Associations of lifetime active and passive smoking with spontaneous abortion, stillbirth and tubal ectopic pregnancy: a cross-sectional analysis of historical data from the Women's Health Initiative
- Andrew Hyland1,
- Kenneth M Piazza1,
- Kathleen M Hovey2,
- Judith K Ockene3,
- Christopher A Andrews4,
- Cheryl Rivard1,
- Jean Wactawski-Wende2
- 1Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Buffalo, Roswell Park Cancer Institute, New York, USA
- 2Department of Social & Preventive Medicine, University at Buffalo School of Public Health & Health Professions, Buffalo, New York, USA
- 3Division of Preventive & Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- 4University at Buffalo School of Public Health & Health Professions, Department of Biostatistics, Buffalo, New York, USA
- Correspondence to Dr Andrew Hyland, Roswell Park Cancer Institute, Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Buffalo, 14263 NY, USA;
- Received 3 December 2013
- Accepted 7 January 2014
- Published Online First 26 February 2014
Objective To examine the associations between tobacco exposure and adverse pregnancy outcomes using quantitative measures of lifetime active smoking and secondhand smoke (SHS) exposure.
Methods Historical reproductive data on 80 762 women who participated in the Women's Health Initiative Observational Study were examined with a cross-sectional analysis. We assessed self-reported lifetime active and passive tobacco smoke exposure, self-reported spontaneous abortions, stillbirths and ectopic pregnancies.
Results When compared with never-smoking women, participants who were ever active smokers during their reproductive years had ORs (OR) of 1.16 (95% CI 1.08 to 1.26) for 1 or more spontaneous abortions, 1.44 (95% CI 1.20 to 1.73) for 1 or more stillbirths, and 1.43 (95% CI 1.10 to 1.86) for 1 or more ectopic pregnancies. Never-smoking women participants with the highest levels of lifetime SHS exposure, including childhood >10 years, adult home >20 years and adult work exposure >10 years, when compared with never-smoking women with no SHS exposure had adjusted ORs of 1.17 (95% CI 1.05 to 1.30) for spontaneous abortion, 1.55 (95% CI 1.21 to 1.97) for stillbirth, and 1.61 (95% CI 1.16 to 2.24) for ectopic pregnancy.
Conclusions Women who were ever-smokers during their reproductive years had significantly greater estimates of risk for spontaneous abortion, stillbirth and tubal ectopic pregnancy. Never-smoking women with the highest levels of lifetime exposure to SHS had significantly increased estimates of risk for spontaneous abortion, stillbirth and tubal ectopic pregnancy.