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Women Birth. The risk of unexplained antepartum stillbirth in second pregnancies following caesarean section in the first pregnancy. Maternal and biochemical predictors of antepartum stillbirth among nulliparous women in relation to gestational age of fetal death.
Hogberg L, Cnattingius S. The influence of maternal smoking habits on the risk of subsequent stillbirth: Is there a causal relation? Rockville MD: U. Health Consequences of Tobacco use among women; pp.
Cigarette smoking as risk factor for late fetal and early neonatal death. Effects of maternal age, parity and smoking on the risk of stillbirth. Schramm WF. Smoking during pregnancy: Missouri longitudinal study. Paediatr Perinat Epidemiol. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Hum Reprod. Newcastle-Ottawa scale NOS for assessing the quality of non-randomised studies in meta-analysis.
The Cochrane Collaboration Prenatal tobacco use and risk of stillbirth: a case-control and bidirectional case-crossover study.
A case-control study of stillbirths in Northeast Brazil. Int J Gynaecol Obstet. Maternal health-care program and makers for late fetal death. Acta Obstet Gynecol Scand. Stillbirth risk factors according to timing of exposure. Ann Epidemiol. Case-control study of factors associated with intrauterine fetal deaths. Health-risk behaviours: examining social disparities in the occurrence of stillbirth. Ahlenius I, Thomassen P. The changing panorama of late fetal death in Sweden between and The risk of intrapartum stillbirth among smokers of advanced maternal age.
Arch Gynecol Obstet. Prenatal smoking and risk of intrapartum stillbirth. Arch Environ Occup Health. Contribution of smoking during pregnancy to inequalities in stillbirth and infant death in Scotland retrospective population based study using hospital maternity records. The risk of adverse pregnancy outcomes is increased in preeclamptic women who smoke compared with nonpreeclamptic women who do not smoke.
The influence of antenatal and maternal factors on stillbirths and neonatal deaths in New South Wales. J Biosoc Sci. Prepregnancy risk factors for antepartum stillbirth in the United States.
Obstet Gynecol. The risk factors for unexplained antepartum stillbirths in Scotland, to J Perinatol. Maternal cigarette smoking and pregnancy outcome. Exposure to tobacco smoke in utero and the risk of stillbirth and death in the first year of life.
Am J Epidemiol. Maternal risk factors for cause-specific stillbirth and neonatal death. Cooking smoke and tobacco smoke as risk factors for stillbirth. Int J Environ Health Res. Birth outcomes for teenage women in New South Wales, The effects of maternal smoking on fetal and infant mortality. Smoking in early gestation or through pregnancy: a decision crucial to pregnancy outcome. Prev Med. Determinants of unexplained antepartum fetal deaths. Stillbirths and infant deaths associated with maternal smoking among mothers aged not greater than or equal to 40 years: a population study.
Am J Perinatol. Moga M, Preda GH. Smoking and pregnancy. J Environ Prot Ecol. Association between stillbirth and risk factors known at pregnancy confirmation. Kunzel W, Misselwitz B. Unexpected fetal death during pregnancy — a problem of unrecognised fetal disorders during antenatal care?
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Comparative epidemiology of sudden infant death syndrome and sudden intrauterine unexplained death. Arch Dis Child. Risk-factors for antepartum and intrapartum still-birth. Fetal growth restriction and other risk factors for stillbirth in a New Zealand setting. Prenatal smoking among adolescents and risk of fetal demise before and during labor. J Pediatr Adolesc Gynecol. Profile of maternal smokers and their pregnancy outcomes in south western Sydney.
J Obstet Gynaecol Res. Flenady V. Causes and risk factors of stillbirth in Australia. Gold Coast. Paediatr Child Health. Maternal cigarette smoking: the effects on umbilical and uterine blood flow velocity. The maternal and fetal physiologic effects of nicotine. Semin Perinatol.
Effect of nicotine on fetal prostacyclin and thromboxane in humans. Bruner JP, Forouzan I. Smoking and Bucally administered nicotine. Acute effect on uterine and umbilical artery Doppler flow velocity wave forms. J Reprod Med. In utero nicotine exposure and fetal growth inhibition among twins.
Smoking in pregnancy revisited: findings from a large population-based study. Relapse prevention interventions for smoking cessation.
Cochrane Database Syst Rev , Issue 8. Pharmacological interventions for promoting smoking cessation during pregnancy.
Cochrane Database Syst Rev , Issue 9. CD [ PubMed ]. Support Center Support Center. External link. Please review our privacy policy. Sweden — Swedish National study Participants with two consecutive pregnancies. Why do women continue to smoke in pregnancy? Women Birth. The risk of unexplained antepartum stillbirth in second pregnancies following caesarean section in the first pregnancy. Maternal and biochemical predictors of antepartum stillbirth among nulliparous women in relation to gestational age of fetal death.
Hogberg L, Cnattingius S. The influence of maternal smoking habits on the risk of subsequent stillbirth: Is there a causal relation? Health Consequences of Tobacco use among women. In: Women and smoking: a report of the surgeon general. Rockville MD: U. Cigarette smoking as risk factor for late fetal and early neonatal death.
