In Utero Nicotine Exposure and Fetal Growth Inhibition among Twins

ABSTRACT

We examined the impact of cigarette smoking on fetal growth among twins by analyzing matched twin live births in the United States from 1995 through 1998. The outcomes of interest were low and very low birthweight, preterm and very preterm birth, and small for gestational age. Out of a total of 163,901 mothers, 19,234 reported active smoking during pregnancy (11.7%). Twins born to smokers weighed an average of 182 g less than their counterparts born to nonsmokers (p < 0.001). The risk for fetal growth inhibition was greater among twins of smokers: low birthweight (adjusted odds ratio [OR], 1.84; 95% confidence Interval [CI], 1.79 to 1.89), very low birthweight (OR, 1.27; 95% CI, 1.21 to 1.32), preterm (OR, 1.3; 95% CI, 1.09 to 1.16), very preterm (OR, 1.18; 95% CI, 1.13 to 1.23), and small for gestational age (OR, 1.91; 95% CI, 1.84 to 1.98). In conclusion, prenatal smoking significantly inhibits fetal growth among twins, and small for gestational age appeared more affected than shortened gestation.

KEYWORDS

Maternal smoking - fetal growth - twins

REFERENCES

• 1 Hellerstedt W L, Himes J H, Story M et al.. The effects of cigarette smoking and gestational weight change on birth outcomes in obese and normal-weight women.  Am J Public Health. 1997;  87 591-596
• 2 Wang X, Tager I B, Van Vunakis H et al.. Maternal smoking during pregnancy, urine cotinine concentrations and birth outcomes.  Int J Epidemiol. 1997;  26 978-988
• 3 Meis P J, Michielutte R, Peters T J et al.. Factors associated with term low birth weight in Cardiff, Wales.  Paediatr Perinat Epidemiol. 1997;  11 287-297
• 4 Pollack H, Lantz P M, Frohna J G. Maternal smoking and adverse birth outcomes among singletons and twins.  Am J Public Health. 2000;  90 395-400
• 5 Berkowitz G S, Papiernik E. Epidemiology of preterm birth.  Epidemiol Rev. 1993;  15 414-443
• 6 Cnattingius S, Granath F, Petersson G, Harlow B L. The influence of gestational age and smoking habits on the risk of subsequent preterm deliveries.  N Engl J Med. 1999;  341 943-948
• 7 Kyrklund-Blomberg N B, Cnattinguis S. Preterm birth and maternal smoking: risks related to gestational age and onset of delivery.  Am J Obstet Gynecol. 1998;  179 1051-1055
• 8 Hadley C, Main D, Gabbe S. Risk factors for preterm premature rupture of the fetal membranes.  Am J Perinatol. 1990;  7 374-379
• 9 Meyer M, Tonascia J. Perinatal events associated with maternal smoking during pregnancy.  Am J Epidemiol. 1976;  1103 464-476
• 10 Naeye R. Abruptio placentae and placenta previa. Frequency, perinatal mortality and cigarette smoking.  Obstet Gynecol. 1980;  155 701-794
• 11 Williams M, Mittendorf R, Lieberman E et al.. Cigarette smoking during pregnancy in relation to placenta previa.  Am J Obstet Gynecol. 1991;  165 28-32
• 12 Monica G, Lilja C. Placenta previa, maternal smoking, and recurrence risk.  Acta Obstet Gynecol Scand. 1995;  74 341-345
• 13 Ananth C V, Smulian J C, Vintzileos A M. Incidence of placental abruption in relation to cigarette smoking and hypertensive disorders during pregnancy: a meta-analysis of observational studies.  Obstet Gynecol. 1999;  93 622-628
• 14 Cnattinguis S, Mills J L, Yuen J, Eriksson O, Salonen H. The paradoxical effect of smoking in preeclamptic pregnancies: smoking reduces the incidence but increases the rates of perinatal mortality, abruptio placentae and intra-uterine growth restriction.  Am J Obstet Gynecol. 1997;  177 156-161
• 15 Niswander K, Gordon M. Cigarette smoking. The women and their pregnancies. Philadelphia; W.B. Saunders 1972
• 16 Salihu H M, Aliyu M H, Pierre-Louis B J, Alexander G R. Levels of excess infant deaths attributable to maternal smoking during pregnancy in the United States.  Matern Child Health J. 2003;  7 219-227
• 17 Tuthill D P, Stewart J H, Coles E C et al.. Maternal cigarette smoking and pregnancy outcome.  Paediatr Perinat Epidemiol. 1999;  13 245-253
• 18 Hoo A F, Henschen M, Dezateux C et al.. Respiratory function among preterm infants whose mothers smoked during pregnancy.  Am J Respir Crit Care Med. 1998;  158 700-705
• 19 Blair P S, Fleming P J, Bensley D et al.. Smoking and the sudden infant death syndrome: results from 1993-5 case-control study for confidential inquiry into stillbirths and deaths in infancy. Confidential Enquiry into Stillbirths and Deaths Regional Coordinators and Researchers.  BMJ. 1996;  313 195-198
• 20 Salihu H M, Aliyu M H, Rouse D J, Kirby R S, Alexander G R. Potentially preventable excess mortality among higher-order multiples.  Obstet Gynecol. 2003;  102 679-684
• 21 Martin J, Curtin S, Saulnier M, Mousavi J. Development of the Matched Multiple Birth File. In: 1995-1998 Matched Multiple Birth Dataset. NCHS CD-ROM series 21, no. 13a Hyattsville, MD; National Center for Health Statistics 2003
• 22 Ventura S J, Martin J A, Curtin S C, Mathews T J, Park M M. Births: Final data for 1998. Natl Vital Stat Rep.  2000;  48 1-100
• 23 Klebanoff M A, Levine R J, Morris C D et al.. Accuracy of self-reported cigarette smoking among pregnant women in the 1990s.  Pediatr Perinat Epidemiol. 2001;  15 140-143
• 24 Alexander G R, Cornely D A. Prenatal care utilization: its measurement and relationship to pregnancy outcome.  Am J Prevent Med. 1987;  3 243-253
• 25 Alexander G R, Kotelchuck M. Quantifying the adequacy of prenatal care: a comparison of indices.  Public Health Rep. 1996;  3 408-418
• 26 Alexander G R, Kogan M, Martin J, Papiernik E. What are the fetal growth patterns of Singletons, Twins and Triplets in the United States?.  Clin Obstet Gynecol. 1998;  41 114-125
• 27 Zeger S L, Liang K Y. Longitudinal data analysis for discrete and continuous outcomes.  Biometrics. 1986;  42 121-130
• 28 White H A. A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity.  Econometrica. 1980;  48 817-838
• 29 Clayton D, Hills M. Statistical Models in Epidemiology. Oxford; Oxford University Press 1993
• 30 Morrow R J, Ritchie J W, Bull S B. Maternal cigarette smoking: the effects on umbilical and uterine blood flow velocity.  Am J Obstet Gynecol. 1988;  159 1069-1071
• 31 Lambers D S, Clark K E. The maternal and fetal physiologic effects of nicotine.  Semin Perinatol. 1996;  20 115-126