Comment on “Maternal smoking, alcohol drinking, and febrile convulsion”

To the Editors, I read with interest the article by Vahidnia and colleagues regarding the risk of febrile convulsions among children whose mothers smoked cigarettes and/or drank alcohol during pregnancy. Maternal smoking has been linked to multiple adverse outcomes both in pregnant mothers and in their infants. Vahidnia et al. add to the existing evidence that in utero cigarette smoke exposure increases infants’ vulnerability to febrile seizures. Febrile seizures are common among children and are generally relatively benign. However, these convulsions cause considerable parental angst and some children with febrile seizures go on to develop epilepsy. In Vahidnia’s prospective cohort of 10,108 patients, 36% had in utero tobacco exposure and there was an increased risk of febrile seizures in the exposed infants. This risk was exacerbated by concurrent in utero alcohol exposure. The authors appropriately conclude that alcohol and tobacco cessation programs are important for young women of child-bearing age. Additional more tangible information, which can be derived from the data the authors present, may be helpful both to physicians and patients. In Vahidnia’s study, the incidence of febrile seizures in infants exposed to both tobacco and alcohol was 2.98% (55/1898), compared to 2.06% (85/4126) in unexposed infants. This translated to a relative risk of 1.41 among those exposed to tobacco and alcohol. The attributable risk percent (AR%) provides a measure of the proportion of febrile seizures among those exposed to tobacco and alcohol that are attributable to these exposures. In this study,