Smoking cessation in the first trimester reduces most obstetric risks, but not the risks of major congenital anomalies and admission to neonatal care: a population-based cohort study of 1 164 953 singleton pregnancies in Finland

Räisänen, Sari; Sankilampi, Ulla; Gissler, Mika; Kramer, Michael R.; Hakulinen, Tuovi; Saari, Juho; Heinonen, Seppo

doi:10.1136/jech-2013-202991

Cited by 61 publications

(54 citation statements)

References 29 publications

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“…6–8 However, these findings of no significant risk increase in women who smoked but quit earlier in pregnancy may have been limited by smaller sample size (n<11,200) compared to our large cohort of nearly 1 million singleton live births 5,6,8 , In addition, few similar studies included a population of US women, and the findings of those born in other areas of the world may not be applicable given regional and racial differences in birth weights and smoking patterns across the world. 7,8 Finally, one other large U.S. cohort study concluded that quitting smoking in the first trimester reduced risk of FGR compared to a referent group of women who smoked throughout pregnancy. 14 This study also drew the conclusion that quitting smoking in the first trimester brought risk of SGA similar to that of non-smokers, but did not use non-smokers as a referent group.…”

Section: Discussionmentioning

confidence: 99%

Association of Reported Trimester-Specific Smoking Cessation With Fetal Growth Restriction

Blatt

Moore

Chen

et al. 2015

Obstetrics &Amp; Gynecology

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Objective To assess the association of reported smoking cessation at various time points during pregnancy with fetal growth restriction (FGR). Methods This was a population-based retrospective cohort study of singleton nonanomalous live births using Ohio birth certificates, 2006–2012. Outcomes of women who reported smoking only in the 3 months before conception and women who reported smoking through the first, second, or third trimester were compared to a referent group of nonsmokers. Multivariate logistic regression assessed the association between smoking cessation at various times in pregnancy and FGR less than the 10th and 5th percentiles. Results Of 927,424 births analyzed, 75% did not smoke. Of smokers, 24% smoked preconception only, 10% quit after the 1st trimester, 4% quit after the 2nd trimester, and 59% smoked throughout pregnancy. The rate of FGR less than the 10th and 5th percentiles among non-smokers was 8.1% and 3.6%, respectively. Although smoking only in the preconception period did not significantly increase FGR risk, smoking in any trimester did. The adjOR(95%CI) for FGR less than the 10th and 5th percentiles, respectively, of cessation after the 1st trimester was 1.19(1.13,1.24) and 1.25(1.17,1.33), and 1.67(1.57,1.78) and 1.83(1.68,1.99) for cessation after the second trimester. Women who reported smoking throughout pregnancy had the highest risks of FGR, 2.26 (2.22,2.31) and 2.44(2.37,2.51), after accounting for the influence of race, low socioeconomic status, and medical comorbidities. Conclusions Smoking of any duration during pregnancy is associated with an increased risk of FGR, with decreasing risk the earlier that cessation occurs. Smoking cessation programs should focus on the benefit of quitting as early in pregnancy as possible.

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Section: Discussionmentioning

confidence: 99%

Association of Reported Trimester-Specific Smoking Cessation With Fetal Growth Restriction

Blatt

Moore

Chen

et al. 2015

Obstetrics &Amp; Gynecology

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“…Numerous other studies have shown analogous results related to early smoking cessation and preterm risk relative to that of a non-smoker. 17–19 Polakowski et al similarly used birth certificate data, however their study only evaluated preterm births >28 weeks. 18 Our results show a 20% increase in extreme preterm births (20–27 weeks) if cessation occurred after the 1 st trimester.…”

