Original Article

Smoking and Respiratory Conditions in Pregnancy: Associations with Adverse Pregnancy Outcomes

Authors: Panagiota Kitsantas, PhD, Kenneth E. Christopher, MS, MPH

Abstract

Objectives: Acute and chronic respiratory conditions affect a large segment of pregnant women. The purpose of the current study was to examine the concomitant effects of respiratory conditions and smoking during pregnancy on gestational age, birth weight, fetal distress, infant mortality, premature rupture of membranes, placenta abruption, and mode of delivery.


Methods: This study used data (n = 1,064,969) from the North Carolina linked birth/infant death files from 1999 to 2007. Logistic regression was used to compute odds ratios and 95% confidence intervals (CIs) in assessing risk of adverse pregnancy outcomes.


Results: We found that women with respiratory conditions/smoking status were significantly more likely than nonsmokers with no respiratory conditions to have a low-birth-weight infant, an infant with fetal distress, and experience preterm birth and an infant’s death. Adjusted odds ratios also revealed that smokers with respiratory conditions were 2.37 (95% CI 1.69–3.32) times more likely than women with no respiratory conditions/nonsmoking status to have placenta abruption and 2.20 (95% CI 1.85–2.61) times more likely to have premature rupture of membranes. Regardless of smoking status, women with respiratory conditions were less likely to have a vaginal delivery.


Conclusions: These findings underscore the need for clinical and public health programs to educate women, particularly those with respiratory diseases, of the immense array of adverse outcomes that may occur as a consequence of active maternal smoking during gestation. It is important for interventions to target mothers with respiratory conditions early on to ensure favorable birth outcomes.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Leighton B, Fish J. Pulmonary disease in pregnancy. http://www.glowm.com/?p=glowm.cml/section_view&articleid=170. Published 2008. Accessed February 21, 2013.
 
2. Acs N, Puho E, Banhidy F, et al. Association between bronchial asthma in pregnancy and shorter gestational age in a population-based study. J Matern Fetal Med 2005; 18: 107–112.
 
3. Ellegard E, Hellgren M, Toren K, et al. The incidence of pregnancy rhinitis. Gynecol Obstet Invest2000; 49: 98–101.
 
4. Brito V, Niederman MS. Pneumonia complicating pregnancy. Clin Chest Med 2011; 32: 121–132.
 
5. Goodnight WH, Soper DE. Pneumonia in pregnancy. Crit Care Med 2005; 33: S390–S397.
 
6. Alexander S, Dodds L, Armson BA. Perinatal outcomes in women with asthma during pregnancy. Obstet Gynecol 1998; 92: 435–440.
 
7. Kwon HL, Belanger K, Bracken MB. Asthma prevalence among pregnant and childbearing-aged women in the United States: estimates from national health surveys. Ann Epidemiol 2003; 13: 317–324.
 
8. Murphy VE, Clifton VL, Gibson PG. Asthma exacerbations during pregnancy: incidence and association with adverse pregnancy outcomes. Thorax 2006; 61: 169–176.
 
9. Minerbi-Codish I, Fraser D, Avnun L, et al. Influence of asthma in pregnancy on labor and the newborn. Respiration 1998; 65: 130–135.
 
10. Clark JM, Hulme E, Devendrakumar V, et al. Effect of maternal asthma on birthweight and neonatal outcome in a British inner-city population. Paediatr Perinat Epidemiol 2007; 21: 154–162.
 
11. Liu S, Wen SW, Demissie K, et al. Maternal asthma and pregnancy outcomes: a retrospective cohort study. Am J Obstet Gynecol 2001; 184: 90–96.
 
12. Bracken MB, Triche EW, Belanger K, et al. Asthma symptoms, severity, and drug therapy: a prospective study of effects on 2205 pregnancies. Obstet Gynecol 2003; 102: 739–752.
 
13. Breton M-C, Beauchesne MF, Lemiere C, et al. Risk of perinatal mortality associated with asthma during pregnancy. Thorax 2009; 64: 101–106.
 
14. National Heart, Lung, and Blood Institute. National Asthma Education Program Report of the Working Group on Asthma and Pregnancy. Management of Asthma During Pregnancy. NIH Publication 93-3279A. Bethesda, MD, National Institutes of Health, 1993.
 
15. Thomson NC, Chaudhuri R, Livingston E. Asthma and cigarette smoking. Eur Respir J 2004; 24: 822–833.
 
16. Carroll KN, Gebretsadik T, Griffin MR, et al. Maternal asthma and maternal smoking are associated with increased risk of bronchiolitis during infancy. Pediatrics 2007; 119: 1104–1112.
 
17. Carter S, Percival T, Paterson J, et al. Maternal smoking: risks related to maternal asthma and reduced birth weight in a Pacific Island birth cohort in New Zealand. N Z Med J 2006; 119: 1–12.
 
18. Newman RB, Momirova V, Dombrowski MP, et al. The effect of active and passive household cigarette smoke exposure on pregnant women with asthma. Chest 2010; 137: 601–608.
 
19. Reynolds MA, Schieve LA, Martin JA, et al. Trends in multiple births conceived using assisted reproductive technology, United States, 1997–2000. Pediatrics 2003; 111: 1159–1162.
 
20. Getahun D, Ananth CV, Peltier MR, et al. Acute and chronic respiratory diseases in pregnancy: associations with placenta abruption. Am J Obstet Gynecol 2006; 195: 1180–1184.
 
21. Matsuda Y, Hayashi K, Shiozaki A, et al. Comparison of risk factors for placental abruption and placenta previa: a case-cohort study. J Obstet Gynaecol Res 2011; 37: 538–546.
 
22. Sheiner E, Mazor M, Levy A, et al. Pregnancy outcome of asthmatic patients: a population-based study. J Matern Fetal Neonatal Med 2005; 18: 237–240.
 
23. Getahun D, Ananth CV, Oyelese Y, et al. Acute and chronic respiratory diseases in pregnancy: associations with spontaneous premature rupture of membranes. J Matern Fetal Med 2007; 20: 669–675.
 
24. Sorensen TK, Dempsey JC, Xiao R, et al. Maternal asthma and risk of preterm delivery. Ann Epidemiol 2003; 13: 267–272.
 
25. Alexander GR, Wingate MS, Bader D, et al. The increasing racial disparity in infant mortality rates: composition and contributors to recent US trends. Am J Obstet Gynecol 2008; 198: 51.e1–51.e9.
 
26. Bruckner TA, Saxton KB, Anderson E, et al. From paradox to disparity: trends in neonatal death in very low birth weight non-Hispanic black and white infants, 1989-2004. J Pediatr 2009; 155: 482–487.
 
27. Manuel J. Double exposure. Environmental tobacco smoke. Environ Health Perspect 1999; 107: A196–A201.
 
28. Misra DP, Nguyen RH. Environmental tobacco smoke and low birth weight: a hazard in the workplace? Environ Health Perspect 1999; 107: 897–904.