Effects of maternal age, parity and smoking on the risk of stillbirth. Schramm WF. Smoking during pregnancy: Missouri longitudinal study. Paediatr Perinat Epidemiol. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Article Google Scholar. Hum Reprod. Newcastle-Ottawa scale NOS for assessing the quality of non-randomised studies in meta-analysis.
The Cochrane Collaboration Prenatal tobacco use and risk of stillbirth: a case-control and bidirectional case-crossover study. A case-control study of stillbirths in Northeast Brazil. Int J Gynaecol Obstet. Maternal health-care program and makers for late fetal death.
Acta Obstet Gynecol Scand. Stillbirth risk factors according to timing of exposure. Ann Epidemiol. Case-control study of factors associated with intrauterine fetal deaths. Health-risk behaviours: examining social disparities in the occurrence of stillbirth.
Ahlenius I, Thomassen P. The changing panorama of late fetal death in Sweden between and The risk of intrapartum stillbirth among smokers of advanced maternal age.
Arch Gynecol Obstet. Prenatal smoking and risk of intrapartum stillbirth. Arch Environ Occup Health. Contribution of smoking during pregnancy to inequalities in stillbirth and infant death in Scotland retrospective population based study using hospital maternity records. The risk of adverse pregnancy outcomes is increased in preeclamptic women who smoke compared with nonpreeclamptic women who do not smoke. The influence of antenatal and maternal factors on stillbirths and neonatal deaths in New South Wales.
J Biosoc Sci. Prepregnancy risk factors for antepartum stillbirth in the United States. Obstet Gynecol. The risk factors for unexplained antepartum stillbirths in Scotland, to J Perinatol. Maternal cigarette smoking and pregnancy outcome. Exposure to tobacco smoke in utero and the risk of stillbirth and death in the first year of life. Am J Epidemiol. Maternal risk factors for cause-specific stillbirth and neonatal death. Cooking smoke and tobacco smoke as risk factors for stillbirth.
Int J Environ Health Res. Birth outcomes for teenage women in New South Wales, The effects of maternal smoking on fetal and infant mortality. Smoking in early gestation or through pregnancy: a decision crucial to pregnancy outcome. Prev Med. Determinants of unexplained antepartum fetal deaths.
Stillbirths and infant deaths associated with maternal smoking among mothers aged not greater than or equal to 40 years: a population study. Am J Perinatol. Moga M, Preda GH. Smoking and pregnancy. J Environ Prot Ecol. Association between stillbirth and risk factors known at pregnancy confirmation.
Kunzel W, Misselwitz B. Unexpected fetal death during pregnancy — a problem of unrecognised fetal disorders during antenatal care? Maternal smoking in pregnancy and sex differences in perinatal death between boys and girls. Soc Biol. Kallen K. The impact of maternal smoking during pregnancy on delivery outcome. Eur J Public Health. Differential misclassification of alcohol and cigarette consumption by pregnancy outcome. Int J Epidemiol.
Scio-economic demographic and obstetric risk factors for late death of unknown etiology in Luthuania: a case—referent study. Improvement in pregnancy-related outcomes in the offspring of diabetic mothers in Bavaria, Germany, during — Diabet Med. Comparative epidemiology of sudden infant death syndrome and sudden intrauterine unexplained death. Arch Dis Child. Risk-factors for antepartum and intrapartum still-birth.
Fetal growth restriction and other risk factors for stillbirth in a New Zealand setting. Prenatal smoking among adolescents and risk of fetal demise before and during labor. J Pediatr Adolesc Gynecol. Profile of maternal smokers and their pregnancy outcomes in south western Sydney. J Obstet Gynaecol Res. Flenady V. Causes and risk factors of stillbirth in Australia. Gold Coast. Paediatr Child Health. Maternal cigarette smoking: the effects on umbilical and uterine blood flow velocity.
The maternal and fetal physiologic effects of nicotine. Semin Perinatol. Effect of nicotine on fetal prostacyclin and thromboxane in humans. Bruner JP, Forouzan I. Smoking and Bucally administered nicotine. Acute effect on uterine and umbilical artery Doppler flow velocity wave forms. J Reprod Med. In utero nicotine exposure and fetal growth inhibition among twins. Smoking in pregnancy revisited: findings from a large population-based study. Relapse prevention interventions for smoking cessation.
Cochrane Database Syst Rev , Issue 8. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev , Issue 9. Download references. You can also search for this author in PubMed Google Scholar. Correspondence to Sarah Lewis. All authors participated in electronic search, title screening, study selection, data extraction, analysis and manuscript preparation.
AA and TM contributed equally in the manuscript preparation, and thus shared the first authorship equally. All four authors provided intellectual content and approved the manuscript for publication.
In contrast, a Canadian study found that stillbirth risk for women who had quit smoking by 16 weeks was higher than corresponding risk among nonsmokers and similar to that for women who smoked throughout pregnancy. In a nationwide Swedish register study, we included more than women with two successive single births.
