Adverse Impact of Maternal Cigarette Smoking on Preterm Infants: A Population-Based Cohort Study

Abstract

Objective The aim of the study is to examine the impact of exposure to maternal cigarette smoking on neonatal outcomes of very preterm infants.

Study Design A retrospective cohort study examined preterm infants (< 33 weeks gestational age) admitted to the Canadian Neonatal Network centers between 2003 and 2011. Mortality and major morbidities (bronchopulmonary dysplasia, severe intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy) were compared between infants exposed and unexposed to maternal smoking during pregnancy after adjusting for confounders.

Results Among 29,051 study infants, 4,053 (14%) were exposed to maternal smoking during pregnancy. Multivariable analysis revealed higher odds of grade 3 or 4 intraventricular hemorrhage or periventricular leukomalacia (adjusted odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.04–1.41) and bronchopulmonary dysplasia (adjusted OR: 1.16, 95% CI: 1.02–1.33) in the smoking group, while mortality, severe retinopathy, and necrotizing enterocolitis were not significantly different.

Conclusion Maternal smoking during pregnancy is associated with severe neurological injury and bronchopulmonary dysplasia in preterm infants.

Keywords

pregnancy - smoking - preterm infants - morbidity - cohort study

• References

• 1 Ng M, Freeman MK, Fleming TD , et al. Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA 2014; 311 (2) 183-192
• 2 Cnattingius S. The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine Tob Res 2004; 6 (Suppl. 02) S125-S140
• 3 Weitzman M, Gortmaker S, Walker DK, Sobol A. Maternal smoking and childhood asthma. Pediatrics 1990; 85 (4) 505-511
• 4 Schoendorf KC, Kiely JL. Relationship of sudden infant death syndrome to maternal smoking during and after pregnancy. Pediatrics 1992; 90 (6) 905-908
• 5 Lee SK, McMillan DD, Ohlsson A , et al. Variations in practice and outcomes in the Canadian NICU network: 1996-1997. Pediatrics 2000; 106 (5) 1070-1079
• 6 Semenic S, Edwards N. Do Canadian prenatal records support evidence-based practices to reduce maternal smoking?. J Obstet Gynaecol Can 2006; 28 (5) 368-372
• 7 Kramer MS, Platt RW, Wen SW , et al; Fetal/Infant Health Study Group of the Canadian Perinatal Surveillance System. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics 2001; 108 (2) E35
• 8 Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 2001; 138 (1) 92-100
• 9 Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM. Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics 1988; 82 (4) 527-532
• 10 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (4) 529-534
• 11 Bell MJ, Ternberg JL, Feigin RD , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (1) 1-7
• 12 International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 2005; 123 (7) 991-999
• 13 Agresti A. Categorical Data Analysis. 2nd ed. New York: John Wiley and Sons, Inc; 2002
• 14 EXPRESS Group. Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS). Acta Paediatr 2010; 99 (7) 978-992
• 15 Spinillo A, Ometto A, Stronati M, Piazzi G, Iasci A, Rondini G. Epidemiologic association between maternal smoking during pregnancy and intracranial hemorrhage in preterm infants. J Pediatr 1995; 127 (3) 472-478
• 16 Ekblad M, Korkeila J, Parkkola R, Lapinleimu H, Haataja L, Lehtonen L ; PIPARI Study Group. Maternal smoking during pregnancy and regional brain volumes in preterm infants. J Pediatr 2010; 156 (2) 185-90.e1
• 17 Antonucci R, Contu P, Porcella A, Atzeni C, Chiappe S. Intrauterine smoke exposure: a new risk factor for bronchopulmonary dysplasia?. J Perinat Med 2004; 32 (3) 272-277
• 18 Downard CD, Grant SN, Maki AC , et al. Maternal cigarette smoking and the development of necrotizing enterocolitis. Pediatrics 2012; 130 (1) 78-82
• 19 Perlman JM, McMenamin JB, Volpe JJ. Fluctuating cerebral blood-flow velocity in respiratory-distress syndrome. Relation to the development of intraventricular hemorrhage. N Engl J Med 1983; 309 (4) 204-209
• 20 Ballabh P. Intraventricular hemorrhage in premature infants: mechanism of disease. Pediatr Res 2010; 67 (1) 1-8
• 21 Cohen G, Vella S, Jeffery H, Lagercrantz H, Katz-Salamon M. Cardiovascular stress hyperreactivity in babies of smokers and in babies born preterm. Circulation 2008; 118 (18) 1848-1853
• 22 Beratis NG, Panagoulias D, Varvarigou A. Increased blood pressure in neonates and infants whose mothers smoked during pregnancy. J Pediatr 1996; 128 (6) 806-812
• 23 Suzuki K, Horiguchi T, Comas-Urrutia AC, Mueller-Heubach E, Morishima HO, Adamsons K. Pharmacologic effects of nicotine upon the fetus and mother in the rhesus monkey. Am J Obstet Gynecol 1971; 111 (8) 1092-1101
• 24 Lambers DS, Clark KE. The maternal and fetal physiologic effects of nicotine. Semin Perinatol 1996; 20 (2) 115-126
• 25 Kluckow M, Evans N. Low superior vena cava flow and intraventricular haemorrhage in preterm infants. Arch Dis Child Fetal Neonatal Ed 2000; 82 (3) F188-F194
• 26 Khwaja O, Volpe JJ. Pathogenesis of cerebral white matter injury of prematurity. Arch Dis Child Fetal Neonatal Ed 2008; 93 (2) F153-F161
• 27 Sekhon HS, Keller JA, Benowitz NL, Spindel ER. Prenatal nicotine exposure alters pulmonary function in newborn rhesus monkeys. Am J Respir Crit Care Med 2001; 164 (6) 989-994
• 28 Collins MH, Moessinger AC, Kleinerman J , et al. Fetal lung hypoplasia associated with maternal smoking: a morphometric analysis. Pediatr Res 1985; 19 (4) 408-412
• 29 Lødrup Carlsen KC, Jaakkola JJ, Nafstad P, Carlsen KH. In utero exposure to cigarette smoking influences lung function at birth. Eur Respir J 1997; 10 (8) 1774-1779
• 30 Hoo AF, Henschen M, Dezateux C, Costeloe K, Stocks J. Respiratory function among preterm infants whose mothers smoked during pregnancy. Am J Respir Crit Care Med 1998; 158 (3) 700-705
• 31 Elliot J, Vullermin P, Robinson P. Maternal cigarette smoking is associated with increased inner airway wall thickness in children who die from sudden infant death syndrome. Am J Respir Crit Care Med 1998; 158 (3) 802-806
• 32 Fitzgerald K, Cai J, Hoff G, Dew P, Okah F. Clinical manifestation of small-for-gestational-age risk pregnancy from smoking is gestational age dependent. Am J Perinatol 2007; 24 (9) 519-524
• 33 Mook-Kanamori DO, Steegers EA, Eilers PH, Raat H, Hofman A, Jaddoe VW. Risk factors and outcomes associated with first-trimester fetal growth restriction. JAMA 2010; 303 (6) 527-534
• 34 Hebel JR, Fox NL, Sexton M. Dose-response of birth weight to various measures of maternal smoking during pregnancy. J Clin Epidemiol 1988; 41 (5) 483-489