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Background While childhood airway outcomes have been associated with prenatal nutrition, few studies examined carotenoids, a group of nutrients with antioxidant properties, as potential modifiers.Objectives In n=677 mother–child dyads enrolled in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood cohort, we examined associations between prenatal carotenoids (α-carotene, β-carotene, β-cryptoxanthin, lycopene and zeaxanthin) and child lung function at ages 8–9 years. Maternal-child factors that may modify associations were also assessed.Methods Second-trimester plasma carotenoid concentrations were assayed and corrected for cholesterol. Outcomes included forced expiratory volume in one second (FEV 1), forced vital capacity (FVC) and FEV1/FVC z-scores. We used multivariable linear regression to investigate associations between individual carotenoids and lung function z-scores adjusting for covariates. We also examined effect modification by maternal smoking, body mass index, asthma, and child sex by including cross-product terms.Results We did not detect statistically significant associations between individual carotenoid concentrations and child lung function in main effect models. Modifying effects of prenatal smoking were observed between all five carotenoids and FEV 1 (all pinteraction<0.05). For example, a twofold increase in α-carotene was associated with an increase in FEV1 z-score of 0.45 (95% CI 0.08 to 0.86) among children whose mothers smoked prenatally versus a 0.01 (−0.08 to 0.10) change in children born to women who did not smoke.Conclusion A protective association between higher prenatal carotenoid concentrations and FEV 1 in middle childhood was observed among children whose mothers smoked during pregnancy.