Abstract
Smoking during pregnancy is a key contributor to poor infant health. Our study presents a dynamic relationship between the timing of prenatal smoking cessation or reduction and infant birth weight. Using a large representative dataset of a birth cohort in the United Kingdom, we apply regression analysis to examine the influences of cessation in smoking or reduction in smoking intensity at different months or trimesters on infant birth weight. For robustness checks, we use a rich set of additional covariates, a series of variable selection procedures, alternative birth outcome measures, and stratified samples. We find robust evidence that mothers who quit smoking by the third month of pregnancy or the end of the first trimester have infants of the same weight as those infants of nonsmokers. However, we find smoking cessation in the fourth month or any time beyond is associated with substantially lower infant birth weights. Two-thirds of the total adverse smoking impact on infant birth weight occurs in the second trimester. Our study also shows mothers who smoke throughout pregnancy but cut smoking intensity by the third month in pregnancy deliver infants of the same weight as those infants born to persistent light smokers. Our research suggests the efficacy of prenatal smoking cessation services can be significantly improved, if health professionals can encourage more pregnant women to quit smoking or reduce smoking intensity timely by the end of the first trimester.
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References
Simpson, W. J. (1957). A preliminary report on cigarette smoking and the incidence of prematurity. American Journal of Obstetrical & Gynecological, 73, 808–815.
Stein, Z., & Kline, J. (1983). Smoking, alcohol and reproduction. American Journal of Public Health, 73(10), 1154–1156.
Ananth, C. V., Savitz, D. A., & Luther, E. R. (1996). Maternal cigarette smoking as a risk factor for placental abruption, placenta previa, and uterine bleeding in pregnancy. American Journal of Epidemiology, 144(9), 881–889.
Floyd, R. L., Zahniser, S. C., Gunter, E. P., & Kendrick, J. S. (2007). Smoking during pregnancy: Prevalence, effects, and intervention strategies. Birth, 18(1), 48–53.
US Department of Health and Human Services. (2001). Women and smoking: A report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Office of the Surgeon General.
Ghodse, H., Herrman, H., Maj, M., & Sartorius, N. (2011). Substance abuse disorders: Evidence and experience (Vol. 23). Oxford, UK: Wiley.
Tong, V. T., Jones, J. R., Dietz, P. M., D’ Angelo, D., & Bombard, J. M. (2009). Trends in smoking before, during, and after pregnancy: Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 31 sites, 2000–2005. Morbidity and Mortality Weekly Report, 58(39), 911–915.
Bolling, K. (2006). Infant Feeding Survey 2005: Early results. Leeds, UK: UK Information Centre for Health and Social Care.
Department of Health. (1999). Smoking kills: A white paper on tobacco. London, UK: Stationery Office.
Sexton, M., & Hebel, J. R. (1984). A clinical trial of change in maternal smoking and its effect on birth weight. The Journal of the American Medical Association, 251(7), 911–915.
Li, C. Q., Windsor, R. A., Perkins, L., Goldenberg, R. L., & Lowe, J. B. (1993). The impact on infant birth weight and gestational age of cotinine-validated smoking reduction during pregnancy. The Journal of the American Medical Association, 269(12), 1519–1524.
West, R., McNeill, A., & Raw, M. (2000). Smoking cessation guidelines for health professionals: An update. Thorax, 55(12), 987–999.
Gaither, K. H., Huber, L. R. B., Thompson, M. E., & Huet-Hudson, Y. M. (2009). Does the use of nicotine replacement therapy during pregnancy affect pregnancy outcomes? Maternal and Child Health Journal, 13(4), 497–504.
Bombard, J. M., Farr, S. L., Dietz, P. M., Tong, V. T., Zhang, L., & Rabius, V. (2013). Telephone smoking cessation quitline use among pregnant and non-pregnant women. Maternal and Child Health Journal, 17(6), 989–995.
Marks, J. S., Koplan, J. P., Hogue, C. J., & Dalmat, M. E. (1990). A cost-benefit/cost-effectiveness analysis of smoking cessation for pregnant women. American Journal of Preventive Medicine, 6(5), 282–289.
