Tobacco control policies and perinatal health: a national quasi-experimental study

Abstract

We investigated whether changes in perinatal outcomes occurred following introduction of key tobacco control policies in the Netherlands: smoke-free legislation in workplaces plus a tobacco tax increase and mass media campaign (January-February 2004); and extension of the smoke-free law to the hospitality industry, accompanied by another tax increase and mass media campaign (July 2008). This was a national quasi-experimental study using Netherlands Perinatal Registry data (2000–2011; registration: ClinicalTrials.gov NCT02189265). Primary outcome measures were: perinatal mortality, preterm birth, and being small-for-gestational age (SGA). The association with timing of the tobacco control policies was investigated using interrupted time series logistic regression analyses with adjustment for confounders. Among 2,069,695 singleton births, there were 13,027 (0.6%) perinatal deaths, 116,043 (5.6%) preterm live-births and 187,966 (9.1%) SGA live-births. The 2004 policies were not associated with significant changes in the odds of developing any of the primary outcomes. After the 2008 policy change, a -4.4% (95% CI -2.4; -6.4, p < 0.001) decrease in odds of being SGA was observed. A reduction in SGA births, but not preterm birth or perinatal mortality, was observed in the Netherlands after extension of the smoke-free workplace law to bars and restaurants in conjunction with a tax increase and mass media campaign.

Smoke-free legislation and child health

“…58 Follow-on studies also show mixed evidence. 24,40,45,59,71,72 A closer look at this evidence suggests that reductions in low birthweight are generally observed in countries with the most comprehensive laws. 40,42,45,59 …”

“…45 In a smaller study in the Netherlands, we did not observe a significant association between phased introduction of smoke-free legislation, introduced in conjunction with other tobacco control policies, and perinatal mortality. 24 We speculated that lack of enforcement and lower compliance compared with that in England may have attenuated the impact of smoke-free legislation on these outcomes in the Netherlands. 63–67 Other factors including methodological and population differences may also have contributed to the discrepant findings, and additional studies are needed to investigate the impact of comprehensive smoke-free legislation on perinatal mortality.…”

“…73 Furthermore, a reduction in very preterm births was observed following extension of the smoke-free workplace law in the Netherlands to include hospitality venues. 24 On the other hand, two large evaluations of local US smoke-free laws failed to demonstrate a link between smoke-free laws and preterm birth. 71,72 A systematic and comprehensive assessment of the strengths and weaknesses of these studies, and the coverage and enforcement of and compliance with the legislation in relation to the reported effect sizes, is ongoing and will help to better understand the discrepant findings.…”

“…58 Follow-on work conducted in Quebec and the Netherlands also showed significant reductions in the risk for SGA birth following smoke-free legislation. 24,59 Again, this was mainly owing to a reduction in very SGA births. 24 …”

The impact of anti-tobacco legislation on birth weight in Peru

“…Anti-tobacco laws have shown positive effect on hospitalizations for respiratory tract infection and asthma in children [27][28][29][30]. Likewise, anti-tobacco laws have reduced adverse effects on newborns from Canada, United States, Ireland, England, Belgium, Norway, Spain, the Netherlands, Switzerland, Hungary, Scotland and Uruguay [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]. Nevertheless, the information from developing and middle-income countries is still limited.…”