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A systematic review and meta-analysis of prospective studies on the association between maternal cigarette smoking and preterm delivery
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We have attempted to quantify the most up-to-date estimate of the association between cigarette smoking by the mother and preterm delivery. Studies were selected for inclusion in this review if they were prospective, reported data stratified across at least two levels of maternal smoking, and defined preterm delivery on the basis of gestational age. In a meta-analysis we combined results from multiple studies that reported on preterm delivery and maternal smoking during pregnancy. Pooled odds ratios were computed for various strata of smoking intensity with the Mantel-Haenszel fixed-effects model. Twenty studies met all inclusion criteria and were included in meta-analysis. The pooled point estimate from 20 prospective studies on any maternal smoking versus no maternal smoking was 1.27 (95% confidence interval, 1.21-1.33). Subgroup analyses stratifying maternal smoking on number of cigarettes per day suggest a dose-response relationship at low to moderate levels of smoking, which was not further increased at high levels of smoking. A nonsignificant level of publication bias appears to exist in the smoking-preterm delivery literature. Cigarette smoking is a preventable risk factor that is associated with preterm delivery. Consistent results across many study populations and research designs and evidence of a dose-response relationship support its causal role in preterm delivery.
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“In accordance with previous studies, we indeed found that smoking is associated with a higher odds of sPTB and birth of SGA neonates [38–41].”
From Associations between periconceptional lifestyle behaviours and adverse pregnancy outcomes (2021) · cites this paper as [38]
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BackgroundTsai, H.-J., Liu, X., Mestan, K. K. L., Yu, Y., Zhang, S., Fang, Y., Pearson, C., Ortiz, K., ZUCKERMAN, B. S., Bauchner, H., et al. (2008) · Human Genetics · doi:10.1007/s00439-008-0485-9 · Cited by 81
“Maternal cigarette smoking is an important preventable environmental factor known to increase the risk of PTD, with odds ratios ranging from 1.1 to 2.4 (Cnattingius 2004; Pollack et al. 2000; Shah and Bracken 2000; Wang et al. 1997).”
BackgroundInfluentialPrenatal nicotine exposure increases connective tissue expression in foetal monkey pulmonary vessels
Sekhon, H. S., Proskocil, B. J., Clark, J. A., & Spindel, E. R. (2004) · European Respiratory Journal · doi:10.1183/09031936.04.00069604 · Cited by 81
Ambient temperature as a trigger of preterm delivery in a temperate climate
Cox, B., Vicedo-Cabrera, A. M., Gasparrini, A., Roels, H. A., Martens, E., Vangronsveld, J., Forsberg, B., & Nawrot, T. S. (2016) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2015-206384 · Cited by 79
Risk factors for spontaneous preterm birth among Aboriginal and non‐Aboriginal women in Manitoba
Heaman, M. I., Blanchard, J., Gupton, A. L., MOFFATT, M. E. K., & Currie, R. F. (2005) · Paediatric and Perinatal Epidemiology · doi:10.1111/j.1365-3016.2005.00644.x · Cited by 77
Patorno, E., Hernández–Dı́az, S., Huybrechts, K. F., Desai, R. J., Cohen, J. M., Mogun, H., & Bateman, B. T. (2020) · PLoS Medicine · doi:10.1371/journal.pmed.1003322 · Cited by 75
Tegethoff, M., Belardi, A., Stalujanis, E., & Meinlschmidt, G. (2015) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000151 · Cited by 72
Risk factors for preterm birth among opiate-addicted gravid women in a methadone treatment program
Almario, C. V., Seligman, N. S., Dysart, K., Berghella, V., & Baxter, J. K. (2009) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2009.05.052 · Cited by 72
Mongan, D., Lynch, J., Hanna, D., Shannon, C., Hamilton, S., Potter, C., Gorman, C., McCambridge, O., Morrow, R., & Mulholland, C. C. (2019) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-019-2572-4 · Cited by 73
Prevention of preterm birth: a renewed national priority
Damus, K. H. (2008) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/gco.0b013e3283186964 · Cited by 70
Janisse, J. J., Bailey, B. A., Ager, J. W., & Sokol, R. J. (2013) · Substance Abuse · doi:10.1080/08897077.2013.804483 · Cited by 70
“(9) Pregnancy cigarette smoking has been linked with preterm delivery,(10) and other studies have suggested fetal growth is also affected.”
BackgroundThe Contribution of Birth Defects to Preterm Birth and Low Birth Weight
Dolan, S. M., Gross, S. J., Merkatz, I. R., Faber, V., SULLIVAN, L. M., Malone, F. D., Porter, T. F., Nyberg, D. A., Comstock, C. H., Hankins, G. D. V., et al. (2007) · Obstetrics and Gynecology · doi:10.1097/01.aog.0000275264.78506.63 · Cited by 69
Influence of smoking and snuff cessation on risk of preterm birth
Baba, S., Wikström, A.-K., Stephansson, O., & Cnattingius, S. (2012) · European Journal of Epidemiology · doi:10.1007/s10654-012-9676-8 · Cited by 69
Flood, K., & Malone, F. D. (2011) · Seminars in Fetal and Neonatal Medicine · doi:10.1016/j.siny.2011.08.001 · Cited by 72
Smoking Patterns and Use of Cessation Interventions During Pregnancy
Tong, V. T., England, L. J., Dietz, P. M., & Asare, L. A. (2008) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2008.06.033 · Cited by 68
Women’s Knowledge, Attitudes and Behavior about Maternal Risk Factors in Pregnancy
Esposito, G., Ambrosio, R., Napolitano, F., & Giuseppe, G. D. (2015) · PLoS ONE · doi:10.1371/journal.pone.0145873 · Cited by 65
Poon, L. C., Savvas, M., Zamblera, D., Skyfta, E., & Nicolaides, K. H. (2012) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2011.03203.x · Cited by 65
Rich-Edwards, J. W., Klungsøyr, K., Wilcox, A. J., & Skjærven, R. (2015) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2015.06.001 · Cited by 65
“3.(18) As is typical of registries, there were no data available on CVD risk factors, such as body mass index.”
