health Survey. Eur Respir J.\u20082006;27(3):517\u2013524","DOI":"10.1183\/09031936.06.00106605"},{"key":"2021120905590491700_R39","doi-asserted-by":"crossref","unstructured":"Cnattingius S, Akre O, Lambe M, et al. Will an adverse pregnancy outcome influence the risk of continued smoking in the next pregnancy?Am J Obstet Gynecol.\u20082006;195(6):1680\u20131686","DOI":"10.1016\/j.ajog.2006.06.071"},{"key":"2021120905590491700_R40","doi-asserted-by":"crossref","unstructured":"Venters MH, Jacobs DR Jr, Luepker RV, Maiman LA, Gillum RF. Spouse concordance of smoking patterns: the Minnesota Heart Survey. Am J Epidemiol.\u20081984;120(4):608\u2013616","DOI":"10.1093\/oxfordjournals.aje.a113922"},{"key":"2021120905590491700_R41","doi-asserted-by":"crossref","unstructured":"Kallio K, Jokinen E, Raitakari OT, et al. Tobacco smoke exposure is associated with attenuated endothelial function in 11-year-old healthy children. Circulation.\u20082007;115(25):3205\u20133212","DOI":"10.1161\/CIRCULATIONAHA.106.674804"},{"key":"2021120905590491700_R42","doi-asserted-by":"crossref","unstructured":"England LJ, Grauman A, Qian C, et al. Misclassification of maternal smoking status and its effects on an epidemiologic study of pregnancy outcomes. Nicotine Tob Res.\u20082007;9(10):1005\u20131013","DOI":"10.1080\/14622200701491255"},{"key":"2021120905590491700_R43","doi-asserted-by":"crossref","unstructured":"Lindqvist R, Lendahls L, Tollbom O, Aberg H, Hakansson A. Smoking during pregnancy: comparison of self-reports and cotinine levels in 496 women. Acta Obstet Gynecol Scand.\u20082002;81(3):240\u2013244","DOI":"10.1034\/j.1600-0412.2002.810309.x"},{"key":"2021120905590491700_R44","unstructured":"National Board of Health and Welfare. The Swedish Medical Birth Register: A Summary of Content and Quality. Stockholm, Sweden: Center for Epidemiology, National Board of Health and Welfare; 2003"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/122\/2\/e459\/1034666\/zpe0080800e459.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/122\/2\/e459\/1034666\/zpe0080800e459.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T19:00:33Z","timestamp":1639076433000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/122\/2\/e459\/73059\/Maternal-Smoking-During-Pregnancy-Other-Prenatal"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,8,1]]},"references-count":44,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2008,8,1]]},"published-print":{"date-parts":[[2008,8,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2008-0307","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.3360962.3050063","asserted-by":"object"}]},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,8,1]]}}}