Section: Commentmentioning

confidence: 99%

Relationship of trimester-specific smoking patterns and risk of preterm birth

Moore

Blatt

Chen

et al. 2016

American Journal of Obstetrics and Gynecology

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Background In 2011, the US national rate of smoking early in pregnancy was 11.5%. Unfortunately, our home state of Ohio had a rate twice as high at 23%. Smoking in pregnancy remains one of the most important modifiable risk factors for pregnancy complications, specifically preterm birth. Objective To quantify the preterm birth risk to various trimester-specific smoking behaviors. Study Design Population-based retrospective cohort study of singleton non-anomalous live births utilizing Ohio birth records 2006–2012. Preterm birth rates were compared between non-smokers, and women who smoked in the preconception period only, those who quit smoking after the 1st and 2nd trimesters and those who smoked throughout pregnancy. Multivariate logistic regression quantified the risk of smoking with cessation at various times in pregnancy and preterm birth risk, adjusted for maternal race, education, age, Medicaid use, marital status, and parity. A stratified analysis was performed based on preterm birth subtype: spontaneous preterm birth versus indicated preterm birth. We also performed an additional analysis stratifying for maternal race using the 2 largest categories of race (non-Hispanic white and non-Hispanic black). Results Of the 913,757 birth records analyzed, nearly 1/4 of the women reported some smoking behavior on the birth certificate data. Of smokers, less than half quit during pregnancy (38.8% vs 61.2% smoked throughout pregnancy). Early quitters had a similar preterm birth rate compared to non-smokers. Women who smoked through the 1st trimester only did not have a significant increase in their overall preterm birth odds ratio <37 weeks; however it did increase the odds of extreme preterm birth <28 weeks by 20%; adjusted odds ratio 1.20 (95% Confidence interval 1.02, 1.40). Quitting late in pregnancy resulted in the highest odds ratio increase, 70% for preterm birth <37 wks, adjusted odds ratio 1.70 (CI 1.60, 1.80), even after adjustment for the confounding influences. Quitting smoking early in pregnancy after the 1st trimester did not increase the overall risk of spontaneous or indicated preterm birth <37 weeks significantly. However, quitting after the 1st trimester was associated with a significant increase in risk of extreme spontaneous preterm birth <28 weeks, an effect not seen with indicated preterm birth <28 weeks. Delaying cessation until late in pregnancy – after the 2nd trimester - was associated with the highest risk increases, 65% increased odds of spontaneous and 78% increase in odds of indicated preterm births. The rate of preterm births to non-Hispanic black mothers was increased in all categories over those of non-Hispanic white mothers. The relative influence of smoking cessation in pregnancy was similar in black compared to white mothers. The effect modification in the regression model was analyzed and revealed no significant interaction between race and smoking patterns on preterm birth risk. Conclusions Smoking throughout pregnancy is associated with an increased risk of preterm bir...

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“…[12] Accordingly, several interventions that successfully reduce smoking during pregnancy have been shown to result in improvements in perinatal outcomes. [13] In recent years, associations between smoke-free laws and population health have been investigated in a substantial number of quasi-experimental studies.…”

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confidence: 99%

“…The available circumstantial evidence indicates that a causal link between smoke-free legislation and a decrease in stillbirths is indeed likely: SHS exposure and tobacco smoking increase the risk of stillbirth [7][8][9]; smoke-free legislation is followed by reductions in SHS exposure and smoking [1,[15][16][17][18][19]; and stillbirth risk is known to normalize after smoking cessation. [12] At the same time, the study needs to be interpreted in the light of the aforementioned methodological limitations associated with its quasi-experimental nature. The continuing roll-out of smoke-free laws across the globe to protect people from ETS offers opportunities for replication of our work in other jurisdictions and can further strengthen (or undermine) confidence in our findings.…”

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confidence: 99%

Investigating the link between smoke-free legislation and stillbirths

Been

Sheikh

2015

Expert Review of Respiratory Medicine

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Smoking cessation in the first trimester reduces most obstetric risks, but not the risks of major congenital anomalies and admission to neonatal care: a population-based cohort study of 1 164 953 singleton pregnancies in Finland

Abstract: Smoking cessation appeared to reduce pregnancy risks close to those of non-smoking peers. Exposure to early pregnancy smoking was, however, associated with an increased admission to neonatal intensive care and an increased prevalence of major congenital anomalies.

Cited by 61 publications

References 29 publications

Association of Reported Trimester-Specific Smoking Cessation With Fetal Growth Restriction

Association of Reported Trimester-Specific Smoking Cessation With Fetal Growth Restriction

Relationship of trimester-specific smoking patterns and risk of preterm birth

Investigating the link between smoke-free legislation and stillbirths

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