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Table 3.1
Studies of Birthweight and ETS Exposure
Defined by paternal Smoking Status
Authors (year) |
Study Design |
Difference in Mean Birthweight by Exposure1 |
| MacMahon et al. (1966) US (Massachusetts) |
Retrospective mail questionnaire (12,192 white singletons) (5,935 maternal nonsmokers) |
-22g (-57, 13) females -20g (-55, 15) males -28g for pipe/cigar (n.s.) no consistent effect by amount |
| Comstock & Lundin (1967) US (Maryland) |
Special census linked to vital records (448 births) | -42g (no statistics provided) |
| Underwood et al. (1967) Worldwide |
Naval records of labor and delivery; cross-sectional (48,505
singletons with 24,674 maternal nonsmokers) |
-7 to -3g, by amount smoked |
| Borlee et al. (1978) Belgium |
Retrospective interview (175 normal live births, 202 malformed) | -228g (-429.0, -26.7) crude (p = 0.06 for paternal smoking impact analysis that controlled for maternal smokers) 2 |
| Magnus et al. (1984) Norway |
Retrospective interview of twins (parents of offspring studied) (3130 families; 5,188 births) |
regression for categories of about 10 cigs/day: crude: -48g (-65, -31) adjusted for maternal smoking2: -5g (-23, 13) |
| Rubin et al. (1986) Denmark |
Interview at delivery (500 term live births >2000g) |
adjusted for maternal smoking: -6.1g/cig (-12, -0.2)
2 |
| MacArthur & Knox (1987) England |
Unknown (180 mothers who quit smoking in pregnancy) |
-14g crude not significant in an analysis for the effect of paternal smoking |
1 All effect measures assessed in non-smoking mothers unless
otherwise specified
(e.g., "smoking adjusted"). All 95% confidence intervals calculated by reviewers
from available data.
n.s. = not statistically significant (p>0.05).
2 Control for at least some confounders (see text discussion of studies).
3 Based on living with a household smoker, not only the spouse.
Table 3.1 (continued)
Studies of Birthweight and ETS Exposure
Defined by paternal Smoking Status
Authors (year) |
Study Design |
Difference in Mean Birthweight by Exposure1 |
| Schwartz-Bickenbach et al. (1987) Germany |
Interview at delivery (54 pairs-smoke and not, followed while breast-feeding) |
-205g (-440, 30.1), crude |
| Campbell et al. (1988) England |
Interview 1 month post- delivery (518 white singles) |
-113g (-216, - 8)2 (from regression after adjusting for maternal smoking) |
| Brooke et al. (1989) 3 England (London) |
Prospective interview (1513 white births with 1,018 nonsmokers) |
-18g or 0.5% reduction2 (p = 0.56) |
| Chen et al. (1989) 3 China (Shangai) |
Retrospective mail questionnaire (1,058 births) |
-11g (-81.9, 64.1) paternal smoking >10/day -15g (-94.5, 64.5) adj made no difference2 |
| Saito (1991) Japan |
Interview at infant care visit (3,000 couples) |
smoke any: -33.4g (-66.3, -0.5) For ³
40 cigs/day: -111g (-191.0, -31.7), crude |
| Mathai et al. (1990)2 England (Liverpool) |
Prospective interview (285 white singles) |
-66g (-213.0, 81.1), crude |
| Mathai et al. (1992) India (Vellore) |
Interview (994 singletons) |
-63g (-114g, -12)2 |
| Zhang & Ratcliffe (1993) China (Shangai) |
Interview post-delivery (1,785 singleton term births) |
-30g (-66,7)2 -62g for 15-19 cigs/day but + 32 for > 20/day |
| Martinez et al. (1994) US (Arizona) |
Interview at delivery (1219 births, 907 nonsmokers) |
-34g (-63, -5)2 per 10 cigarettes |
1 All effect measures assessed in non-smoking mothers unless
otherwise specified
(e.g., "smoking adjusted"). All 95% confidence intervals calculated by reviewers
from available data.
n.s. = not statistically significant (p>0.05).
