The impact of tobacco smoking on perinatal outcome among patients with gestational diabetes

Abstract

Objective: To determine the effects of tobacco use on perinatal outcomes among patients with gestational diabetes (GDM).Study Design: This was a retrospective cohort study of singleton pregnancies with GDM and live births from 2003 to 2006. The primary outcome, large for gestational age (LGA) infants, was compared between smoking and nonsmoking groups. Secondary outcomes included cesarean deliveries, shoulder dystocia, birth trauma, peripartum complications, macrosomia, 5-min Apgar score p3, birth defects, and neonatal intensive care unit (NICU) admissions. w 2 and Student t-tests compared the two groups; a P-value <0.05 was statistically significant and odds ratios (OR) were reported with 95% confidence intervals (CI). A multivariate logistic regression analysis controlled for variables known to affect outcomes in GDM. Result:We identified 915 patients with GDM, of which 130 (14.2%) smoked during pregnancy. Women who smoked during pregnancy were less likely to have LGA infants (22.4 vs 31.2%; OR, 0.61; 95% CI, 0.39 to 0.95). In a logistic regression analysis, the inverse relationship between smoking and LGA persisted (OR, 0.59; 95% CI, 0.36 to 0.97) after controlling for maternal age, multiparity, ethnicity, weight status before pregnancy, weight gain during pregnancy, and male gender. Preterm labor, preeclampsia, Cesareans, shoulder dystocia, and birth trauma were similar in both groups. PPROM was more likely to occur in nonsmokers (0 vs 4%, P ¼ 0.03), but postpartum hemorrhage was more common among smokers (OR, 2.3; 95% CI, 1.02 to 5.31). Macrosomia, low 5-min Apgar score, birth defects, and NICU admissions were similar between the groups. Conclusion:Patients with GDM who smoke during pregnancy were 40% less likely to have LGA infants. However, smoking was not protective of other common morbidities associated with GDM.

Risk Factors for Severe Secondary Postpartum Hemorrhages: A Historical Cohort Study

“…Although our multivariate analysis did not confirm these findings, our univariate analysis did find that maternal smoking was more frequent in the group with severe secondary PPH than in the group without it. Smoking is known to play a role in numerous obstetric complications, including immediate PPH and, in only one study, late PPH . In our work, the proportion of women who smoked was lower than that in the study by Marchant et al (20.9% vs 41%) .…”

Environmental tobacco smoke exposure during pregnancy affects complications and birth outcomes in women with and without asthma

“…Our results are consistent with earlier studies on tobacco smoke exposure [19,23,24]. The fraction of active smokers (1.4%) was too low in our study to allow a specific analysis, but other studies demonstrate that active smoking is related to the same endpoints and only the impact seems to be more pronounced [25,26]. It has been shown that cigarette or hookah smoking during pregnancy increases serum levels of thyroid hormones T3 and T4, which may explain fetal weight loss and subsequent low birth weight [27].…”

Psychometric properties of the Turkish version of the Fagerström test for nicotine dependence

“…Because the FTND includes measures of daily consumption, it may not be ideal for cross-cultural comparisons where the cost and affordability of tobacco differs substantially, or over time as tobacco prices change, or in comparisons between racial groups with varied rates of nicotine metabolism (27). Furthermore, because the instrument does not measure withdrawal or indicate what areas of addiction are troublesome for an individual, patients' responses are not particularly helpful for modifying the content of smoking cessation counseling (28)(29)(30).…”