Abstract / Summary
Background: The studies on the direct and indirect effects of maternal cigarette smoking and alcohol consumption during pregnancy on cardiometabolic risk in offspring have been rather inconsistent. This review evaluated the associations between maternal cigarette smoking and alcohol exposure during pregnancy and cardiometabolic outcomes in infants, children, and adolescents. Methods: PubMed, Scopus, Web of Science and Google Scholar were searched in May 2026. Twenty-five prospective cohort studies published from 2001 onwards, investigating maternal cigarette smoking, alcohol use, or both during pregnancy, and offspring vascular or cardiometabolic outcomes, were included. Results: The association between maternal cigarette smoking during pregnancy and offspring systolic blood pressure was inconclusive. The pooled estimate suggested a small increase; however, the result was at borderline statistical significance (MD = 0.40 mmHg; 95% CI = 0.00, 0.81; Z = 1.96; p = 0.05). No significant associations were observed for diastolic blood pressure (MD = −0.16 mmHg; 95% CI = −0.59, 0.28; Z = 0.71; p = 0.48) and right carotid intima-media thickness (MD = 0.01 mm; 95% CI = −0.01, 0.03; Z = 1.27; p = 0.20), as well as maternal alcohol exposure and DBP (MD = −0.00 mmHg; 95% CI = −2.60, 2.59; Z = 0.00; p = 1.00). Evidence relating to alcohol exposure alone, dual exposure to smoking and alcohol, vascular outcomes, and lipid profiles was limited and synthesised narratively. Conclusions: The association between maternal cigarette smoking and offspring systolic blood pressure was inconclusive due to borderline significance. The evidence regarding vascular outcomes and lipid profiles remained limited and inconsistent. The certainty of the evidence was low for the adjusted systolic and diastolic analyses and very low for all remaining outcomes.