Smoking In Early Pregnancy Research Articles

Active and passive maternal smoking during pregnancy and the risks of low birthweight and preterm birth: the Generation R Study

The objective of this study was to examine the associations between active and passive smoking in different periods of pregnancy and changing smoking habits during pregnancy, with low birthweight and preterm birth. The study was embedded in the Generation R Study, a population-based prospective cohort study from early fetal life onwards in Rotterdam, The Netherlands. Active and passive smoking were assessed by questionnaires in early, mid- and late pregnancy. Analyses were based on 7098 pregnant women and their children. Active smoking until pregnancy was ascertained and was not associated with low birthweight and preterm birth. Continued active smoking after pregnancy was also recorded and was associated with low birthweight (adjusted odds ratio 1.75 [95% CI 1.20, 2.56]) and preterm birth (adjusted odds ratio 1.36 [95% CI 1.04, 1.78]). The strongest associations were found for active maternal smoking in late pregnancy. Passive maternal smoking in late pregnancy was associated with continuously measured birthweight (P for trend <0.001). For all active smoking categories in early pregnancy, quitting smoking was associated with a higher birthweight than continuing to smoke. Tendencies towards smaller non-significant beneficial effects on mean birthweight were found for reducing the number of cigarettes without quitting completely. This study shows that active and passive smoking in late pregnancy are associated with adverse effects on weight and gestational age at birth. Smoking in early pregnancy only, seems not to affect fetal growth adversely. Health care strategies for pregnant women should be aimed at quitting smoking completely rather than reducing the number of cigarettes.

Smoking in early gestation or through pregnancy: A decision crucial to pregnancy outcome

Objective. To assess maternal risk profile and pregnancy outcome of women who continued to smoke, reduced smoking to less than five cigarettes per day or did not smoke during pregnancy. Methods. We analyzed a population-based database of 26,414 singleton pregnancies from 1989 to 2001. Odds ratios (ORs) for adverse pregnancy outcomes were obtained from multiple logistic regression models. Results. The prevalence of smoking in early pregnancy was 25.7% and went down to 12.7% at 20 weeks of pregnancy. Women who smoked were more often young, primiparous or unmarried, used alcohol and more often had prior pregnancy terminations than women who did not smoke. Women who reduced smoking were mostly primiparous, and they also quit using alcohol. Continuing to smoke was associated with elevated risks of small-for-gestational-age infants (SGA) (OR 2.11), preterm birth (OR 1.15) and perinatal death (OR 1.15). SGA was avoided by reducing smoking, but not prematurity (OR 1.18) or elevated risk of perinatal death (OR 1.18). Conclusion. Smoking in early gestation and through pregnancy is associated with adverse pregnancy outcomes, and some of the harmful effects can be avoided by reducing smoking, although the behavioral risk profile of those who reduced smoking is closer to that of smokers than of non-smokers.

Obstetric Outcome of 6346 Pregnancies With Infants Affected by Congenital Heart Defects

This prospective, population-based, cohort study analyzed 6346 singleton pregnancies in Sweden during the years 1992 to 2001 in which the infant had a congenital heart defect. The prevalence of cardiovascular defects in the study population, totaling 770,355 infants, was 9.1 per 1000 births. Cases with known chromosomal abnormalities or preexisting maternal diabetes were excluded. An isolated cardiovascular defect was present in 84% of infants, and in 22%, it was severe. Case mothers did not differ substantially from control subjects with regard to age, parity, or smoking in early pregnancy. Obesity was more frequent in the case group; the crude odds ratio for having a body mass index of 25 kg/m2 or higher was 1.08 (95% confidence interval, 1.02–1.13). Cesarean delivery occurred more often in the case group, especially in cases with severe cardiac defects. The risk of instrumental delivery also was increased, but only when all cardiac defects were considered. In term infants, labor induction was significantly more frequent in the case group (odds ratio [OR], 1.12; 1.02–1.22), and the risk of preterm delivery was increased 2- to 3-fold. Infants with cardiac defects—especially severe ones—had lower birth weights than expected and were significantly more likely to be small for gestational age (OR, 2.46; 1.98–3.05). Those with milder defects, however, were likelier to be large-for-gestational-age infants (OR, 1.45; 1.28–1.64). Severe cardiac defects occurred in 26% of preterm infants compared with 21% of term infants (P < .001). Fetal distress, meconium aspiration, and low Apgar scores all were significantly more frequent in infants with cardiac defects. The incidence of preeclampsia was higher in case pregnancies (OR, 1.21; 1.06–1.37), but the incidence of stillbirth was the same in cases and control subjects. In this large-scale, population-based study, several obstetric and neonatal complications were more frequent when a fetal heart defect was present. A search for congenital cardiac defects is appropriate in neonates who had complicated pregnancies.