2 Control for at least some confounders (see text discussion of studies).
3 Based on living with a household smoker, not only the spouse.
Table 3.2
Studies of Fetal Growth and ETS Exposure at home
Defined by paternal Smoking Status
Study |
Odds Ratios (95% CI)4 |
|||
Authors (year) |
Study Design |
Low Birth Weight (LBW) |
IUGR/SGA |
Preterm |
| Underwood et al. (1967)1 Worldwide |
Naval records of labor and delivery (24,674 nonsmoking mothers) |
0.9 (0.8, 1.0) any 1.05 (0.82, 1.3) >30 cigs |
- - | 0.9 (0.8, 1.0) any 1.05 (0.8, 1.3) >30 cigs |
| Yerulshalmy (1971)1 US (N. California) |
Prospective study of Kaiser members (9,793) |
0.9 (n.s.) mother nonsmoker 1.4 (p<0.05) mother smoker |
- - | - - |
| Mau & Netter (1974)1 Germany |
Prospective interview (5,183; 3,696 nonsmokers) |
1.4 (1.0, 1.9) >10 cigs/day |
1.2 (0.9, 1.7) >10 cigs/day |
1.2 (0.9, 1.6) >10 cigs/day |
| Nakamura et al. (1988) Japan (Osaka) |
Prospective interview (2,371 nonsmokers) |
1.4 (0.9, 2.2)3 ----------------------------------- In non-working women: 1.7 (1.0, 2.9)3 |
1.2 (0.8, 2.0) ------------------ 1.4 (0.8, 2.4) |
1.2 (0.8, 1.8) ---------------------- 1.1 (0.7, 1.8) |
| Chen et al. (1989)1,2 China (Shanghai) |
Retrospective, self-administered (1,163) |
1.5 (0.75, 3.2) |
- - | - - |
| Saito (1991)1 Japan (Osaka) |
Retrospective interview (3,000 couples) |
- - | 1.3 (1.1, 1.5) | 1.0 (0.8, 1.3) |
| Mathai et al. (1992)1,2 India |
Interview, but timing unclear (994) |
1.0 (0.4, 2.3) (LBW defined as <2000g) |
- - | 1.6 (0.8, 2.9) |
| Zhang & Ratcliffe (1993) China (Shanghai) |
Interview post-delivery (1,785 term births of nonsmokers) |
- - | 1.1 (0.83, 1.5) | - - |
1 Odds ratios and/or confidence intervals estimated from published data, not published by original authors.
2 Based on any household smoker, instead of only paternal smoker.
3 Controlled for confounders.
IUGR - Intrauterine Growth Retardation; SGA - small for age gestational; LBW at term.
Table 3.3
Studies of Fetal Growth and ETS Exposure
of maternal Non-Smokers From Multiple ETS Sources
Study |
Results2 |
||
Authors (year) |
ETS Level |
Difference in Mean Weight |
IUGR/LBW |
| Martin & Bracken (1986) US (Connecticut) (n=2,473) Prospective interview |
> 2 hr/day at home or work (34%) | -24 g adjusted (-60,13) -85 g (p<
0.002) crude |
2.2 (1.1-4.5) LBW |
| Ogawa et al. (1991) Japan (n=5,336) Interview around delivery |
> 2 hr/day at home, work or elsewhere (35%) |
-10.8 g (n.s.) -24 g (-47, -2) crude |
1.0 (0.7-1.5) LBW |
| Lazzaroni et al. (1990) Italy (n=648; examined births >2000g, > 37 wks gestation) Interview postpartum |
> 1 hr/day at home or work (25%) | -38 g (-106.9, 30.7) -17 g/hr (-35, 1.3) |
- - |
| Ahlborg & Bodin (1991) Sweden (n=2,461 employed) Interviewed during month 2 or 3 of pregnancy |
Home exposure only (16%) ---------------------------- Most time at work in rooms with smokers (11%) |
-34 g (-82, 15) (very small numbers) ------------------------------- 20 g (-37, 77) |
0.7 (0.21-2.3) LBW (based on 3 infants) ------------------------ 1.1 (0.33-3.6) LBW |
| Fortier et al. (1994) Canada (Quebec) (n = 4,644 non smokers) Interview within few months post partum |
Home only (13%) ---------------------------- Work only ---------------------------- Home and Work |
------------------------------- ------------------------------- |
0.98 (0.67- 1.44) IUGR ------------------------ 1.18 (0.90-1.56) IUGR ------------------------ 0.94(0.60-1.49) IUGR |
2 Effect measure adjusted for a number of confounders, unless otherwise indicated as "crude". Abbreviations: LBW - low birth weight; IUGR - intrauterine growth retardation.
