Effects of maternal smoking on offspring reproductive outcomes

an intergenerational study in the North East of Scotland

Sam Tweed* (Corresponding Author), Sohinee Bhattacharya, Paul A. Fowler

*Corresponding author for this work

Research output: Contribution to journalArticle

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Abstract

STUDY QUESTION
How does exposure to cigarette smoke in utero influence women's reproductive outcomes?
SUMMARY ANSWER
Women exposed to cigarette smoke in utero were more likely to have a pregnancy and more likely to experience miscarriage.
WHAT IS ALREADY KNOWN
Existing epidemiological studies have been inconsistent, but generally suggest a small decrease in fertility of women exposed to cigarette smoke in utero.
STUDY DESIGN, SIZE, DURATION
This cohort study included all women born prior to 31st December 1972 as recorded in the Aberdeen Maternity and Neonatal Databank. Exposure to maternal cigarette smoking in utero was retrieved from their birth records within the database. The primary outcome was any pregnancy occurring in the offspring over the course of their reproductive life. The 12 321 eligible women were followed up for 40 years for any pregnancies and the outcome of those pregnancies recorded in the same database.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Within the cohort, 3836 women were exposed to cigarette smoke and 8485 women were not exposed to cigarette smoke in utero. Generalized estimating equations were used to generate odds ratios (OR) and 95% CIs for all outcomes with adjustment made for all differences between groups at baseline.
MAIN RESULTS AND THE ROLE OF CHANCE
The study did not find a link between exposure to cigarette smoke in utero and a decrease in fertility. Women exposed to cigarette smoke in utero were more likely to have a pregnancy than those whose mother did not smoke; adjusted OR = 1.25 (95% CIs: 1.13–1.38). Women exposed to cigarette smoke in utero were also likely to have a pregnancy earlier (adjusted OR for age at first delivery ≤19 years 1.31 [95% CIs: 1.12–1.54)] than those not exposed. Women exposed to cigarette smoke in utero were significantly more likely to have a miscarriage than those not exposed; adjusted OR = 1.16 (95% CIs: 1.01–1.32).
LIMITATIONS, REASONS FOR CAUTION
Although the cohort in this study was large, there were women for whom exposure data was unavailable. Data on the adult circumstances of women who did not record a pregnancy was unavailable, precluding adjustment for their own smoking status or social class. In addition, women who migrated from the area or chose childlessness voluntarily were not included in the study.
WIDER IMPLICATIONS OF THE FINDINGS
Despite the wide-ranging harmful effects of cigarette smoke on foetal reproductive development, the effect at a population level remains uncertain. An increased risk of miscarriage in women exposed to cigarette smoke is a potentially important novel finding, which should be investigated further. This study illustrates the lack of consensus on the reproductive effects of in utero cigarette exposure, compelling continuing study in this important area.
Original languageEnglish
Article numberhox006
Pages (from-to)1-7
Number of pages7
JournalHuman Reproduction Open
Volume2017
Issue number2
DOIs
Publication statusPublished - 12 Jul 2017

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Scotland
Smoke
Tobacco Products
Smoking
Mothers
Outcome Assessment (Health Care)
Pregnancy
Spontaneous Abortion
Odds Ratio
Databases
Fertility
Cohort Studies
Birth Certificates
Social Adjustment
Maternal Exposure
Pregnancy Outcome
Fetal Development
Social Class
Epidemiologic Studies
Consensus

Keywords

  • smoking
  • pregnancy
  • fertility
  • in utero
  • miscarriage

Cite this

Effects of maternal smoking on offspring reproductive outcomes : an intergenerational study in the North East of Scotland. / Tweed, Sam (Corresponding Author); Bhattacharya, Sohinee; Fowler , Paul A.

In: Human Reproduction Open, Vol. 2017, No. 2, hox006, 12.07.2017, p. 1-7.

