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A systematic review and meta-analysis of prospective studies on the association between maternal cigarette smoking and preterm delivery
Open accessAbstract
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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“These include: increased risks of premature delivery [1]; low birth weight babies [2]; certain congenital anomalies [3]; foetal death [4]; and pregnancy complications such as placenta praevia, placenta abruption and premature rupture of membranes [5-6].”
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“Antenatal Smoking Maternal smoking during pregnancy is a significant modifiable risk factor associated with substantial pregnancy related morbidity and mortality, and has been identified as a direct risk factor for inducing preterm birth (34).”
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“Potentially modifiable factors, examined individually, that have been linked to risk of PTB include obesity (12–14), low diet quality or unhealthy dietary patterns (15–17), inadequate physical activity (18), stress (19), and smoking (20).”
BackgroundSocio-economic risk factors for preterm birth in Norway 1999–2009
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“…abruption (Handler et al., 1994), intrauterine growth restriction (Nordentoft et al., 1996), miscarriage (Armstrong et al., 1992), preterm birth (Shah and Bracken, 2000), low-birth-weight babies (US Department of Health and Human Services, 2006), and having a child die from sudden infant death…”
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“A few other maternal risk factors implicated in spontaneous PTB include low socioeconomic status, black race, younger age, intrauterine infection, inflammation (6), low pre-pregnancy weight (12), cholesterol levels (13,14), and substance abuse (15,16).”
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Detectable Risks in Studies of the Fetal Benefits of Maternal Influenza Vaccination
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“In comparison, smoking, an established risk factor for both PTD and CVD, is associated with a nearly 30% greater risk of PTD and 70% greater risk of CVD ( 37 – 39 ).”
Within-Family Effects of Smoking during Pregnancy on ADHD: the Importance of Phenotype
Marceau, K., Bidwell, L. C., Karoly, H. C., Evans, A. S., Todorov, A. A., Palmer, R. H. C., Heath, A. C., & Knopik, V. S. (2017) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-017-0320-7 · Cited by 31
“…& Waldron, 2009; Knopik, Marceau, Bidwell, et al., 2016; Knopik, Marceau, Palmer, Smith, & Heath, 2016; Kuja-Halkola, D'Onofrio, Larsson, & Lichtenstein, 2014; Marceau et al., 2016; Marceau et al., in press; Shah & Bracken, 2000; Smith, Schmidt-Kastner, McGeary, Kaczorowski, & Knopik, 2016).”
Poulsen, G., Andersen, A. N., Jaddoe, V. W. V., Magnus, P. M., Raat, H., Stoltenberg, C., Osler, M., & Mortensen, L. H. (2019) · Paediatric and Perinatal Epidemiology · doi:10.1111/ppe.12544 · Cited by 25
Smoking cessation in pregnancy
Rore, C., Brace, V., Danielian, P., & Williams, D. J. (2008) · Expert Opinion on Drug Safety · doi:10.1517/14740330802196756 · Cited by 26
“Maternal smoking during pregnancy is known to be associated with low birth weight, premature delivery, spontaneous abortion, abruptio placentae, increased perinatal mortality and ectopic pregnancy [6-12] .”
BackgroundHardcastle, K., Ford, K., & Bellis, M. A. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-04454-z · Cited by 25
“maternal smoking [6] and obesity [7]), and pregnancy-related factors such as multiple gestation or intra-uterine infection [8].”
BackgroundTobacco control policies and perinatal health: a national quasi-experimental study
Peelen, M. J. C. S., Sheikh, A., Kok, M., Hajenius, P. J., Zimmermann, L. J. I., Kramer, B. W. W., Hukkelhoven, C. W. P. M., Reiss, I. K. M., Mol, B. W., & Been, J. V. (2016) · Scientific Reports · doi:10.1038/srep23907 · Cited by 25
Relationship of childhood trauma to depression and smoking outcomes in pregnant smokers.
