Household Exposure to Secondhand Cigarette Smoke during Pregnancy and Adverse Offspring Health Outcomes in The Gambia: A Cross-Sectional Study

The adverse effects of maternal passive smoking during pregnancy on offspring health remain understudied in sub-Saharan Africa, particularly in The Gambia, where smoke-free regulations are limited. To determine the prevalence of maternal passive smoking (MPS) during pregnancy and investigate its associations with adverse pregnancy outcomes and offspring health complications in The Gambia. A cross-sectional study was conducted in February 2023 among 401 mothers with children under 5 years in urban and rural regions of The Gambia. Data was collected through structured interviews and verification of antenatal care records. Multivariate logistic regression analyses were performed to examine associations between maternal passive smoking and various health outcomes. The prevalence of maternal passive smoking during pregnancy was 18% (72/401). Mothers exposed to passive smoking had significantly higher odds of having children with cleft palate [adjusted OR = 3.39, 95% CI (1.01-11.41), P = 0.049] and offspring with asthma [aOR = 3.32, 95% CI (1.06-10.43), P = 0.038]. Passive smokers showed an increased tendency toward developing eclampsia during pregnancy [aOR = 1.24, 95% CI (0.58-2.66)], although this association was not statistically significant. Additionally, 36% of participants reported having smoking spouses, with 20.4% reporting indoor smoking exposure. This study reveals significant associations between maternal passive smoking during pregnancy and increased risks of cleft palate (p = 0.03) and asthma (p = 0.04) in offspring within the Gambian context. These findings highlight the need for strengthened smoke-free policies and targeted interventions to protect pregnant women from secondhand smoke exposure. Future prospective studies with biochemical validation of exposure are warranted to establish causality and examine long-term health impacts.