3 The analysis adjusted for LBW in previous births. This may result in substantial under estimation of effect.
Table 3.3 (continued)
Studies of Fetal Growth and ETS Exposure
of maternal Non-Smokers From Multiple ETS Sources
Study |
Results |
||
Authors (year) |
ETS Level |
Difference in Mean Weight |
IUGR/LBW3 |
| Mainous & Hueston (1994) US (nationwide) (n=3,253) Retrospective survey |
Categorized as: never (23%) occasional (46%) often (17%) always (13%) |
-84g (-150, -18) for highest exposure, crude No decrement at lower levels |
1.6 (0.92, 2.7) LBW with high exposure (p < 0.01 dose response trend) |
| Chen & Petitti (1995) US (California) (n=111 cases, 124 controls, whites) Retrospective interview |
Assessed in 4 locations and as average hrs/week Any exposure (54%) ³ 30 hours/wk (7%) |
- - | ³ 30 hrs/week: 0.5 (0.14, 1.7) IUGR work only: home only: |
| Roquer et al. (1995) Spain (n=129) Interview at delivery |
"Significant" defined as exposed to ³ 20 cigarettes/day |
-192 (-365, -19), crude |
|
| Rebagliato et al. (1995) Spain (n=710) Interview in 3rd trimester |
Assessed hours per week from 4 sources Any exposure (88%) ³ 42 hours/week (22%) |
Any: -85g, crude any ³ 42 hours/wk: -41g (-144, 61)2 spouse ³ 42hrs/wk: 31g (-103, 165) |
- - |
2 Effect measure adjusted for a number of confounders, unless otherwise indicated as "crude". Abbreviations: LBW = low birth weight; IUGR = intrauterine growth retardation.
3 The analysis adjusted for LBW in previous births. This may result in substantial under estimation of effect.
Table 3.4
Studies of Fetal Growth and ETS Exposure
Determined by Biomarkers
Study |
Results |
||||
Authors (year) |
Design |
Biomarker |
Weight Difference |
Low Birth Weight |
|
| Hauth et al. (1984) US (Texas) |
Maternal serum at labor Cord blood at delivery (163; 134 nonsmokers) |
Mean in ETS = 26 + 2.5 umol/L SCN vs. 23 + 1.5 in nonsmokers cord blood (n.s.) | Correlation of wt and SCN = -0.74 in smokers (p<0.001) vs.
r = 0.02 in ETS exposed, r = 0.15 in nonsmokers |
-- | |
| Haddow et al. (1988) U.S. Maine |
Serum drawn early in 2nd trimester (1231 nonsmokers) |
1-10 ng/ml cotinine vs. <0.5 in nonsmokers | -104 g (adj.) (-173,-35) -28 g/ng/ml cotinine (CI = -55, -2,) |
"rate 29%" (e.g., OR : 1.29) |
|
| Mathai et al. (1990) England |
Urine at 16 weeks (285; 184 nonsmokers) |
Mean in ETS = .85 + 2.8 vs. .29 + 1.4 µg cotinine/mg creatinine in nonsmokers |
-25 g/µg cotinine/mg creatinine (p0.001) (includes smokers) |
-- | |
| Eskenazi et al. (1995) U.S. (California) |
Serum in 2nd trimester, stored for 25 years (3,578; 2,292 nonsmokers) |
2 - 10 ng/ml cotinine versus <2 ng/ml continuous cotinine level |
-45g (adj.) (-126, 36) inclding smokers: 1g per ng/ml cotinine (adj.) (-1.14, -0.79) |
1.35 (0.60, 3.0) crude |
|
| Rebagliato et al. (1995) Spain |
Saliva in 3rd trimester (n=710 nonsmokers) |
£ 0.5 = unexposed Quintiles of cotinine (Mean in ETS exposed = 1.2 ng/ml) |
Any: -35g, crude Highest quintile (>1.7ng/ml): -87g, (adj.) (-174, -1) |
- - | |
1 Abbreviations: SCN = thiocyanate, CI = confidence interval, OR = odds
ratio,
r = correlation coefficient.
