Maternal factors associated with smoking during gestation and consequences in newborns: Results of an 18-year study
Background: Tobacco use is one of the most important causes of obstetric and perinatal pathologies. Its frequency during pregnancy is high and could be related to various socioeconomic and cultural characteristics of the mothers.
Aim: The aim of this study is to determine the trend and prevalence of smoking in pregnant mothers in our area over the years and the socio-cultural or obstetric factors associated with smoking as well as the repercussions on the newborns related to its consumption.
Methods: Retrospective study of 18,959 mothers of healthy newborns in the maternity ward of the regional hospital during the years 2002–2019. The variable under study was maternal smoking during pregnancy compared with various maternal, obstetric, and perinatal factors.
Results: Amean percentage of 20.4% of the mothers smoked, with significantly decreasing percentages over the years. There was a significant association between smoking and mothers’ age, origin, level of education, the occurrence of previous abortions, parity, type of breastfeeding at discharge, type of delivery, low birth weight, and need for neonatal resuscitation.
Conclusions: This defines a profile of pregnant smokers on whom it is important to act: young, Spanish, with a low level of education, multiparous, and with previous miscarriages. Its repercussions are also evident with a lower birth weight in newborns. Knowledge of these factors will make it possible to design more effective intervention strategies to reduce smoking during pregnancy.
Relevance for Patients: Any effort that reduces smoking habits can improve the health status of mothers and newborns and the first step is to know who are risk pregnants.
[1] Delgado-Peña YP, Rodríguez-Martínez G, SamperVillagrasa MP, Caballero-Pérez V, Cuadrón-Andrés L,
Álvarez-Sauras ML, et al. Características Socioculturales, Obstétricas y Antropométricas de Los Recién Nacidos
Hijos de Madre Fumadora. (Socio-Cultural, Obstetric and Anthropometric Characteristics of Newborns Born to Mothers Who Smoke). An Pediatr 2012;76:4-9.
[2] Ooka T, Akiyama Y, Shinohara R, Yokomichi H, Yamagata Z. Individual and Regional Characteristics Associated with Maternal Smoking During Pregnancy in Japan: Healthy Parents and Children. Int J Environ Res Public Health 2019;17:173.
[3] Martínez-Frías ML, Rodríguez-Pinilla E, Bermejo E. Consumo de Tabaco Durante el Embarazo en España:
Análisis Por Años, Comunidades Autónomas y Características Maternas (Tobacco use During Pregnancy in Spain: Analysis by Years, Autonomous Communities and Maternal Characteristics). Med Clin (Barc) 2005;124:86-92.
[4] Monasso GS, Jaddoe VW, de Jongste JC, Duijts L, Felix JF. Timing-and Dose-Specific Associations of Prenatal Smoke Exposure with Newborn DNA Methylation. Nicotine Tob Res 2020;22:1917-22.
[5] Chahal N, McLain AC, Ghassabian A, Michels KA, Bell EM, Lawrence DA, et al. Maternal Smoking and Newborn Cytokine and Immunoglobulin Levels. Nicotine Tob Res 2017;19:789-96..
[6] Anderson TM, Lavista Ferres JM, You Ren S, Moon RY, Goldstein RD, Ramirez JM, et al. Maternal Smoking
Before and During Pregnancy and the Risk of Sudden Unexpected Infant death. Pediatrics 2019;143:e20183325.
[7] Cabral M, Fonseca MJ, González-Beiras C, Santos AC, Correia-Costa L, Barros H. Maternal Smoking: A Life
Course Blood Pressure Determinant? Nicotine Tob Res 2018;20:674-80.
[8] Chattrapiban T, Smit HA, Wijga AH, Brunekreef B, Vonk JM, Gehring U, et al. The Joint Effect of Maternal
Smoking during Pregnancy and Maternal Pre-Pregnancy Overweight on Infants’ Term Birth Weight. BMC
Pregnancy Childbirth 2020;20:1-10.