P04.50: Maternal smoking as a prognostic factor in prenatally diagnosed gastroschisis

Objective: Some studies have pointed at maternal smoking as a causative factor for gastroschisis. To our knowledge no study has investigated the role of maternal smoking on outcome of gastroschisis patients. The aim was to compare postnatal outcome of gastroschisis patients of smoking and non-smoking mothers. Methods: We conducted an observational study based on data from the institutional registry of neonatal surgery and chart review including all fetuses with a prenatal diagnosis of gastroschisis between January 1990 and February 2005 (n = 68). Maternal smoking habits during the first half of the pregnancy were recorded. Long term survival (censoring date 15.04.2005) was checked by census data. The main endpoints were postnatal mortality and morbidity of the gastroschisis patients. Statistical analyses were performed by SPSS 12.0. Results: Two pregnancies were terminated and 1 fetus died inutero. Sixty-five babies were live born; 21 (32.3%) mothers were smokers, 44 (67.7%) were non-smokers. The smoker/nonsmoker groups did not differ significantly concerning maternal age (24.2 vs. 24.5 years), percentage of nullipara (76.2 vs. 68.2%), time of diagnosis (21.5 vs. 21.8 weeks), percentage Cesarean deliveries (90.5 vs. 68.2% p = 0.07), gestational age at delivery (36.1 vs. 36.4 weeks), birth weight (2604 vs. 2716 g), 1 min (6.9 vs. 7.3) and 5 min Apgar scores (8.0 vs. 8.5) and associated major anomalies (14.3 vs. 20.5%). Primary closure was performed in 90.5 vs. 79.5%, p = 0.48 and the frequency of reoperation for complications was 19.0 vs. 39.5%, p = 0.16 (smoker vs. nonsmoker). Neonatal survival was 85.7 vs. 97.7% (p = 0.095) in the smoker vs. non-smoker groups, respectively. Long term survival was significantly decreased in the smoking group; 76.2 vs. 95.5%, p = 0.031 (smoker/non-smoker). Conclusion: Maternal smoking in early pregnancy was associated with a tendency to reduced neonatal and long term survival.

Preterm birth in Sweden 1973–2001: Rate, subgroups, and effect of changing patterns in multiple births, maternal age, and smoking

The objectives of this report are to evaluate changes in the preterm birth rate in Sweden 1973-2001. Furthermore, describe the proportion of spontaneous and indicated preterm births and assess risk factors for the subgroups of preterm birth during the period from 1991 to 2001. A population-based register study of all births occurring in Sweden from 1973 to 2001 registered in the Swedish Medical Birth Register was designed. The analysis of subgroups was restricted to the period 1991-2001. Gestational age was calculated using last menstrual period and best estimate. Odds ratio for preterm birth related to risk factors was calculated for the subgroups' spontaneous and indicated preterm birth. After an increase in the beginning of the 1980s, the preterm birth rate has decreased from 6.3% in 1984 to 5.6% in 2001 (P < 0.0001). The proportion of multiple births born preterm of the total birth rate increased from 0.34% in 1973 to 0.71% in 2001 (P < 0.0001). Spontaneous preterm births account for 55.2% and iatrogenic preterm births for 20.2% of all preterm births. The strongest association with maternal smoking in early pregnancy was found at gestational age <28 weeks and spontaneous preterm birth [odds ratio (OR) smoking versus no smoking: 1.55, 95% confidence intervals (CI): 1.42-1.69]. The strongest association for maternal age was found between gestational age <28 weeks and indicated preterm birth (OR 5-year increase: 1.34, 95% CI: 1.21-1.47). The preterm birth rate in Sweden has decreased since the mid 1980s. The composition of different subtypes of preterm birth in a Scandinavian low-risk population seems to be similar to populations with higher incidence of preterm birth and perinatal infections.

