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Cited by 387Smoking Behavior and CessationPrenatal Substance Exposure EffectsPregnancy and Medication Impact

Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy

Open access
Pineles, Beth L., Park, Edward, Samet, Jonathan M.·2014·American Journal of Epidemiology
DOI 10.1093/aje/kwt334PMC PMC3969532
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Abstract

We conducted a systematic review and meta-analysis to characterize the relationship between smoking and miscarriage. We searched the PubMed database (1956-August 31, 2011) using keywords and conducted manual reference searches of included articles and reports of the US Surgeon General. The full text of 1,706 articles was reviewed, and 98 articles that examined the association between active or passive smoking and miscarriage were included in the meta-analysis. Data were abstracted by 2 reviewers. Any active smoking was associated with increased risk of miscarriage (summary relative risk ratio = 1.23, 95% confidence interval (CI): 1.16, 1.30; n = 50 studies), and this risk was greater when the smoking exposure was specifically defined as during the pregnancy in which miscarriage risk was measured (summary relative risk ratio = 1.32, 95% CI: 1.21, 1.44; n = 25 studies). The risk of miscarriage increased with the amount smoked (1% increase in relative risk per cigarette smoked per day). Secondhand smoke exposure during pregnancy increased the risk of miscarriage by 11% (95% CI: 0.95, 1.31; n = 17 studies). Biases in study publication, design, and analysis did not significantly affect the results. This finding strengthens the evidence that women should not smoke while pregnant, and all women of reproductive age should be warned that smoking increases the risk of miscarriage.

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  • Since 2013 the data on hospital admissions for miscarriage are no longer included in the UK maternity statistic report.

    “Unfortunately, since 2013 the data on hospital admissions for miscarriage are no longer included in the UK maternity statistic report. 33”

    From Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss (2021) · cites this paper as [33]

    The included-studies table (p. 817) lists historical UK miscarriage studies but does not discuss the UK maternity statistics report. Searches for the report, hospital admissions, and the claimed change since 2013 found no passage addressing it. (LLM, conf=0.76)

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  • In the UK, there were 40-45,000 hospital admissions in 2012-2013 for miscarriage management.

    “In the UK, there were 40-45,000 hospital admissions in 2012-2013 for miscarriage management, 33 but since miscarriages and preclinical pregnancy losses are commonly managed at home, the actual number of miscarriages is considerably higher.”

    From Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss (2021) · cites this paper as [33]

    Table 1 (p. 817) lists studies of smoking and miscarriage, including UK studies, but gives study sample sizes rather than UK hospital-admission counts. Searches for the 2012–2013 period and 40,000–45,000 miscarriage-management admissions found no passage addressing that figure. (LLM, conf=0.76)

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Cites

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Research works printed but not linked: 5

  1. Cunningham FG, Leveno KJ, Bloom SL, et al. Chapter 9. Abortion. In: Cunningham FG, Leveno KJ, Bloom SL, et al., eds. Williams Obstetrics. Vol 23. New York, NY: The McGraw-Hill Companies, Inc.; 2010:215-237.
  2. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) Group. JAMA. 2000;283(15): 2008-2012.
  3. Burns DM, Major JM, Shanks TJ. Changes in number of cigarettes smoked per day: cross-sectional and birth cohort analyses using NHIS. In: Amarcher RH, Marcus SE, eds. Those Who Continue to Smoke: Is Achieving Abstinence From Smoking Harder and Do We Need to Change Our Interventions? Bethesda, MD: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute; 2003:83-99.
  4. Bernhard P. Effects on the mother [in German]. MMW Fortschr Med. 1964;82:95-100.
  5. Koller S. Risk Factors During Pregnancy. Berlin, Germany: Springer; 1983.

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Authors
Pineles, B. L., Park, E., & Samet, J. M.
Corresponding author
Samet, Jonathan M.
ORCID
Pineles, Beth L.
Venue
American Journal of Epidemiology
Publisher
Oxford University Press (OUP)
Published
2014-02-10
Volume
179
Issue
7
Pages
807-823
ISSN
  • 0002-9262 (ISSN-L)
  • 1476-6256
DOI
10.1093/aje/kwt334
PMC
PMC3969532
OpenAlex
W2098308943
Cited by
387
References
149
Citations by year
2026: 27 · 2025: 29 · 2024: 41 · 2023: 43 · 2022: 42 · 2021: 55 · 2020: 26 · 2019: 34 · 2018: 26 · 2017: 29 · 2016: 16 · 2015: 12 · 2014: 7
FWCI
2.50
Type
journal article
Language
en
Open access
Locations
  • American Journal of Epidemiology (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • University of Southern California
  • National Institute on Drug Abuse (F30DA032190)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
Keywords
miscarriage, tobacco smoke exposure, passive smoking, pregnancy, maternal smoking, reproductive health, risk factors
MeSH terms
Abortion, Spontaneous, Female, Humans, Pregnancy, Risk, Smoking, Tobacco Smoke Pollution, Odds Ratio, Maternal Exposure, PubMed

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