[9] Smart SJ, Nikaj AN, Yu L, Li H, Yan F, Zhang J. Association Between Maternal Smoking during Pregnancy
and Offspring Overweight in U.S.-Born Children. Pediatr Obes 2021;16:1-9.
[10] Huang L, Wang Y, Zhang L, Zheng Z, Zhu T, Qu Y, et al. Maternal Smoking and Attention-Deficit/Hyperactivity Disorder in Offspring: A Meta-Analysis. Pediatrics 2018;141:e20172465.
[11] Gustavson K, Ystrom E, Stoltenberg C, Susser E, Suren P, Magnus P, et al. Smoking in Pregnancy and Child ADHD. Pediatrics 2017;139:e20162509.
[12] Yu C, Wei Y, Tang X, Liu B, Shen L, Long C, et al. Maternal Smoking during Pregnancy and Risk of Cryptorchidism: A Systematic Review and Meta-Analysis. Eur J Pediatr 2019;178:287-97.
[13] Yang Y, Wang C, Gan Y, Jiang H, Fu W, Cao S, et al. Maternal Smoking during Pregnancy and the Risk
of Strabismus in Offspring: A Meta-Analysis. Acta Ophthalmol 2019;97:353-63.
[14] Al-Ani AH, Antoun JS, Thomson WM, Merriman TR, Farella M. Maternal Smoking during Pregnancy
Is Associated with Offspring Hypodontia. J Dent Res 2017;96:1014-9.
[15] Konishi S, Kitagawa G. Information Criteria and Statistical Modeling. New York: Springer; 2008. p. 287.
[16] Cuadrón-Andrés L, Samper-Villagrasa MP, ÁlvarezSauras ML, Lasarte-Velillas JJ, Rodríguez -Martínez G.
Prevalencia de la Lactancia Materna Durante el Primer Año de Vida en Aragón. Estudio CALINA (Prevalence
of Breastfeeding During the First Year of Life in Aragon. CALINA Study). An Pediatr 2013;79:312-8.
[17] Mateos-Vílchez PM, Aranda-Regules JM, Díaz-Alonso G, Mesa-Cruz P, Gil-Barcenilla B, et al. Smoking Prevalence and Associated Factors During Pregnancy in Andalucía 2007-2012. Rev Esp Salud Publica 2014;88:369-81.
[18] Rygh E, Gallefoss F, Grøtvedt L. Trends in Maternal Use of SNUS and Smoking Tobacco in Pregnancy. A Register Study in Southern Norway. BMC Pregnancy Childbirth 2019;19:1-10.
[19] Oves-Suárez B, Escartín-Madurga L, Samper-Villagrasa MP, Cuadrón-Andrés L, Álvarez-Sauras ML, Lasarte
Velillas JJ, et al. Inmigración y Factores Asociados Con la Lactancia Materna. Estudio CALINA (Immigration and
Factors Associated with Breastfeeding. CALINA Study). An Pediatr 2014;81:32-8.
[20] Urquia ML, Juarez S, Wall-Wieler E, Hjern A. Smoking during Pregnancy among Immigrant Women with SameOrigin and Swedish-Born Partners. Nicotine Tob Res 2021;23:349-56.
[21] Marino JL, Lewis LN, Bateson D, Hickey M, Skinner SR. Teenage Mothers. Aust Fam Physician 2016;45:712-7.
[22] Rius JM, Rivas C, Ortuño J, Maravall M, Aguar M, Calzado MA, et al. Factores Asociados al Inicio de la
Lactancia Materna y Razones de la Madre Para la Toma de su Decisión (Factors Associated with the Initiation of
Breastfeeding and mothers’ Reasons for Breastfeeding Decisions). Acta Pediatr Esp 2015;73:65-72.
[23] Mund M, Louwen F, Klingelhoefer D, Gerber A. Smoking and Pregnancy-A Review on the First Major Environmental Risk Factor of the Unborn. Int J Environ Res Public Health 2013;10:6485-99.