The epidemiology of anophthalmia and microphthalmia in Sweden

Infants with a clinical diagnosis of anophthalmia or microphthalmia were identified from four health registers in Sweden, covering different parts of the period 1965-2001. During the observation period, the rate of anophthalmia decreased from the early 1970s from 0.4 to 0.2 per 10,000 births. The registered rate of microphthalmia increased markedly during the observation period to reach a maximum in 1987 of about 1.5 per 10,000. About 10% of the 432 identified children had a chromosome anomaly. There was no geographical variation in prevalence and infants born in urban or rural districts had, if anything, a lower risk than infants born in cities (0.93 and 1.13 per 10,000, respectively). Non-eye malformations were more common at anophthalmia (63%) than at microphthalmia (30%). Sex ratio was normal and no statistically significant variation between sub-groups (anophthalmia, microphthalmia, isolated, associated with non-eye malformations) could be demonstrated. There was a marked risk increase with maternal age but no certain parity effect, no effect of maternal education, but a possible association with subfertility. Maternal smoking in early pregnancy seemed to increase the risk for anophthalmia or microphthalmia in the absence of a coloboma.

Preterm birth in Sweden 1973-2001: Rate, subgroups, and effect of changing patterns in multiple births, maternal age, and smoking

Background. The objectives of this report are to evaluate changes in the preterm birth rate in Sweden 1973–2001. Furthermore, describe the proportion of spontaneous and indicated preterm births and assess risk factors for the subgroups of preterm birth during the period from 1991 to 2001. Methods. A population-based register study of all births occurring in Sweden from 1973 to 2001 registered in the Swedish Medical Birth Register was designed. The analysis of subgroups was restricted to the period 1991–2001. Gestational age was calculated using last menstrual period and best estimate. Odds ratio for preterm birth related to risk factors was calculated for the subgroups' spontaneous and indicated preterm birth. Results. After an increase in the beginning of the 1980s, the preterm birth rate has decreased from 6.3% in 1984 to 5.6% in 2001 (P < 0.0001). The proportion of multiple births born preterm of the total birth rate increased from 0.34% in 1973 to 0.71% in 2001 (P < 0.0001). Spontaneous preterm births account for 55.2% and iatrogenic preterm births for 20.2% of all preterm births. The strongest association with maternal smoking in early pregnancy was found at gestational age <28 weeks and spontaneous preterm birth [odds ratio (OR) smoking versus no smoking: 1.55, 95% confidence intervals (CI): 1.42–1.69]. The strongest association for maternal age was found between gestational age <28 weeks and indicated preterm birth (OR 5-year increase: 1.34, 95% CI: 1.21–1.47). Conclusions. The preterm birth rate in Sweden has decreased since the mid 1980s. The composition of different subtypes of preterm birth in a Scandinavian low-risk population seems to be similar to populations with higher incidence of preterm birth and perinatal infections.

Use of folic acid supplementation and risk for dizygotic twinning

Background An increase in dizygotic twinning rate after folic acid supplementation has previously been described, but in a recent study from China, no such effect was seen. Aims To further investigate the association between use of folic acid supplement and dizygotic twinning. Study design Using the Swedish Medical Birth Registry, the rate of dizygotic twinning among infants of women who reported the use of folic acid was studied, taking a number of confounders into consideration. Comparisons were made with all women recorded in the register. Outcome measure Unlike-sexed twin pairs were used as representatives of dizygotic twinning. Results A number of confounders for the association between folic acid use and twinning were identified and taken into consideration. Women who were immigrants (who used less folic acid and had slightly lower twinning rates than women born in Sweden) and women who reported subfertility problems or treatment for subfertility (who had a high use of folic acid and a high twinning rate) were excluded, and adjustment was then made for year of birth, maternal age, parity, and smoking in early pregnancy. Folic acid use and twinning risk increased with maternal age and decreased with parity. Smokers used less folic acid than nonsmokers. Concomitant use of other drugs was no important confounder except for those used at subfertility. The odds ratio (OR) for dizygotic twinning after folic acid supplementation was then 1.71 (95%CI=1.21–2.42) and for the years 2000–2001 even 2.09 (95%CI=1.39–3.12). Conclusion There is an increase in twinning rate after folic acid supplementation in a Western population which should be taken into consideration when folic acid supplementation or food fortification is recommended.