BackgroundWomen with a recent history of early‐onset pre‐eclampsia have a worse periodontal condition
Kunnen, A., Blaauw, J., van Doormaal, J. J., van Pampus, M. G., van der Schans, C. P., Aarnoudse, J. G., Winkelhoff, A. J. V., & Abbas, F. (2006) · Journal Of Clinical Periodontology · doi:10.1111/j.1600-051x.2006.01036.x · Cited by 64
Maternal tobacco use and extremely premature birth – a population‐based cohort study
Dahlin, S., Gunnerbeck, A., Wikström, A., Cnattingius, S., & Bonamy, A. E. (2016) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.14213 · Cited by 69
Ruiz, R. J., Fullerton, J. T., Brown, C. E., & Dudley, D. J. (2002) · Biological Research For Nursing · doi:10.1177/1099800402004001007 · Cited by 65
Adverse effects of parental smoking during pregnancy in urban and rural areas
Andriani, H., & Kuo, H. (2014) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-014-0414-y · Cited by 60
“Moore and Zaccaro [43] also found different risks for different numbers of cigarettes smoked per day, but, in a systematic review and metaanalysis, this relationship was not clear [44].”
BackgroundBird, A. L., Grant, C. C., Bandara, D. K., Mohal, J., Carr, P. A., WISE, M. R., Inskip, H. M., Miyahara, M., & Morton, S. (2016) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/ajo.12557 · Cited by 60
“0 (or weight loss) 223 (4) 1–5 kg 672 (12) 6–10 kg 2079 (38) 11–15 kg 1588 (29) 16–20 kg 597 (11) >20 kg 348 (6) Maternal smoking (n = 6161) No smoking (before or during) 4904 (80) Stopped smoking for pregnancy 610 (10) Continued smoking during pregnancy 647 (10) Alcohol use before pregnancy (n = 6805) No alcohol 1982…”
Heaman, M. I., & Chalmers, K. I. (2005) · Birth · doi:10.1111/j.0730-7659.2005.00387.x · Cited by 59
Second Births to Teenage Mothers: Risk Factors For Low Birth Weight and Preterm Birth
Partington, S. N., Steber, D. L., Blair, K. A., & Cisler, R. A. (2009) · Perspectives on Sexual and Reproductive Health · doi:10.1363/4110109 · Cited by 57
“Smoking during pregnancy has been consistently associated with decreased birth weight and preterm birth in both teenage and older mothers.(38,39) One study estimated that among infants born to teenagers, maternal smoking during pregnancy accounted for 39% of the risk of low birth weight and 12% of the risk of preterm…”
BackgroundSelected Vaginal Bacteria and Risk of Preterm Birth: An Ecological Perspective
Wen, A., Srinivasan, U., Goldberg, D. E., Owen, J., Marrs, C. F., Misra, D. P., Wing, D. A., Ponnaluri-Wears, S., Miles-Jay, A., Bucholz, B., et al. (2013) · The Journal of Infectious Diseases · doi:10.1093/infdis/jit632 · Cited by 60
“These factors include black race [3], smoking [15], douching [16–19], extremes of BMI [3, 20], and shortened cervical length during pregnancy [3, 21].”
BackgroundIon, R., Wills, A. K., & Bernal, A. L. (2015) · Reproductive Sciences · doi:10.1177/1933719115612135 · Cited by 57
“27).(2) The prospective way in which exposure information was collected reduces the risk of reporting bias.”
BackgroundPrenatal substance exposure and offspring development: Does DNA methylation play a role?
Knopik, V. S., Marceau, K., Bidwell, L. C., & Rolan, E. P. (2018) · Neurotoxicology and Teratology · doi:10.1016/j.ntt.2018.01.009 · Cited by 59
“, non-genetically informed studies) suggest that SDP is associated with multiple adverse birth related outcomes, such as preterm delivery (Castles et al., 1999; Kaddar et al., 2009; Shah and Bracken, 2000), increased risk for spontaneous abortion (Castles et al.”
Background
Metadata
- Authors
- Shah, N. R., & Bracken, M. B.
- Affiliations
- Yale University (US)
- ORCID
- Shah, Nirav R.
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2000-02
- Volume
- 182
- Issue
- 2
- Pages
- 465-472
- ISSN
- 0002-9378 (ISSN-L)
- PMC
- PMC2706697
- OpenAlex
- W2014933068
- Cited by
- 394
- References
- 48
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 10 · 2023: 13 · 2022: 23 · 2021: 18 · 2020: 22 · 2019: 23 · 2018: 15 · 2017: 26 · 2016: 23 · 2015: 24 · 2014: 17 · 2013: 23 · 2012: 16
- FWCI
- 2.15
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (F32HL074478)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Medicine › Obstetrics and Gynecology › Preterm Birth and Chorioamnionitis
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Keywords
- maternal cigarette smoking, preterm birth, smoking during pregnancy, dose-response relationship, smoking intensity, preterm birth risk factors, publication bias
- MeSH terms
- Dose-Response Relationship, Drug, Female, Gestational Age, Humans, Obstetric Labor, Premature, Pregnancy, Prospective Studies, Retrospective Studies, Smoking, Odds Ratio, Case-Control Studies, MEDLINE
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