Effects of Maternal Smoking on Adverse Pregnancy Outcomes: Examination of the Criteria of Causation

Smoking during pregnancy has been associated with many adverse pregnancy outcomes. However, debate continues about whether smoking causes these outcomes. This review of the criteria of causation found that the relative risk of having a low-birth-weight baby is nearly doubled in women who smoke durin...

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Bibliographic Details
Published in:Human biology 1994-12, Vol.66 (6), p.1059-1092
Main Author: WALSH, RAOUL A.
Format: Article
Language:English
Subjects:
Abortion, Spontaneous - epidemiology
Abortion, Spontaneous - etiology
Adult
Birth weight
Births
Case-Control Studies
Causality
Cigarette smoking
Cigarettes
Dose-Response Relationship, Drug
Female
Health Problems
Health risk assessment
Humans
Infant Mortality
Infant, Low Birth Weight
Infant, Newborn
Infants
Male
Medical research
Mortality
Pregnancy
Pregnancy outcome
Pregnancy Outcome - epidemiology
Pregnant women
Prospective Studies
Research Design
Smokers
Smoking
Smoking - adverse effects
Smoking and women
Smoking cessation
Spontaneous abortion
Women
Women smokers
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Summary:Smoking during pregnancy has been associated with many adverse pregnancy outcomes. However, debate continues about whether smoking causes these outcomes. This review of the criteria of causation found that the relative risk of having a low-birth-weight baby is nearly doubled in women who smoke during pregnancy compared with nonsmoking women and that the relative risks of spontaneous abortion and perinatal and neonatal mortality are increased by about one-third. The magnitude of the long-term effects of maternal smoking on the physical and mental development of the offspring is small but measurable. The epidemiologic evidence associating maternal smoking with major adverse pregnancy outcomes in prospective and case-control studies displays a high degree of consistency. A dose-response gradient for smoking during pregnancy has not been clearly shown in relation to perinatal and neonatal mortality. However, there is strong support for a dose-response gradient in relation to low birth weight and spontaneous abortion and moderate support for long-term developmental effects. Although a biological causal mechanism has not been clearly delineated, considerable evidence indicates that the chemicals in tobacco smoke are capable of producing deleterious changes in the placenta and fetus.
ISSN:0018-7143
1534-6617