Blalock, J. A., Minnix, J. A., Mathew, A. R., Wetter, D. W., McCullough, J. P., & Cinciripini, P. M. (2013) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0033381 · Cited by 26
“…smoking (Goodwin, Keyes, & Simuro, 2007; Blalock, Fouladi, Wetter, & Cinciripini, 2005), and the adverse consequences of both on birth outcomes, (Shah & Bracken, 2000; Grote et al., 2010), improving our understanding of treatment related predictors could have beneficial effects both on…”
BackgroundDuko, B., Pereira, G., Tait, R. J., Nyadanu, S. D., Betts, K., & Alati, R. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.108993 · Cited by 22
Preterm birth and secondhand smoking during pregnancy: A case–control study from Vietnam
Nguyen, R. N., Hien, T. Q., Chanh, T. Q., & Thuyen, T. K. (2020) · PLoS ONE · doi:10.1371/journal.pone.0240289 · Cited by 29
“There has been evidence that women who smoke cigarettes are at risk of preterm birth [3], but the relationship between women who are exposed to secondhand smoke and preterm birth was still controversial.”
BackgroundThe complex enterprise of modelling prenatal exposure to cigarettes: what is ‘enough’?
Pickett, K. E., Rathouz, P. J., Dukić, V., Kasza, K., Niessner, M., Wright, R. J., & Wakschlag, L. S. (2009) · Paediatric and Perinatal Epidemiology · doi:10.1111/j.1365-3016.2008.01010.x · Cited by 22
Acute effects of maternal smoking on fetal-placental-maternal system hemodynamics.
Müller, J. S., Antunes, M., Behle, I., Teixeira, L., & Zielinsky, P. (2002) · Arquivos Brasileiros de Cardiologia · doi:10.1590/s0066-782x2002000200002 · Cited by 19
Zubcevic, J. A., Watkins, J., Lin, C., Bautista, B., Hatch, H. M., Tevosian, S. G., & Hayward, L. F. (2022) · Metabolites · doi:10.3390/metabo12080735 · Cited by 21
Goals and Strategies for Prevention of Preterm Birth: An Obstetric Perspective
Lang, C., & Iams, J. D. (2009) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2009.03.006 · Cited by 21
Factors Associated with Smoking Cessation in Pregnancy
Blatt, K., Chen, A., Hook, J. W. V., DeFranco, E., & Moore, E. (2015) · American Journal of Perinatology · doi:10.1055/s-0035-1570319 · Cited by 21
Walker, R., Blumfield, M., & Truby, H. (2018) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.12554 · Cited by 20
The burden of adverse obstetric and perinatal outcomes from maternal smoking in an Australian cohort
Li, R., Lodge, J., Flatley, C. J., & Kumar, S. (2018) · Australian and New Zealand Journal of Obstetrics and Gynaecology · doi:10.1111/ajo.12849 · Cited by 21
Jones, M., Smith, M. D., Lewis, S., Parrott, S., & Coleman, T. J. (2018) · Addiction · doi:10.1111/add.14476 · Cited by 22
Does a Baby Help Young Women Transition Out of Homelessness? Motivation, Coping, and Parenting
Ruttan, L., Laboucane-Benson, P., & Munro, B. (2012) · Journal of Family Social Work · doi:10.1080/10522158.2012.642671 · Cited by 21
Guan, H., Zhou, P., Qi, Y., Huang, H., Wang, J., & Liu, X. (2022) · Ecotoxicology and Environmental Safety · doi:10.1016/j.ecoenv.2022.114015 · Cited by 20
England, L. J., Kim, S. Y., Shapiro‐Mendoza, C. K., Wilson, H. G., Kendrick, J. S., Satten, G. A., Lewis, C. A., Tucker, M. J., & Callaghan, W. M. (2013) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.12124 · Cited by 20
“In our study, we found no statistically significant associations between smokeless tobacco use and increased risk of preterm delivery, PAH or placental abruption, although the point estimate for smokeless tobacco and preterm delivery was similar to those previously reported (11,12).”