Consequences of smoking and caffeine consumption during pregnancy in women with type 1 diabetes

Objective: To test the hypothesis that, in women with type 1 diabetes, prenatal smoking and caffeine consumption during pregnancy are associated with an increased risk of adverse maternal and perinatal outcomes.Methods: A secondary analysis of data on pregnant women with type 1 diabetes from an interdisciplinary program of Diabetes in Pregnancy. Women were interviewed monthly, by a trained non-medical member of the research team, using a standardized questionnaire, to ascertain daily smoking habits and caffeine consumption.Results: Smoking and caffeine information were available on 191 pregnancies, 168 progressing beyond 20 weeks of gestation. Early pregnancy smoking (OR 3.3, 95% CI 1.2, 8.7) and caffeine consumption (OR 4.5, 95% CI 1.2, 16.8) were associated with increased risk of spontaneous abortion when controlling for age, years since diagnosis of diabetes, previous spontaneous abortion, nephropathy and retinopathy. Smoking throughout pregnancy was significantly associated with decreased birth weight and prolonged neonatal hospital stay. Smoking throughout pregnancy (OR 0.2, 95% 0.1, 1.0) and caffeine consumption after 20 weeks (OR 0.3, 95% CI 0.1, 1.0) were associated with reduced risk of pre-eclampsia.Conclusions: Caffeine consumption during early pregnancy, regardless of glycemic control, increases the risk of spontaneous abortion. Smoking throughout pregnancy and caffeine consumption are associated with reduced risk of pre-eclampsia.

Earlier smoking habits are associated with higher serum lipids and lower milk fat and polyunsaturated fatty acid content in the first 6 months of lactation

To investigate the relation between maternal smoking habits, plasma lipids and milk fatty acid (FA) content and composition. Breastfeeding mothers who gave birth to healthy, full-term infants were recruited. Mothers were interviewed on smoking habits, being defined smokers (S) when usually smoking at least five cigarettes per day before pregnancy. Department of Pediatrics, San Paolo Hospital, Milan, Italy. In total, 92 mothers: 61 non-S (NS) and 31 S. Pooled hindmilk was collected at the first raise of milk (colostrum stage), 1, 3 and 6 months, and total lipid (TL) content and fatty acid (FA) composition were evaluated. Maternal dietary habits were assessed by a food-frequency questionnaire. Two subsamples (16 NS, 6 S) were investigated after delivery and at 3 months for serum lipids and FA status. At 6 months after delivery, the number of mothers still breastfeeding decreased to 30. Variables were compared using nonparametric tests. In smoking mothers serum levels of triglycerides, cholesterol and low-density lipoproteins were higher, while those of high-density lipoproteins were lower. TL content in breast milk was similar in the two groups just after delivery but higher in milk from NS at 1 month. TL content and FA absolute amounts of linoleic, arachidonic, alpha-linolenic and docosahexaenoic (DHA) acid in breast milk were lower in S vs NS 1 month after delivery. Also 3 months after delivery, the breast milk of smoking mothers contained less DHA than the breast milk of nonsmoking mothers. Maternal cigarette smoking in early pregnancy is associated with higher plasma lipid levels and lower milk TL and DHA content in the first months of lactation.

Caesarean section increases the risk of hospital care in childhood for asthma and gastroenteritis.

To investigate if caesarean section (CS) increases the risk for childhood asthma and gastroenteritis with reference made to children born with vaginal delivery (VD). Retrospective study of data from linked Swedish medical service registers--Medical Birth Registry (MBR) and Hospital Discharge Registry (HDR). Data were obtained from women without any background/perinatal morbidity noted, and from children without any neonatal complications. Children that had reached at least 1 year of age and were found in the HDR were considered as cases, whereas children not found in the HDR or hospitalized for other causes than asthma or gastroenteritis were defined as controls. Odds ratios (OR) stratified for year of birth, maternal age, parity and smoking in early pregnancy were calculated. Investigations were made comparing the risk for in hospital treatment for asthma or gastroenteritis in CS children and in VD siblings of CS children. The overall inpatient morbidity in CS and VD children were also investigated. The OR for asthma in CS children was 1.31 [95% confidence interval (CI) 1.23-1.40]. The same OR, 1.31, was found for gastroenteritis (95% CI 1.24-1.38). The OR for CS children having experienced both asthma and gastroenteritis was further increased (1.74, 95% CI 1.36-2.23). The risk for asthma in VD siblings of CS children was not significantly increased, whereas VD siblings experienced a slightly increased risk for gastroenteritis. CS children had an increased overall in hospital morbidity when compared to VD children. There is a significant increase of the risk for developing symptoms of asthma and/or gastroenteritis that motivates admission for hospital care in CS children older than 1 year. It is speculated that a disturbed intestinal colonization pattern in CS children may be a common pathogenic factor.