Table 3.5
ETS Exposure in Relation to Spontaneous Abortion and Perinatal Death1
Authors (yr) |
Design |
Exposure Definition |
Results |
Comments |
| Comstock & Lundin (1967)2 Maryland |
Sample from special census, vital records (n = 234 still births, 158 neonatal) |
Paternal smoking (non-smoking mother) | RR = 1.45 (0.9-2.4) for NM. No effect on SB. (noted increased NM in small group where mom started smoking after pregnancy). | Adjusted for infant sex and patient education only. Exposure not specific to pregnancy. Completeness of FD records? |
| Mau & Netter (1974)2 Germany |
Interview in early pregnancy (n = 5,183) | Paternal smoking by amount (>10 cigs/day) |
RR of perinatal death = 1.5 (C.I.= 1.1-2.3) RR for SB = 1.2 (n.s.) RR for SAB = 1.1 (n.s.) |
Considered confounders, but RR not adjusted. Methods sketchy.
No dose response. |
| Lindbohm et al. (1991) Finland |
Case-control study of SABs in lead-monitored men and wives (n=213 SABs, 300 controls) | Paternal smoking status | OR for SAB = 1.3 (0.9-1.9) |
Not adjusted. Includes maternal smokers. Generalizability? |
| Ahlborg & Bodin (1991) Sweden |
Prospective questionnaire (n = 4,687 pregnancies) | "Live with smoker." Most time at work with smokers (non-smoking mother) |
RR for SAB + SB and ETS at home = 1.0 at work = 1.5 (0.98-2.4) RR = 2.2 (1.2-3.8) for early SAB & work ETS. |
Adjusted. Work exposure more intense. |
| Windham et al. (1992) California |
Case-control (n = 626 SABs, 1,300 births) | > 1 hr/day (yes/no) in first 20 weeks. Paternal smoking (non-smoking mother) |
OR for SAB = 1.6 (1.2-2.1) late SAB (> 12 wks) OR = 1.9 (1.4-2.7) |
Adjusted. No effect of paternal smoking when adjusted. |
1 Includes stillbirth or fetal death and neonatal mortality.
2 Odds ratios and confidence intervals calculated from data, not by original authors.
Abbreviations: SAB = spontaneous abortion, SB = stillbirth, NM = neonatal mortality, FD = fetal death, RR = rate ratio, OR = odds ratio.
