In their article, 'Familial factors confound the association between maternal smoking during pregnancy and offspring overweight', Iliadou et al.1 report three key messages: (i) maternal smoking during pregnancy (SDP) is associated with increased risk for offspring overweight in young adulthood; (ii) this association is partly confounded by familial factors; and (iii) specific familial factors common to both SDP and offspring overweight need to be identified. These messages offer important contributions to the literature on the role of SDP and later offspring outcome. First, this research demonstrates additional support for the value of using genetically informative designs to address this complex question. Secondly, we are reminded of the complexity surrounding the human condition and to tread carefully when making inferences of causation. Rarely, in the world of human research, are we considering scientific inquiries that are simple questions of nature vs nurture, or whether genes plus environment equal outcome. Rather, we are dealing with multifaceted questions that, perhaps unsurprisingly, have multifaceted answers.
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