Deliveries, mothers and newborn infants in Sweden, 1973–2000

The aim of this report is to present descriptive data from the Swedish Medical Birth Register (MBR) reflecting trends in obstetric and neonatal practices over three decades. Since 1973 the MBR at the Swedish National Board of Health and Welfare receives information on all pregnancies in Sweden--around 95,000 annually--that have lead to delivery regarding the pregnancy, delivery and the newborn infant. In this study selected data from the MBR are presented as they have developed between 1973 and 2000. There was a shift in age distribution of childbearing women towards older women. Cigarette smoking in early pregnancy decreased from 30% to 12%. In-hospital time after both vaginal and cesarean (CS) delivery decreased and more than 50% of all women with a vaginal singleton delivery left hospital within 48 hours in 2000. The proportion of CS increased from 5 to 15% at singleton deliveries. The CS rate for breech deliveries increased and was nearly 80% in 2000. The mean birth weight increased, particularly the proportion of heavy infants. The proportion of early neonatal deaths decreased continuously, both for term infants and infants born after short gestational length, whereas no such downward trends was found for stillbirth during the last 10-15 years. Although several of the changes regarding pregnancy and delivery that occurred between 1973 and 2000 could be expected to influence pregnancy outcome negatively, the trends described here generally suggest improvement in maternal and child health.

Perinatal risk factors for infantile autism.

Etiologic hypotheses in infantile autism suggest a strong genetic component, as well as possible environmental risks linked to early fetal development. We evaluated the association of maternal, pregnancy, delivery, and infant characteristics and risk of infantile autism. We conducted a case-control study nested within a population-based cohort (all Swedish children born in 1974-1993). We used prospectively recorded data from the Swedish Birth Register, which were individually linked to the Swedish Inpatient Register. Cases were 408 children (321 boys and 87 girls) discharged with a main diagnosis of infantile autism from any hospital in Sweden before 10 years of age in the period 1987-1994, plus 2,040 matched controls. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). The risk of autism was associated with daily smoking in early pregnancy (OR = 1.4; CI = 1.1-1.8), maternal birth outside Europe and North America (OR = 3.0; CI = 1.7-5.2), cesarean delivery (OR = 1.6; CI = 1.1-2.3), being small for gestational age (SGA; OR = 2.1; CI = 1.1-3.9), a 5-minute Apgar score below 7 (OR = 3.2, CI = 1.2-8.2), and congenital malformations (OR = 1.8, CI = 1.1-3.1). No association was found between autism and head circumference, maternal diabetes, being a twin, or season of birth. Our findings suggest that intrauterine and neonatal factors related to deviant intrauterine growth or fetal distress are important in the pathogenesis of autism.

The working-class context of pregnancy smoking

The risk of smoking during pregnancy in the US is strongly associated with women's individual socioeconomic status (SES) but little is known about the influence of local area context. The aim of this study was to examine whether local-area characteristics increase the risk of smoking during pregnancy above and beyond individual SES. In a hospital-based cohort of 878 pregnant women in California, who delivered between 1980 and 1990, we compared risk of smoking during pregnancy based on individual and local-area factors. Adjusting for individual SES, neighborhood social class was related to smoking in early pregnancy. Living in a predominantly working-class area significantly increased the risk of pregnancy smoking for both working-class and non-working-class women. However, local-area economic and demographic indicators were not related to smoking early in pregnancy. Individual and family characteristics alone may be insufficient to explain smoking during pregnancy; the social class context of the places in which pregnant women live may also influence this behavior.

