Maternal cigarette smoking and invasive meningococcal disease: A cohort study among young children in metropolitan Atlanta, 1989-1996

Objectives. This study assessed the association between maternal cigarette smoking during pregnancy and the risk of invasive meningococcal disease dur ing early childhood. Methods. Using a retrospective cohort stud design, cases from an active sur veillance project monitoring all invasive meningococcal disease in the metr opolitan Atlanta area from 1989 to 1995 were merged with linked birth and d eath certificate data files. Children who had not died or acquired meningoc occal disease were assumed to be alive and free of the illness. The Cox pro portional hazards analysis was used to assess the independent association b etween maternal smoking and meningococcal disease. Results. The crude rate of meningococcal disease was 5 times higher for chi ldren whose mothers smoked during pregnancy than for children whose mothers did not smoke (0.05% vs. 0.01%). Multivariate analysis revealed that mater nal smoking (risk ratio [RR] = 2.9; 95% confidence interval [CI] = 1.5, 5.7 ) and a mother's having fewer than 12 years of education (RR = 2.1; 95% CI = 1.0 4.2) were independently associated with invasive meningococcal diseas e. Conclusions. Maternal smoking, a likely surrogate for tobacco smoke exposur e following delivery, appears to be a modifiable risk factor for sporadic m eningococcal disease in young children.