A systematic review of maternal smoking during pregnancy and fetal measurements with meta-analysis

Abstract

BackgroundMaternal smoking during pregnancy is linked to reduced birth weight but the gestation at onset of this relationship is not certain. We present a systematic review of the literature describing associations between maternal smoking during pregnancy and ultrasound measurements of fetal size, together with an accompanying meta-analysis.MethodsStudies were selected from electronic databases (OVID, EMBASE and Google Scholar) that examined associations between maternal smoking or smoke exposure and antenatal fetal ultrasound measurements. Outcome measures were first, second or third trimester fetal measurements.ResultsThere were 284 abstracts identified, 16 papers were included in the review and the meta-analysis included data from eight populations. Maternal smoking was associated with reduced second trimester head size (mean reduction 0.09 standard deviation (SD) [95% CI 0.01, 0.16]) and femur length (0.06 [0.01, 0.10]) and reduced third trimester head size (0.18 SD [0.13, 0.23]), femur length (0.27 SD [0.21, 0.32]) and estimated fetal weight (0.18 SD [0.11, 0.24]). Higher maternal cigarette consumption was associated with a lower z score for head size in the second (mean difference 0.09 SD [0, 0.19]) and third (0.15 SD [0.03, 0.26]) trimesters compared to lower consumption. Fetal measurements were not reduced for those whose mothers quit before or after becoming pregnant compared to mothers who had never smoked.ConclusionsMaternal smoking during pregnancy is associated with reduced fetal measurements after the first trimester, particularly reduced head size and femur length. These effects may be attenuated if mothers quit or reduce cigarette consumption during pregnancy.

Smoking during Pregnancy Is a Predictor of Poor Perinatal Outcomes in Maternal Anorexia Nervosa: A Case Series and Single-Center Cross-Sectional Study in Japan

“…Our result may correspond with the previous multivariate analysis with large samples employing smoking as a covariate, and could explain their result, that is, a partial effect of smoking on the infant size at birth in maternal AN (Micali et al 2016). Generally, smoking cessation in pregnancy is recommended for adequate weight gain and normal fetal growth (Abraham et al 2017;Tong et al 2017). On the other hand, our results indicated that interventions for smoking cessation, without considering latent problems involving eating behaviors, could easily fail.…”

“…As is well known, smoking itself has deleterious effects on the fetal growth (Abraham et al 2017;Tong et al 2017). Besides that, after considering the limitations due to the small-scale samples, we feel that smoking during pregnancy may be an indicator of abnormal eating behavior, and both could adversely affect perinatal outcomes.…”

“…Therefore, we suggest that successful psychiatric treatment and the amelioration of anorexia symptoms before pregnancy could improve perinatal outcomes and decrease the risk of poor health in infants through both normal nutrition and smoking cessa-tion. Maternal smoking (Abraham et al 2017;Tong et al 2017), chronic malnutrition, and hypercortisolemia resulting from a stress reaction due to disturbed self-image during pregnancy, have already been reported to be major candidates for symmetric growth restriction in maternal AN (Lou et al 1994;Koubaa et al 2005;Micali et al 2016). Small head circumference at birth, similarly to low birth weight may have a detrimental effect on brain development (Koubaa et al 2005), and might be associated with an increased risk of coronary heart disease in adulthood (Risnes et al 2009).…”

“…Recent studies with larger samples have failed to show an elevated risk of SGA or premature births in association with maternal eating disorders (Micali et al 2012;O'Brien et al 2017). Although smoking during pregnancy has been associated with SGA and premature births in the general population (Abraham et al 2017;Tong et al 2017), previous investigations on maternal eating disorders have suggested only a partial mediation effect of smoking on adverse fetal outcomes (Micali et al 2016). Both remission and relapse have been reported among pregnant women with AN, and remain controversial issues (Koubaa et al 2005;Micali et al 2007;Hoffman et al 2011;Kimmel et al 2016).…”

Smoking and quitting smoking during pregnancy: A qualitative exploration of the socio-cultural context for the development of a couple-based smoking cessation intervention in Romania

“…Smoking during pregnancy has significant negative effects on both the mother and the unborn infant [1][2][3][4][5][6] . The smoking gap across genders has been closing steadily in Central and Eastern Europe, with women smoking rates increasing significantly over the past 20 years 7 .…”