Coeliac disease is associated with intrauterine growth and neonatal infections

To investigate whether factors in the fetal or neonatal period influence the risk of later development of coeliac disease we conducted a population‐based register study. The Swedish Medical Birth Register was linked with the Hospital Discharge Register and identified 3392 singleton infants born in the period 1987‐97 who developed coeliac disease. Perinatal data for these children were compared with all children born in these years. Exposure variables: Maternal age, parity and smoking habits in early pregnancy, preeclampsia, pregnancy duration and birthweight, birthweight by gestational week, Apgar score, neonatal icterus, neonatal infections, maternal‐fetal blood group incompatibility, exchange transfusion, phototherapy. Odds ratios and test‐based confidence intervals were calculated. Analyses were made with stratification for year of birth and other risk factors. The risk of developing coeliac disease decreased with maternal age and was lower in first‐born than in second‐born children. Maternal smoking in early pregnancy was a weak risk factor, as was low birthweight. The most evident risk factors were being exposed to neonatal infections (OR = 1.52, confidence limits 1.19; 1.95) and being small for gestational age (OR = 1.45, confidence limits 1.20; 1.75). These risk factors were independent of each other. Conclusions: We have demonstrated that the intrauterine environment, mainly as mirrored by a low birthweight for gestational age and, independently, neonatal infection diagnosis, is associated with the risk of developing coeliac disease, supporting the idea of a multifactorial aetiology of the disease.

Maternal cigarette smoking during pregnancy and infant ponderal index at birth in the Swedish Medical Birth Register, 1991-1992.

This study examined the effect of maternal smoking during pregnancy on infant body proportion. The ponderal index, defined as birthweight divided by crown-heel length cubed, was examined in 207,607 infants from the Swedish Medical Birth Register for 1991 and 1992. Infant ponderal index was used as the outcome variable in an ordinary least squares continuous regression, which included early pregnancy smoking status, gestational age, and birthweight among the predictors. Ponderal index increased by 0.030 (+/- 0.0014) among infants of moderate smokers and by 0.040 (+/- 0.0017) among infants of heavy smokers, showing a dose response. Smoking differentially alters the trajectory of weight vs length growth in the fetus.

Stage of change, low income and benefit status: a profile of women's smoking in early pregnancy

Smoking cessation interventions in the UK are being developed in the context of widening socio-economic differentials in both prevalence and cessation. These differ entials are evident among pregnant women, the group targeted for interventions directed at women. Recent research has suggested that, among the disadvantages associated with low socio-economic status, being dependent on means-tested benefits may be a particularly powerful influence on snuokimg status and a major barrier to quitting. Intervention programmes have been heavily influenced by the transtheoretical model, which maps the quitting process as a patterned sequeuce of 'stages of change'. However, little is known about the stage-of-change profile in the UK population or about the socio- economic patterning of the profile. This paper begins to fill these gaps in the knowledge base of health promotion with respect to women in pregnancy. It reports on a survey of 2000 expectant mothers conducted in 1996 in the West Midlands. First pregnancy was found to have an intervention-like effect, with a high proportion of first-time expectant mothers who entered pregnancy as smokers either planning to quit or having done so. This intervention-like effect was moderated by women's socio-economic circumstances. Being in receipt of means-tested benefits increased the odds of a woman not intending to give up smoking in the foreseeable future.

Other People’s Smoke: A Major Risk Factor for SGA Births

Article| January 01 1999 Other People’s Smoke: A Major Risk Factor for SGA Births AAP Grand Rounds (1999) 1 (1): 2. https://doi.org/10.1542/gr.1-1-2 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Other People’s Smoke: A Major Risk Factor for SGA Births. AAP Grand Rounds January 1999; 1 (1): 2. https://doi.org/10.1542/gr.1-1-2 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: birth, infant, small for gestational age, smoke Source: Dejin-Karlsson E, Hanson BS, Ostergren PO, et al. Does passive smoking in early pregnancy increase the risk of small-for-gestational-age infants? Am J Public Health. 1998;88:1523–1527. The effect on fetal growth of other people smoking in the pregnant woman’s environment was explored in a recent study by Dejin-Karlsson et al. They prospectively evaluated nulliparous women living in the city of Malmo, Sweden, in both public and private clinics. In 1991–1992, 872 (88%) of 994 women completed a questionnaire during their first prenatal visit, including information on active maternal smoking and exposure to other people smoking at their home or work. There were 826 singleton liveborn infants, 6.7% of whom were classified as small for gestational age (SGA). The rates of SGA in those exposed versus not exposed to passive smoking were 7.9% and 3.6%, respectively. After controlling for confounding factors such as maternal age, height,... You do not currently have access to this content.