Research output: Contribution to journalArticle

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abstract = "STUDY QUESTIONHow does exposure to cigarette smoke in utero influence women's reproductive outcomes?SUMMARY ANSWERWomen exposed to cigarette smoke in utero were more likely to have a pregnancy and more likely to experience miscarriage.WHAT IS ALREADY KNOWNExisting epidemiological studies have been inconsistent, but generally suggest a small decrease in fertility of women exposed to cigarette smoke in utero.STUDY DESIGN, SIZE, DURATIONThis cohort study included all women born prior to 31st December 1972 as recorded in the Aberdeen Maternity and Neonatal Databank. Exposure to maternal cigarette smoking in utero was retrieved from their birth records within the database. The primary outcome was any pregnancy occurring in the offspring over the course of their reproductive life. The 12 321 eligible women were followed up for 40 years for any pregnancies and the outcome of those pregnancies recorded in the same database.PARTICIPANTS/MATERIALS, SETTING, METHODSWithin the cohort, 3836 women were exposed to cigarette smoke and 8485 women were not exposed to cigarette smoke in utero. Generalized estimating equations were used to generate odds ratios (OR) and 95{\%} CIs for all outcomes with adjustment made for all differences between groups at baseline.MAIN RESULTS AND THE ROLE OF CHANCEThe study did not find a link between exposure to cigarette smoke in utero and a decrease in fertility. Women exposed to cigarette smoke in utero were more likely to have a pregnancy than those whose mother did not smoke; adjusted OR = 1.25 (95{\%} CIs: 1.13–1.38). Women exposed to cigarette smoke in utero were also likely to have a pregnancy earlier (adjusted OR for age at first delivery ≤19 years 1.31 [95{\%} CIs: 1.12–1.54)] than those not exposed. Women exposed to cigarette smoke in utero were significantly more likely to have a miscarriage than those not exposed; adjusted OR = 1.16 (95{\%} CIs: 1.01–1.32).LIMITATIONS, REASONS FOR CAUTIONAlthough the cohort in this study was large, there were women for whom exposure data was unavailable. Data on the adult circumstances of women who did not record a pregnancy was unavailable, precluding adjustment for their own smoking status or social class. In addition, women who migrated from the area or chose childlessness voluntarily were not included in the study.WIDER IMPLICATIONS OF THE FINDINGSDespite the wide-ranging harmful effects of cigarette smoke on foetal reproductive development, the effect at a population level remains uncertain. An increased risk of miscarriage in women exposed to cigarette smoke is a potentially important novel finding, which should be investigated further. This study illustrates the lack of consensus on the reproductive effects of in utero cigarette exposure, compelling continuing study in this important area.",
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note = "The authors thank Dr Amalraj Raja (University of Aberdeen) for his expertise in planning the data analysis and the custodians of the Aberdeen Maternity and Neonatal Databank for granting access to the required data. Thanks also to the course leaders of the University of Aberdeen BSc MedSci course for enabling the research project.",
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N1 - The authors thank Dr Amalraj Raja (University of Aberdeen) for his expertise in planning the data analysis and the custodians of the Aberdeen Maternity and Neonatal Databank for granting access to the required data. Thanks also to the course leaders of the University of Aberdeen BSc MedSci course for enabling the research project.

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N2 - STUDY QUESTIONHow does exposure to cigarette smoke in utero influence women's reproductive outcomes?SUMMARY ANSWERWomen exposed to cigarette smoke in utero were more likely to have a pregnancy and more likely to experience miscarriage.WHAT IS ALREADY KNOWNExisting epidemiological studies have been inconsistent, but generally suggest a small decrease in fertility of women exposed to cigarette smoke in utero.STUDY DESIGN, SIZE, DURATIONThis cohort study included all women born prior to 31st December 1972 as recorded in the Aberdeen Maternity and Neonatal Databank. Exposure to maternal cigarette smoking in utero was retrieved from their birth records within the database. The primary outcome was any pregnancy occurring in the offspring over the course of their reproductive life. The 12 321 eligible women were followed up for 40 years for any pregnancies and the outcome of those pregnancies recorded in the same database.PARTICIPANTS/MATERIALS, SETTING, METHODSWithin the cohort, 3836 women were exposed to cigarette smoke and 8485 women were not exposed to cigarette smoke in utero. Generalized estimating equations were used to generate odds ratios (OR) and 95% CIs for all outcomes with adjustment made for all differences between groups at baseline.MAIN RESULTS AND THE ROLE OF CHANCEThe study did not find a link between exposure to cigarette smoke in utero and a decrease in fertility. Women exposed to cigarette smoke in utero were more likely to have a pregnancy than those whose mother did not smoke; adjusted OR = 1.25 (95% CIs: 1.13–1.38). Women exposed to cigarette smoke in utero were also likely to have a pregnancy earlier (adjusted OR for age at first delivery ≤19 years 1.31 [95% CIs: 1.12–1.54)] than those not exposed. Women exposed to cigarette smoke in utero were significantly more likely to have a miscarriage than those not exposed; adjusted OR = 1.16 (95% CIs: 1.01–1.32).LIMITATIONS, REASONS FOR CAUTIONAlthough the cohort in this study was large, there were women for whom exposure data was unavailable. Data on the adult circumstances of women who did not record a pregnancy was unavailable, precluding adjustment for their own smoking status or social class. In addition, women who migrated from the area or chose childlessness voluntarily were not included in the study.WIDER IMPLICATIONS OF THE FINDINGSDespite the wide-ranging harmful effects of cigarette smoke on foetal reproductive development, the effect at a population level remains uncertain. An increased risk of miscarriage in women exposed to cigarette smoke is a potentially important novel finding, which should be investigated further. This study illustrates the lack of consensus on the reproductive effects of in utero cigarette exposure, compelling continuing study in this important area.

