Abstract
Smoke-free legislation is associated with improved early-life outcomes; however its impact on perinatal survival is unclear. We linked individual-level data with death certificates for all registered singletons births in England (1995–2011). We used interrupted time series logistic regression analysis to study changes in key adverse perinatal events following the July 2007 national, comprehensive smoke-free legislation. We studied 52,163 stillbirths and 10,238,950 live-births. Smoke-free legislation was associated with an immediate 7.8% (95%CI 3.5–11.8; p < 0.001) reduction in stillbirth, a 3.9% (95%CI 2.6–5.1; p < 0.001) reduction in low birth weight, and a 7.6% (95%CI 3.4–11.7; p = 0.001) reduction in neonatal mortality. No significant impact on SIDS was observed. Using a counterfactual scenario, we estimated that in the first four years following smoke-free legislation, 991 stillbirths, 5,470 cases of low birth weight, and 430 neonatal deaths were prevented. In conclusion, smoke-free legislation in England was associated with clinically important reductions in severe adverse perinatal outcomes.
Highlights
Smoke-free legislation is associated with improved early-life outcomes; its impact on perinatal survival is unclear
Analysing over 10 million births this is, to the best of our knowledge, one of the largest studies to have investigated the impact of smoke-free legislation on early life health, and the first to focus on perinatal mortality[9]
Registration of individual data items attained a high level of completeness, with over 97% of individuals having complete data on all covariates included in the primary analyses
Summary
Smoke-free legislation is associated with improved early-life outcomes; its impact on perinatal survival is unclear. Using a counterfactual scenario (Figs 2 and 3), we estimated that in the first four years following the implementation of smoke-free legislation in England 5,470 cases of low birth weight, 992 stillbirths, and 501 infant deaths, including 430 neonatal deaths, were averted.
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