[24] García JA, Torres EP, Lorente IM, Giménez VB, López JJ, Ramón FH, et al. Proyecto Malama en la Región de Murcia (España): Medio Ambiente y Lactancia Materna (Malama Project in the Region of Murcia (Spain): Environment and Breastfeeding). An Pediatr (Barc) 2008;68:447-53.
[25] Biosca-Pàmies M, Rodríguez-Martínez G, SamperVillagrasa MP, Odriozola-Grijalba M, Cuadrón-Andrés
L, Álvarez-Sauras ML, et al. Aspectos Perinatales, Crecimiento y Tipo de Lactancia de los Nacidos Pequeños
Para Su Edad Gestacional (Perinatal Aspects, Growth and Type of Breastfeeding of Small-For-Gestational-Age
Newborns). An Pediatr 2013;78:14-20.
[26] Simpson DA, Quigley MA, Kurinczuk JJ, Carson C. Twenty-Five-Year Trends in Breastfeeding Initiation: The
Effects of Sociodemographic Changes in Great Britain, 1985-2010. PLoS One 2019;14:1-2.
[27] Ramiro-González MD, Ortiz-Marrón H, Arana-CañedoArgüelles C, Esparza-Olcina MJ, Cortés-Rico O, TerolClaramonte M, et al. Prevalencia de la Lactancia Materna y Factores Asociados Con el Inicio y la Duración de la Lactancia Materna Exclusiva en la Comunidad de Madrid Entre Los Participantes en el Estudio ELOIN (Prevalence of Breastfeeding and Factors Associated with the Initiation and Duration of Exclusive Breastfeeding in the Community of Madrid among Participants in the ELOIN Study). An Pediatría 2018;89:32-43.
[28] Muñiz CL, Paz-Zulueta M, Del Río EC, Sota SM, de Adana MS, Pérez MM, et al. Impact of Maternal Smoking on the Onset of Breastfeeding Versus Formula Feeding: A Cross-Sectional Study. Int J Environ Res Public Health 2019;16:24-25.
[29] Chimoriya R, Scott JA, John JR, Bhole S, Hayen A, Kolt GS, et al. Determinants of full Breastfeeding at 6 Months and Any Breastfeeding at 12 and 24 Months Among Women in Sydney: Findings from the HSHK Birth Cohort Study. Int J Environ Res Public Health 2020;17:1-14.
[30] Shobeiri F, Masoumi SZ, Jenabi E. The Association between Maternal Smoking and Placenta Abruption: A
Meta-Analysis. J Matern Neonatal Med 2017;30:1963-7.
[31] Alonso-Ojembarrena A, Cano-Fernández J, Girón-Velasco A, Yep-Chullen G, Sánchez-Bayle M. Peso al Nacimiento y Tabaquismo Familiar (Birth Weight and Family Smoking). An Pediatr 2005;63:116-9.
[32] Ribot B, Isern R, Hernández-Martínez C, Canals J, Aranda N, Arija V. Impacto del Tabaquismo, la Exposición Pasiva al Tabaco y el Dejar de Fumar Sobre la Salud del Recien Nacido (Impact of Smoking, Passive Smoking Exposure and Smoking Cessation on Newborn Health). Med Clin (Barc) 2014;143:57-63.
[33] Gould GS, Havard A, Li Lim L, Kumar R. Exposure to Tobacco, Environmental Tobacco Smoke and Nicotine in Pregnancy: A Pragmatic Overview of Reviews of Maternal and Child Outcomes, Effectiveness of Interventions and Barriers and Facilitators to Quitting. Int J Environ Res Public Health 2020;17:1-34.
[34] Abdel-Hafez AM, Elgayar SA, Husain OA, Thabet HS. Effect of Nicotine on the Structure of Cochlea of Guinea Pigs. Anat Cell Biol 2014;47:162-70.