Table 3.6
ETS Exposure and Congenital Malformations
Authors (yr) |
Design |
Exposure Definition1 |
Results |
Comments |
| Mau & Netter (1974)2 Germany |
Interview in early pregnancy (n = 5,183) |
Paternal smoking by amount (>10/day) |
RR for severe BD = 2.6 (1.5-4.7) RR for facial clefts = 7.0 (p<.05) Cardiac defects = 1.9 (n.s.) NTDs = 1.7 (n.s.) |
Looked at some confounders, but not adjusted. Little information on methods. |
| Holmberg & Nurminen (1980) Finland |
Case-control, registry based (n = 120 CNS anomalies & 120 cntrls) | Paternal smoking at conception | OR = 1.3 (0.74-2.5) | Not adjusted. Includes maternal smokers. |
| Hearey et al. (1984) California |
NTD cluster, case-cntrl (n = fathers of 8 cases & 17 controls) Retrospective interview |
Father smoke peri-conceptional (father interviewed) | OR = 16.0 (p<0.05) unmatched | Not adjusted. (Includes maternal smokers.) n.s. in matched analysis. Small numbers. |
| Seidman et al. (1990)2 Israel |
Interview post-partum (n = 17,152 infants) |
Paternal smoking (amount) | RR = 1.45 (0.73 - 2.8) for >30 cigs/day2 and major BDs. RR = 1.1 (0.85, 1.5) for minor BDs. |
Multivariate adjustment (results not shown). Little dose-response. Effect of maternal smoking seen in older women only. |
| Savitz et al. (1991) California |
Prospective in HMO members (Child Health & Development
Study) (n = 14,685 births) |
Paternal smoking at prenatal interview | OR = 2.4 (n.s.) for hydrocephalus OR = 2.0 for VSD and urethral stenosis (n.s) OR = 1.7 for CLP (n.s.) OR = 0.6 for NTDs (n.s.) |
Multivariate adjustment includes smoking mothers. Multiple comparisons. Little dose response. |
| Zhang et al. (1992)2 China |
Case-control interview in hospital (n = 1012 cases, 1012 controls) |
Paternal smoking | RR = 1.2 (1.0 - 1.5) for all BD. Numerous types elevated, but
n.s. RR = 1.6 for CP RR <1.5 for hydrocephalus RR <1.0 for VSD RR = 2.0 (1.1, 3.7)2 for NTDs |
Not adjusted but low-risk subgroup. Greater association with multiple vs. single defects. No dose-response. Multiple comparisons. |
1 Among non-smoking women unless otherwise specified. Exposure
ascertained from mother unless otherwise specified.
2 Confidence interval calculated by reviewer.
Abbreviations: BD = birth defects, NTD = neural tube defects, CNS =
central nervous system, VSD = ventricular septal defect,
CLP = cleft lip and/or cleft palate, CP = cleft palate, n.s. = not significant or p >
0.05.
Table 3.7
ANIMAL STUDIES OF TOBACCO SMOKE EXPOSURE
AND FETAL GROWTH
| Mainstream or Unidentified Type of Smoke | |||
|
|
|
Fetal Weight |
| Essenberg et al. (1940) | rats | mating through lactation | "2/3rds under weight" (no statistics) |
| Younoszai et al. (1969) | rats | day 3 - 22 gestation | -16% |
| Wagner et al. (1972) | mice | day 11 - +16 days gestation | -16% (not significant) |
| Haworth & Ford (1972) | rats | day 3-20 gestation | -19% |
| Reckzeh et al. (1975) | rats | day 1-18 gestation | -6% (not significant) |
| Reznik & Marquard (1980) | rats | day 0-21 gestation | -31% |
| Peterson et al. (1981) | mice | day 6-17 gestation | -4% (not significant) |
| Bertolini et al. (1982) | rats | day 1-20 gestation | -9% (not significant) |
| Tachi & Aoyama (1983) | rats | day 0-21 gestation | -30% |
| Bassi et al. (1984) | rats | day 5-20 gestation | -21% |
| Amankwah et al. (1985) | mice | day 0 - birth | -4% |
| Rogers & Kuehl (1988) | baboons | "throughout pregnancy" | -17% (no statistics) |
Sidestream Smoke |
|||
Authors (year) |
Species |
Exposure Period |
Fetal Weight at Term |
| Leichter (1989) | rats | day 1-20 gestation | -9% |
| Witschi et al. (1994) | rats | day 3-10 gestation | 0% (not significant) |
| Rajini et al. (1994) | rats | day 3, 6-10 and 13-17 gestation | -7% |
| Mohtashamipur et al. (1987) (abstract) | rats | "1st, 2nd and 3rd week of pregnancy" | "significant losses" no statistics |
REFERENCES FOR CHAPTER 3 –
DEVELOPMENTAL TOXICITY I: PERINATAL MANIFESTATIONS
BEGIN HERE IN THE HARDCOPY VERSION AND ARE FOUND AT THE END OF THE TEXT FILE CALLED 3PERINAT.DOC