Since information about maternal smoking was available, this allowed us to study the effects of changed smoking habits in relation to the risk of stillbirth in second pregnancy. The Swedish Medical Birth Register includes prospectively collected information on virtually all births in Sweden. Information on smoking habits has been recorded since In this study, we included women who had their first and second successive single births between and , a total number of women.
To determine gestational age, early second-trimester ultrasonographic examinations were used when available, otherwise the last menstrual period was used. Early second-trimester ultrasound screening was successively introduced in Sweden in the s. The study was approved by the research ethics committee at Karolinska Institutet, Stockholm, Sweden.
We used logistic regression analyses to evaluate associations between maternal smoking habits in the two pregnancies and risk of stillbirth. All analyses were performed using the Statistical Analysis Software version 9. Smoking habits during first and second pregnancies in relation to stillbirth risk in second pregnancy is presented in Table 1. In the crude analyses, risk of stillbirth in second pregnancy increases with the amount smoked in both first and second pregnancies.
However, the majority When we adjusted for smoking in second pregnancy and other factors, smoking in first pregnancy was no longer associated with stillbirth risk in second pregnancy. Thus, the smoking-related risk of stillbirth in second pregnancy was confined to smoking in second pregnancy.
Smoking during first and second pregnancy in relation to stillbirth risk in second pregnancy. Risks of stillbirth in the second pregnancy in relation to maternal characteristics are presented in Table 2. Women with a previous stillborn baby faced a more than doubled increase in risk of stillbirth in the second pregnancy OR 2.
Maternal smoking during both first and second pregnancies involves a significantly increased risk OR 1. No effect on risk was seen in women who stated that they were smokers only in the second pregnancy OR 0. However, after adjustment for smoking and other variables, low maternal age did not increase the risk of stillbirth. The risk of stillbirth was reduced among women with high maternal education.
Characteristics of women who delivered two successive singleton infants between and in Sweden and associations with the risk of stillbirth. Table 3 shows more detailed information of maternal smoking habits in first and second pregnancies in relation to risk of second pregnancy stillbirth. Risk of stillbirth in the second pregnancy was similar among women who were nonsmokers in both pregnancies and among women who were former moderate or heavy smokers but did not smoke during the second pregnancy.
Compared with nonsmokers in both pregnancies, women who were smokers in both pregnancies generally experienced increased risks of stillbirth in the second pregnancy. No effects on risks were seen for women who stated that they were nonsmokers during the first pregnancy but smokers during the second pregnancy. Stillbirth rates in second pregnancy in relation to smoking habits in first and second pregnancy.
We found that women who quit smoking from first to second pregnancy reduced their risk of stillbirth to the same level as nonsmokers in both pregnancies.
These results indicate a causal relation between smoking and stillbirth. However, the finding that women who were smokers in second but not in first pregnancy had similar risk of stillbirth in the second pregnancy as nonsmokers in both pregnancies complicates the interpretation of the study results.
If the smoking-related risk of stillbirth is caused by a direct toxic effect of smoking exposure during pregnancy, women who smoked in the second pregnancy should, irrespective of previous smoking habits, have an increased risk of stillbirth. Smoking is causally associated with fetal growth restriction and probably also with placental abruption, which are two main causes of stillbirth. Furthermore, studies of smoking and stillbirth risk show consistent results, and dose—response relationships have generally been obtained.
The finding that women who only smoked in second pregnancy were not at increased risk of stillbirth may question that the association between smoking and stillbirth is mediated by a direct toxic effect during pregnancy. However, this finding may also have other causes.
These women may therefore be more likely to quit smoking later during pregnancy, and smoking cessation in early pregnancy may reduce stillbirth risk. Thus, the results may, despite the large study population, have been a chance finding because of low statistical power.
This study included virtually all women with first and second consecutive single births in Sweden during the study period. The population-based design favours generalisability of findings at least across Sweden. Information on smoking habits among the more than women was collected prospectively in early pregnancy, which precludes recall bias. We adjusted for maternal characteristics previously associated with stillbirth, such as a history of stillbirth, maternal age, maternal education and country of birth.
We lacked information on other potential confounders, including use of alcohol or illicit drugs, exposure to passive smoking and maternal BMI. The reliability of self-reported smoking habits can be questioned because of decreasing public tolerance towards smoking during pregnancy. This may be especially true for later years, and we therefore included year of second delivery as a covariate in the analyses.
Self-reported smoking information during pregnancy has an acceptable high validity, 19 but women may underreport their smoking habits, either denying the habit or underestimating the number of cigarettes smoked daily.
Although there has been a decreasing trend over the past 20 years, smoking is still common among pregnant women. A decreasing number of smokers in society in general and among pregnant women in particular raises questions about why the rates of stillbirth have not decreased in a corresponding way. Perhaps, the answer can be found in a concurrent increase in maternal BMI and maternal age, which have been pointed out as risk factors for stillbirth.
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