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Longitudinal studies are needed to assess changes in tobacco use behaviors over time and establish temporal relationships

Key points We analyzed 27 brain MRI studies (15,913 participants) comparing offspring exposed to tobacco in pregnancy versus unexposed controls. Exposed offspring showed structural differences, including a thinner cortex and smaller frontal, parietal, and temporal volumes. Altered brain activity within the frontal, parietal, and temporal lobes of the exposed offspring were consistently identified. Our meta-analysis found a reduced activity in the right inferior frontal gyrus of the tobacco-exposed offspring. Maternal smoking during pregnancy may alter brain development in the offspring, but more research is needed on real-world impacts

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