InfluentialPereyra, S., Bertoni, B., & Sapiro, R. (2016) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2016.04.030 · Cited by 20
Modeling Adverse Birth Outcomes via Confirmatory Factor Quantile Regression
Burgette, L. F., & Reiter, J. P. (2011) · Biometrics · doi:10.1111/j.1541-0420.2011.01639.x · Cited by 20
“This is in accord with the meta-analysis of Shah and Bracken (2000).”
ResultRisky substance exposure during pregnancy: a pilot study from Lebanese mothers
Salameh, P., Rachidi, Al‐Hajje, A., Bawab, W., Zein, Saleh, & Awada (2013) · Drug Healthcare and Patient Safety · doi:10.2147/dhps.s44525 · Cited by 19
Systematic critical review of previous economic evaluations of smoking cessation during pregnancy
Jones, M., Lewis, S., Parrott, S., & Coleman, T. J. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-008998 · Cited by 19
Why Do Black Women Experience Higher Rates of Preterm Birth?
Misra, D. P., Slaughter‐Acey, J., Giurgescu, C., Sealy-Jefferson, S. M., & Nowak, A. L. (2017) · Current Epidemiology Reports · doi:10.1007/s40471-017-0102-3 · Cited by 22
Gao, L., Liu, X., Millstein, J., Siegmund, K. D., Dubeau, L., Maguire, R. L., Zhang, J. J., Fuemmeler, B. F., Kollins, S. H., Hoyo, C., et al. (2018) · Clinical Epigenetics · doi:10.1186/s13148-018-0532-x · Cited by 19
Yu, Y., Tsai, H.-J., Liu, X., Mestan, K. K. L., Zhang, S., Pearson, C., Ortiz, K., Xu, X., ZUCKERMAN, B. S., & Wang, X. (2008) · Human Genetics · doi:10.1007/s00439-008-0589-2 · Cited by 19
“Consistent with previous reports, we observed that maternal smoking during pregnancy was associated with a moderately increased risk of PTD (Cnattingius 2004; Fantuzzi et al. 2007; Ness et al. 1999; Pollack et al. 2000; Shah and Bracken 2000; Wang et al. 1997).”
ResultPregnant women quit smoking; what about fathers? Survey study in Bursa Region, Turkey.
Uncu, Y., Özçakır, A., Ercan, İ., Bilgel, N., & Uncu, G. (2005) · PubMed · Cited by 19
Smoking ban and health at birth: Evidence from Hungary
Hajdu, T., & Hajdu, G. (2018) · Economics & Human Biology · doi:10.1016/j.ehb.2018.05.003 · Cited by 18
Are Babies Born Preterm High-Risk Asthma Candidates?
Caffarelli, C., Gracci, S., Giannì, G., & Bernardini, R. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12165400 · Cited by 18
Factors Associated with Early Pregnancy Smoking Status Among Low-Income Smokers
Coleman‐Cowger, V. H., Koszowski, B., Rosenberry, Z. R., & Terplan, M. (2015) · Maternal and Child Health Journal · doi:10.1007/s10995-015-1891-y · Cited by 18
“Women who smoke during pregnancy are more likely to have a wide range of negative pregnancy outcomes including ectopic pregnancy [8], placenta previa and abruption [1], intrauterine growth restriction [3], miscarriage [14], preterm birth [16], and low birth weight babies [20].”
BackgroundThe Burden of Genetic and Epigenetic Traits in Prematurity
Ramos, B. R. D. A., & da Silva, M. G. (2017) · Reproductive Sciences · doi:10.1177/1933719117718270 · Cited by 18
“Smoking habits have been associated with prematurity,(12,13) and the risk of PTB attributable to cigarette exposure has been estimated to be 25%.(14) It has already been demonstrated by extensive research that components of cigarette extract induce oxidative stress and the senescence of fetal membranes via the activat…”
BackgroundRoche, D., Rafferty, A. R., Holden, S., Killeen, S. L., Kennelly, M. A., & McAuliffe, F. M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20010034 · Cited by 17
“Suboptimal diet, alcohol consumption, and smoking in pregnancy have been linked in previous studies to preterm birth, low birth weight, and neurodevelopmental disorders [25,26,67,68].”
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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