Timing of Maternal Tobacco Exposure, Hypertension, and Risk of Singleton Small-For-Gestational Age Infants

Abstract

Objective Small-for-gestational age infants are at an increased risk for disabilities and chronic health problems. Smoking and hypertension during pregnancy pose significant risks for fetal growth restriction. The study aims to identify whether (1) the timing of tobacco use modifies the risk of small-for-gestational age, (2) there are differences in association by percentile of small-for-gestational age (3rd, 5th, and 10th percentile), and (3) the effect of tobacco exposure on small-for-gestational age outcome is mediated by hypertension.

Materials and Methods Data were obtained from the 2009 Natality public use file available through the National Center for Health Statistics. Women were categorized into 11 groups depending on the trimester of tobacco exposure, the number of daily cigarettes smoked, and presence of hypertension. Multivariable log-linear regression models were performed to determine the association between percentile of singleton small-for-gestational age outcome (3rd, 5th, and 10th), trimester and degree of tobacco exposure, and hypertension.

Results Hypertension and smoking worked synergistically to restrict fetal growth. Hypertensive women who smoked heavily in all three trimesters were 4.34 times more likely to give birth to a 3rd percentile small-for-gestational age infant compared with nonsmoking normotensive women.

Conclusion The timing and duration of tobacco exposure mediates the risk and severity of fetal growth restriction.

Keywords

hypertension - small-for-gestational age - tobacco - trimester of pregnancy

Note

This study was conducted with data from the National Center for Health Statistics. Part of this study was presented at the American Public Health Association's Annual Meeting and Exposition; October 31–November 4, 2015; Chicago, IL.

• References

• 1 Aagaard-Tillery KM, Porter TF, Lane RH, Varner MW, Lacoursiere DY. In utero tobacco exposure is associated with modified effects of maternal factors on fetal growth. Am J Obstet Gynecol 2008; 198 (01) 66.e1-66.e6
• 2 Tong VT, Dietz PM, Farr SL, D'Angelo DV, England LJ. Estimates of smoking before and during pregnancy, and smoking cessation during pregnancy: comparing two population-based data sources. Public Health Rep 2013; 128 (03) 179-188
• 3 Bardy AH, Seppälä T, Lillsunde P. , et al. Objectively measured tobacco exposure during pregnancy: neonatal effects and relation to maternal smoking. Br J Obstet Gynaecol 1993; 100 (08) 721-726
• 4 Bardin C, Piuze G, Papageorgiou A. Outcome at 5 years of age of SGA and AGA infants born less than 28 weeks of gestation. Semin Perinatol 2004; 28 (04) 288-294
• 5 Chatelain P. Children born with intra-uterine growth retardation (IUGR) or small for gestational age (SGA): long term growth and metabolic consequences. Endocr Regul 2000; 34 (01) 33-36
• 6 Sanz-Cortés M, Figueras F, Bargalló N, Padilla N, Amat-Roldan I, Gratacós E. Abnormal brain microstructure and metabolism in small-for-gestational-age term fetuses with normal umbilical artery Doppler. Ultrasound Obstet Gynecol 2010; 36 (02) 159-165
• 7 Piper JM, Xenakis EM, McFarland M, Elliott BD, Berkus MD, Langer O. Do growth-retarded premature infants have different rates of perinatal morbidity and mortality than appropriately grown premature infants?. Obstet Gynecol 1996; 87 (02) 169-174
• 8 Reeves S, Bernstein I. Effects of maternal tobacco-smoke exposure on fetal growth and neonatal size. Expert Rev Obstet Gynecol 2008; 3 (06) 719-730
• 9 Lieberman E, Gremy I, Lang JM, Cohen AP. Low birthweight at term and the timing of fetal exposure to maternal smoking. Am J Public Health 1994; 84 (07) 1127-1131
• 10 Polakowski LL, Akinbami LJ, Mendola P. Prenatal smoking cessation and the risk of delivering preterm and small-for-gestational-age newborns. Obstet Gynecol 2009; 114 (2 Pt 1): 318-325
• 11 Wikström A-K, Gunnarsdottir J, Nelander M, Simic M, Stephansson O, Cnattingius S. Prehypertension in pregnancy and risks of small for gestational age infant and stillbirth. Hypertension 2016; 67 (03) 640-646
• 12 Bowe S, Thilaganathan B, Vinayagam D, Khalil A. O114. Maternal cardiovascular changes in pregnancies complicated by small for gestational age neonate with or without maternal hypertension. Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health 2015; 5 (03) 234
• 13 De Paco C, Kametas N, Rencoret G, Strobl I, Nicolaides KH. Maternal cardiac output between 11 and 13 weeks of gestation in the prediction of preeclampsia and small for gestational age. Obstet Gynecol 2008; 111 (2 Pt 1): 292-300
• 14 England L, Zhang J. Smoking and risk of preeclampsia: a systematic review. Front Biosci 2007; 12: 2471-2483
• 15 Peltier MR, Ananth CV. Is the association of maternal smoking and pregnancy-induced hypertension dependent on fetal growth?. Am J Obstet Gynecol 2007; 196 (06) 532.e1-e6
• 16 Schuetze P, Eiden RD, Colder CR, Gray TR, Huestis MA. Physiological regulation in cigarette exposed infants: an examination of potential moderators. Neurotoxicol Teratol 2011; 33 (05) 567-574
• 17 Mitchell EA, Thompson JMD, Robinson E. , et al. Smoking, nicotine and tar and risk of small for gestational age babies. Acta Paediatr 2002; 91 (03) 323-328
• 18 Hebel JR, Fox NL, Sexton M. Dose-response of birth weight to various measures of maternal smoking during pregnancy. J Clin Epidemiol 1988; 41 (05) 483-489
• 19 Rogers JM. Tobacco and pregnancy. Reprod Toxicol 2009; 28 (02) 152-160
• 20 Shea AK, Steiner M. Cigarette smoking during pregnancy. Nicotine Tob Res 2008; 10 (02) 267-278
• 21 Kho EM, North RA, Chan E, Stone PR, Dekker GA, McCowan LME. ; SCOPE consortium. Changes in Doppler flow velocity waveforms and fetal size at 20 weeks gestation among cigarette smokers. BJOG 2009; 116 (10) 1300-1306
• 22 Aliyu MH, Lynch O, Wilson RE. , et al. Association between tobacco use in pregnancy and placenta-associated syndromes: a population-based study. Arch Gynecol Obstet 2011; 283 (04) 729-734