Behavior of cardiac autonomic modulation in baby exposed to tobacco during the prenatal period

Abstract

Objective: to examine, through a literature review, the behavior of cardiac autonomic modulation in infants exposed to secondhand tobacco smoke during the prenatal period. Method: a literature review was conducted by searching the PubMed, WebOfScience, EBSCO, and Scopus databases, including articles published between January 1, 1995, and May 10, 2026. The following terms were used: prenatal; pregnancy; fetal programming; pediatric; tobacco; smoke; smoking; nicotine; autonomic nervous system; cardiac autonomic control; cardiac autonomic activity; cardiac autonomic modulation; heart rate variability; autonomic function. These terms were combined using the Boolean operator "AND". Results: a total of 4,334 articles were identified, with 8 selected for full-text analysis. Older articles generally found no significant differences between exposed groups and controls, which may have been due to small sample sizes and methodological limitations. Conversely, more recent studies showed reduced HRV and parasympathetic activity, along with increased sympathetic activity, in infants exposed to tobacco smoke during gestation. Conclusion: the complexity of the findings highlights the need for campaigns supporting smoking cessation among pregnant women and their household members, thereby contributing to the preservation of both maternal and infant cardiovascular health. Our analysis also indicated a need for more studies in this field and for the standardization of methodologies regarding the measurement of maternal smoking, the timing of infant assessment, and the use of probability samples.