[35] Weitzman M, Govil N, Liu YH, Lalwani AK. Maternal Prenatal Smoking and Hearing Loss among Adolescents. JAMA Otolaryngol Head Neck Surg 2013;139:669-77.
[36] Vasconcellos AP, Kyle ME, Gilani S, Shin JJ. Personally Modifiable Risk Factors Associated with Pediatric Hearing Loss: A Systematic Review. Otolaryngol Head Neck Surg 2014;151:14-28.
[37] Korres S, Riga M, Balatsouras D, Papadakis C, Kanellos P, Ferekidis E. Influence of Smoking on Developing Cochlea. Does Smoking during Pregnancy Affect the Amplitudes of Transient Evoked Otoacoustic Emissions in Newborns? Int J Pediatr Otorhinolaryngol 2007;71:781-6.
[38] Lisowska G, Jochem J, Gierlotka A, Misiołek M, Ścierski W. Sex-Related Cochlear Impairment in Cigarette Smokers. Med Sci Monit 2017;23:377-97.
[39] Vinay S. Effect of Smoking on Transient Evoked Otoacoustic Emissions and Contralateral Suppression.
Auris Nasus Larynx 2010;37:299-302.
[40] Butcher E, Dezateux C, Knowles RL. Risk Factors for Permanent Childhood Hearing Impairment. Arch Dis Child 2020;105:187-9.
[41] İşlek-Seçen E, Filiz-Yavuz A, Levent-Keskin H, FeykanYeğin G, Müderrisoğlu T. Effects of Maternal Smoking on Neonatal Auditory Function. Ankara Med J 2017;17:65‐72.
[42] Mattsson K, Källén K, Rignell-Hydbom A, Lindh CH, Jönsson BA, Gustafsson P, et al. Cotinine validation of
Self-Reported Smoking During Pregnancy in the Swedish Medical Birth Register. Nicotine Tob Res 2016;18:79-83.
[43] Regan AK, Bombard JM, O’Hegarty MM, Smith RA, Tong VT. Adverse Birth Outcomes Associated with
Prepregnancy and Prenatal Electronic Cigarette Use. Obstet Gynecol 2021;138:85-94.
[44] Kedia SK, Ahuja NA, Carswell A, Vander Weg MW, Scarinci IC, Ward KD. Smoking Cessation among Pregnant and Postpartum Women from Low-Income Groups in the United States. J Midwifery Womens Health 2021;66:486-93.
[45] Jaber R, Blaga OM, Dascal MD, Meghea CI. Perceived Safety of Smoking a Few Cigarettes during Pregnancy and Provider Advice in a Sample of Pregnant Smokers from Romania. Addiction 2021;116:394-9.
[46] Jussila H, Pelto J, Korja R, Ekholm E, Pajulo M, Karlsson L, et al. The Association of Maternal-Fetal Attachment with Smoking and Smoking Cessation during Pregnancy in The FinnBrain Birth Cohort Study. BMC Pregnancy Childbirth 2020;20:1-13.
[47] Krist AH, Davidson KW, Mangione CM, Barry MJ, Cabana M, Caughey AB, et al. Interventions for Tobacco
Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation
Statement. JAMA 2021;325:265-79.
[48] Levy D, Jiang M, Szklo A, de Almeida LM, Autran M, Bloch M. Smoking and Adverse Maternal and Child Health Outcomes in Brazil. Nicotine Tob Res 2013;15:1797-804.
[49] Lumley J, Oliver S, Waters E. Interventions for Promoting Smoking Cessation during Pregnancy. Cochrane Database Syst Rev 2004;4:CD001055.
[50] Chamberlain C, O’Mara-Eves A, Porter J, Coleman T, Perlen SM, Thomas J, et al. Psychosocial Interventions
for Supporting Women to Stop Smoking in Pregnancy. Cochrane Database Syst Rev 2017;2:CD001055.