Partner smoking behaviour change is associated with women's smoking reduction and cessation during pregnancy

Objectives. To examine whether partner smoking behaviour change is associated with women's smoking reduction and cessation during pregnancy, independently of a range of potential psychosocial confounding variables. It was hypothesized that a woman's failure to reduce or quit smoking in pregnancy would be associated independently with failure of partner to reduce or quit smoking.Design. Cohort study.Methods. A population‐based sample of 662 women who smoked, or had smoked until becoming pregnant, were recruited in early pregnancy, with follow‐up in late pregnancy. Participants completed questionnaires and self‐report measures of sychosocial variables. The primary outcome measures were women's self‐reported daily cigarette consumption before pregnancy (retrospective), and during early and late pregnancy (contemporary), from which smoking cessation, reduction and maintenance measures were derived.Results. Seventy per cent of partners smoked, and 25 per cent of all partners (34 per cent of smoking partners) reduced or quitted smoking in early pregnancy. The study hypothesis was confirmed in multivariate logistic regression models. Women's failure to quit smoking in early pregnancy was independently associated with partner failing to reduce or quit smoking, higher number of social network smokers, adult attachment style, socio‐economic status, pre‐pregnancy cigarette consumption and older age. Women's failure to reduce smoking was independently associated with partner failing to reduce or quit smoking, socio‐economic status, pre‐pregnancy cigarette consumption, and higher parity. Partner and family emotional support, joint pregnancy planning and depressive symptomatology, were not independently associated with women's smoking reduction or cessation. Follow‐up data confirmed the early pregnancy results.Conclusions. Intervention trials to reduce the prevalence of smoking in pregnancy should include targeting of behavioural change in partner smoking.

Maternal cigarette smoking and child psychiatric morbidity: a longitudinal study.

Previous studies have linked maternal smoking during pregnancy with behavioral disturbance in children. However, additional evidence is needed to address the causality of the relationship. The present study analyses result from an Australian cohort of 5342 5-year-old children whose mothers were recruited early in pregnancy. Smoking history was gathered for prepregnancy, first clinic visit (FCV), late pregnancy, and when the child was 6 months and 5 years of age. Behavior problems at the age of 5 were assessed using a modified Child Behavior Check List (CBCL) shown to have high agreement with the complete CBCL. This resulted in the formation of three scales: internalizing; social, attentional and thought; and externalizing behavior problems, which were then dichotimized at the 90th percentile in each case. Logistic regression was used to model these outcomes as a function of maternal smoking at five time points during which it was assessed. A series of models explored the effect of additional adjustment for confounding. The predictors of attrition (29.5%) throughout the cohort were also identified by multivariate modeling. The final analysis was carried out on a cohort of mother-child pairs for whom data and child behavior outcomes were complete. The mean age of children was 5 years, 6 months with a range from 4 to 6 years. The mean age of mothers at the time of birth of the child was 25 years, with a range from 13 to 47 years. Mothers lost to follow-up were more likely to be younger, single, and less well-educated than those who continued participation, although maternal smoking was not an independent determinant. Unadjusted analyses showed strong associations between externalizing child behavior and maternal smoking during pregnancy and at the 5-year follow-up, with relative risks (RRs) up to 2.6 for children of women smoking at least 20 cigarettes per day at the first antenatal clinic visit. A clear dose-response relationship existed in most relationships with higher levels of smoking being associated with higher rates of externalizing behavior problems. Weaker relationships occurred for internalizing behavior and social, attentional and thought behavior problems. Multivariate analysis of the timing in more detail that the association between maternal smoking and child behavior problems persisted, although the evidence for dose-response diminished. Moreover, it was primarily associated with smoking as determined by questions asked at the FCV (RR = 1.52, 2.03, 2.16) for 1 to 9, 10 to 19, and >/=20 cigarettes per day, respectively, compared with nonsmoking and secondarily by smoking determined at the 5-year follow-up (RR = 1.52, 1.87, 1.29) for 1 to 9, 10 to 19, and >/=20 cigarettes per day respectively, compared with nonsmoking. This association appeared to be independent of a wide range of possible confounders such as maternal age, education, social class, marital status and mental health, gestation at FCV, complications during pregnancy, the child's sex, gestational age at birth, and age at last follow-up. Adjustments were also made for the mother's employment since birth, family structure, and maternal mental health at the time of the CBCL assessment. Associations between externalizing behavior problems and maternal smoking at other times, and those between other behavioral problems examined and maternal smoking were not significant. Although previous studies have found evidence for an association between maternal smoking and child behavior problems, the strength of this study lies in its size, its detailed and consistent measurement of maternal smoking, and its ability to control for many social and biological factors linked to maternal smoking and child behavior. (ABSTRACT TRUNCATED)