Time-to-Pregnancy Associated With Couples’ Use of Tobacco Products

Abstract

Introduction: Previous studies suggest female smoking increases time-to-pregnancy (TTP), a couple-dependent reproductive outcome, while associations with male smoking are more ambiguous. Furthermore, despite small increases in smokeless tobacco use in the United States, no prior study has evaluated TTP among smokeless tobacco users. Methods: Using population-based sampling in 16 counties in Michigan and Texas, 501 couples discontinuing contraception to become pregnant were followed until positive pregnancy test or 12 months of trying. Participants were interviewed on lifetime and current cigarette, cigar, and chew/snuff (smokeless) use and provided blood samples for quantification of heavy metals and cotinine. Fecundability odds ratios (FORs) and 95% confidence intervals (95% CIs) were estimated, adjusted for demographics/lifestyle. FORs less than 1 reflect longer TTP. Results: Eleven percentage of females and 15% of males smoked cigarettes. Among men, 14% smoked cigars, 9% used snuff, and 2% used chew. Compared with never tobacco users, male (FOR: 0.41, 95% CI: 0.24, 0.68) and female (FOR: 0.53, 95% CI: 0.33, 0.85) smoking were individually associated with longer TTP; males' smoking remained significant (FOR: 0.46, 95% CI: 0.27, 0.79) when modeling partners together. Cadmium levels were higher in smokers than smokeless tobacco and never users; adjusting for cadmium attenuated the cigarette-TTP association, particularly among women. TTP was shorter among smokeless tobacco users relative to smokers (FOR: 2.86, 95% CI: 1.47, 5.57). Conclusions: Compared with never users, smokeless tobacco did not alter TTP in our cohort; however, TTP was shorter compared with smokers. We observed longer TTP in male and female smokers; cadmium may partially contribute. Implications: Both partners' preconception smoking contributed to longer TTP, highlighting the importance of both partners' lifestyles in healthy reproduction and underscores the need for couple-based preconception guidance. The male's contribution is a new finding. Higher cadmium levels may partially contribute to longer TTP in smokers, particularly among females. Though we do not observe longer TTP among a small sample of smokeless tobacco users compared with never tobacco users, we observe shorter TTP compared with smokers. Further work is needed to more thoroughly delineate the relationship between smokeless tobacco use and TTP and possible mechanisms of tobacco use's effects on reproduction.

The impact of maternal lifestyle factors on periconception outcomes: a systematic review of observational studies

“…Besides, decreased ovarian function and reduced ovarian reserve may also be possible consequences of smoking, as shown by lower anti-Müllerian hormone (AMH) concentrations in smokers compared with non-smokers (Freour et al, 2008). Studies included in this review confirm these hypotheses by showing statistically significant negative associations of smoking especially with fecundity parameters (Laurent et al, 1992;Axmon et al, 2000;Radin et al, 2014), although a significantly prolonged time to pregnancy was found in only two out of six studies included in this review (Hull et al, 2000;Sapra et al, 2016).…”

“…The characteristics of the included studies are shown in TABLE 1. Thirty-five studies were identified as prospective (Laurent et al, 1992;Florack et al, 1994;Windham et al, 1997;Caan and C. P. Quesenberry, 1998;Hakim et al, 1998;Jensen et al, 1998;Hull et al, 2000;Kesmodel et al, 2002;Arakawa et al, 2006;Law et al, 2007;Strandberg-Larsen et al, 2008;Bakker et al, 2010;Mook-Kanamori et al, 2010;Prabhu et al, 2010;Wise et al, 2010;Hatch et al, 2012;Mutsaerts et al, 2012;Wise et al, 2012;Bouwland-Both et al, 2013;van Uitert et al, 2013b;Wise et al, 2013, Gaskins et al, 2014bHahn et al, 2014;Radin et al, 2014;Van Uitert et al, 2014;Andersen et al, 2015;Hahn et al, 2015;Cueto et al, 2016;Gaskins et al, 2016;McKinnon et al, 2016;Sapra et al, 2016;Wesselink et al, 2016;Zhou et al, 2016;Parisi et al, 2017), six as retrospective cohort studies (Bolúmar et al, 1997, Axmon et al, 2000, Juhl et al, 2001, Juhl et al, 2003, Axmon et al, 20...…”

“…The association between maternal lifestyle factors and time to pregnancy was evaluated in 19 studies (Florack et al, 1994;Bolúmar et al, 1997;Hull et al, 2000;Juhl et al, 2001;Juhl et al, 2003, Arakawa et al, 2006Axmon et al, 2006;Law et al, 2007;Ramlau-Hansen et al, 2007;Wise et al, 2010;Hatch et al, 2012;Mutsaerts et al, 2012;Wise et al, 2012;Wise et al, 2013;McKinnon et al, 2016;Sapra et al, 2016;Somigliana et al, 2016;Wesselink et al, 2016) (TABLE 3). Six studies evaluated the impact of smoking on time to pregnancy (Florack et al, 1994;Hull et al, 2000;Axmon et al, 2006;Law et al, 2007;Mutsaerts et al, 2012;Sapra et al, 2016), all showing a prolonged time to pregnancy among smokers.…”

Partner smoking influences whether mothers quit smoking during pregnancy: a prospective cohort study

“…Prior to pregnancy, the prevalence of partners who smoked was slightly higher than the prevalence of women who smoked, but in contrast to their female counterparts they did not quit smoking during the pregnancy. Whereas tobacco use in pregnancy has been vastly analysed, few studies present data about the prevalence of partners who smoke during pregnancy (15% in Minnesota, EE.UU and 30% in Galicia, north of Spain), or on the prevalence of partners that quit smoking (8.5% in Barcelona, Spain; 11.1% in Ashford, UK, and in Barcelona and Menorca, Spain). Recently, from a qualitative point of view, Fleming et al focused on barriers and facilitators to smoking cessation experienced by women's partners.…”

“…There is evidence that partner smoking affects the offspring, leading to small for gestational age, fetal deaths, and birth defects . Moreover, the prevalence of tobacco use among partners and smoking cessation of the partners is rarely considered . To our knowledge, no studies have shed light on active smoking and passive smoking habits throughout the three trimesters of pregnancy.…”