AB - STUDY QUESTIONHow does exposure to cigarette smoke in utero influence women's reproductive outcomes?SUMMARY ANSWERWomen exposed to cigarette smoke in utero were more likely to have a pregnancy and more likely to experience miscarriage.WHAT IS ALREADY KNOWNExisting epidemiological studies have been inconsistent, but generally suggest a small decrease in fertility of women exposed to cigarette smoke in utero.STUDY DESIGN, SIZE, DURATIONThis cohort study included all women born prior to 31st December 1972 as recorded in the Aberdeen Maternity and Neonatal Databank. Exposure to maternal cigarette smoking in utero was retrieved from their birth records within the database. The primary outcome was any pregnancy occurring in the offspring over the course of their reproductive life. The 12 321 eligible women were followed up for 40 years for any pregnancies and the outcome of those pregnancies recorded in the same database.PARTICIPANTS/MATERIALS, SETTING, METHODSWithin the cohort, 3836 women were exposed to cigarette smoke and 8485 women were not exposed to cigarette smoke in utero. Generalized estimating equations were used to generate odds ratios (OR) and 95% CIs for all outcomes with adjustment made for all differences between groups at baseline.MAIN RESULTS AND THE ROLE OF CHANCEThe study did not find a link between exposure to cigarette smoke in utero and a decrease in fertility. Women exposed to cigarette smoke in utero were more likely to have a pregnancy than those whose mother did not smoke; adjusted OR = 1.25 (95% CIs: 1.13–1.38). Women exposed to cigarette smoke in utero were also likely to have a pregnancy earlier (adjusted OR for age at first delivery ≤19 years 1.31 [95% CIs: 1.12–1.54)] than those not exposed. Women exposed to cigarette smoke in utero were significantly more likely to have a miscarriage than those not exposed; adjusted OR = 1.16 (95% CIs: 1.01–1.32).LIMITATIONS, REASONS FOR CAUTIONAlthough the cohort in this study was large, there were women for whom exposure data was unavailable. Data on the adult circumstances of women who did not record a pregnancy was unavailable, precluding adjustment for their own smoking status or social class. In addition, women who migrated from the area or chose childlessness voluntarily were not included in the study.WIDER IMPLICATIONS OF THE FINDINGSDespite the wide-ranging harmful effects of cigarette smoke on foetal reproductive development, the effect at a population level remains uncertain. An increased risk of miscarriage in women exposed to cigarette smoke is a potentially important novel finding, which should be investigated further. This study illustrates the lack of consensus on the reproductive effects of in utero cigarette exposure, compelling continuing study in this important area.

KW - smoking

KW - pregnancy

KW - fertility

KW - in utero

KW - miscarriage

U2 - 10.1093/hropen/hox006

DO - 10.1093/hropen/hox006

M3 - Article

VL - 2017

SP - 1

EP - 7

JO - Human Reproduction Open

JF - Human Reproduction Open

SN - 2399-3529

IS - 2

M1 - hox006

ER -