{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T04:02:42Z","timestamp":1768536162012,"version":"3.49.0"},"reference-count":69,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2020,2,25]],"date-time":"2020-02-25T00:00:00Z","timestamp":1582588800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004037","name":"Juho Vainion S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["201710136"],"award-info":[{"award-number":["201710136"]}],"id":[{"id":"10.13039\/501100004037","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004785","name":"NordForsk","doi-asserted-by":"publisher","award":["#75007"],"award-info":[{"award-number":["#75007"]}],"id":[{"id":"10.13039\/501100004785","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002341","name":"Academy of Finland","doi-asserted-by":"publisher","award":["285672"],"award-info":[{"award-number":["285672"]}],"id":[{"id":"10.13039\/501100002341","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002341","name":"Academy of Finland","doi-asserted-by":"publisher","award":["322150"],"award-info":[{"award-number":["322150"]}],"id":[{"id":"10.13039\/501100002341","id-type":"DOI","asserted-by":"publisher"}]},{"name":"EU Life project","award":["LIFE15ENV\/PT\/000674"],"award-info":[{"award-number":["LIFE15ENV\/PT\/000674"]}]},{"DOI":"10.13039\/501100003125","name":"Suomen Kulttuurirahasto","doi-asserted-by":"publisher","award":["65161550"],"award-info":[{"award-number":["65161550"]}],"id":[{"id":"10.13039\/501100003125","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Traditional risk factors and environmental exposures only explain less than half of the disease burden. The developmental origin of the health and disease (DOHaD) concept proposes that prenatal and early postnatal exposures increase disease susceptibility throughout life. The aim of this work is to demonstrate the application of the DOHaD concept in a chained risk assessment and to provide an estimate of later in life burden of disease related to maternal smoking. We conducted three systematic literature searches for meta-analysis and reviewed the literature reporting meta-analyses of long-term health outcomes associated with maternal smoking and intermediate risk factors (preterm birth, low birth weight, childhood overweight). In the chained model the three selected risk factors explained an additional 2% (34,000 DALY) of the total non-communicable disease burden (1.4 million DALY) in 2017. Being overweight in childhood was the most important risk factor (28,000 DALY). Maternal smoking was directly associated with 170 DALY and indirectly via the three intermediate risk factors 1000 DALY (1200 DALY in total). The results confirm the potential to explain a previously unattributed part of the non-communicable diseases by the DOHAD concept. It is likely that relevant outcomes are missing, resulting in an underestimation of disease burden.<\/jats:p>","DOI":"10.3390\/ijerph17051472","type":"journal-article","created":{"date-parts":[[2020,2,25]],"date-time":"2020-02-25T08:12:22Z","timestamp":1582618342000},"page":"1472","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Chained Risk Assessment for Life-Long Disease Burden of Early Exposures\u2013Demonstration of Concept Using Prenatal Maternal Smoking"],"prefix":"10.3390","volume":"17","author":[{"given":"Isabell K.","family":"Rumrich","sequence":"first","affiliation":[{"name":"Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), P.O. Box 95, 70701 Kuopio, Finland"},{"name":"Faculty of Science and Forestry, Department of Environmental and Biological Sciences, University of Eastern Finland (UEF), P.O. Box 1627, 70211 Kuopio, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirsi","family":"V\u00e4h\u00e4kangas","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, School of Pharmacy\/Toxicology, University of Eastern Finland (UEF), P.O. Box 1627, 70211 Kuopio, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matti","family":"Viluksela","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, School of Pharmacy\/Toxicology, University of Eastern Finland (UEF), P.O. Box 1627, 70211 Kuopio, Finland"},{"name":"Department of Health Security, Finnish Institute for Health and Welfare (THL), P.O. Box 95, 70701 Kuopio, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4868-4822","authenticated-orcid":false,"given":"Otto","family":"H\u00e4nninen","sequence":"additional","affiliation":[{"name":"Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), P.O. Box 95, 70701 Kuopio, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,2,25]]},"reference":[{"key":"ref_1","unstructured":"GBD 2017 Risk Factor Collaborators (2018). Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017. 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