Windsor, R. A., Lowe, J. B., Perkins, L. L., Smith-Yoder, D., Artz, L., Crawford, M., et al. (1993). Health education for pregnant smokers: Its behavioral impact and cost benefit. American Journal of Public Health, 83(2), 201–206.
Lieberman, E., Gremy, I., Lang, J. M., & Cohen, A. P. (1994). Low birthweight at term and the timing of fetal exposure to maternal smoking. American Journal of Public Health, 84(7), 1127–1131.
Rush, D., & Cassano, P. (1983). Relationship of cigarette smoking and social class to birth weight and perinatal mortality among all births in Britain, 5–11 April 1970. Journal of Epidemiology and Community Health, 37(4), 249–255.
Lindley, A. A., Becker, S., Gray, R. H., & Herman, A. A. (2000). Effect of continuing or stopping smoking during pregnancy on infant birth weight, crown-heel length, head circumference, ponderal index, and brain: Body weight ratio. American Journal of Epidemiology, 152(3), 219–225.
Macarthur, C., & Knox, E. G. (1988). Smoking in pregnancy: Effects of stopping at different stages. BJOG: An International Journal of Obstetrics & Gynecology, 95(6), 551–555.
Butler, N. R., Goldstein, H., & Ross, E. M. (1972). Cigarette smoking in pregnancy: Its influence on birth weight and perinatal mortality. The British Medical Journal, 5806, 127–130.
McDonald, A. D., Armstrong, B. G., & Sloan, M. (1992). Cigarette, alcohol, and coffee consumption and prematurity. American Journal of Public Health, 82(1), 87–90.
Wang, X., Zuckerman, B., Pearson, C., Kaufman, G., Chen, C., Wang, G., et al. (2002). Maternal cigarette smoking, metabolic gene polymorphism, and infant birth weight. The Journal of the American Medical Association, 287(2), 195–202.
McCowan, L. M., Dekker, G. A., Chan, E., Stewart, A., Chappell, L. C., Hunter, M., et al. (2009). Spontaneous preterm birth and small for gestational age infants in women who stop smoking early in pregnancy: Prospective cohort study. British Medical Journal, 338, 1–6.
Conley, D., & Bennett, N. G. (2000). Is biology destiny? Birth weight and life chances. American Sociological Review, 65, 458–467.
Os, J. V., Wichers, M., Danckaerts, M., Van Gestel, S., Derom, C., & Vlietinck, R. (2001). A prospective twin study of birth weight discordance and child problem behavior. Biological Psychiatry, 50(8), 593–599.
Behrman, J. R., & Rosenzweig, M. R. (2004). Returns to birthweight. Review of Economics and Statistics, 86(2), 586–601.
Black, S. E., Devereux, P. J., & Salvanes, K. G. (2007). From the cradle to the labor market? The effect of birth weight on adult outcomes. The Quarterly Journal of Economics, 122(1), 409–439.
Wisborg, K., Kesmodel, U., Henriksen, T. B., Olsen, S. F., & Secher, N. J. (2001). Exposure to tobacco smoke in utero and the risk of stillbirth and death in the first year of life. American Journal of Epidemiology, 154(4), 322–327.
Bell, K., McCullough, L., Greaves, L., Bauld, L., Mulryne, R., Jategaonkar, N., et al. (2006). The effectiveness of National Health Service intensive treatments for smoking cessation in England: A systematic review. London, UK: National Institute for Clinical and Health Excellence.
Bauld, L., Bell, K., McCullough, L., Richardson, L., & Greaves, L. (2010). The effectiveness of NHS smoking cessation services: A systematic review. Journal of Public Health, 32(1), 71–82.
Lumley, J., Chamberlain, C., Dowswell, T., Oliver, S., Oakley, L., & Watson, L. (2009). Interventions for promoting smoking cessation during pregnancy. Cochrane Database Systematic Reviews, 3, 1–136.
Cnattingius, S. (2004). The epidemiology of smoking during pregnancy: Smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine & Tobacco Research, 6, 125–140.
Kathleen Adams, E., Miller, V. P., Ernst, C., Nishimura, B. K., Melvin, C., & Merritt, R. (2002). Neonatal health care costs related to smoking during pregnancy. Health Economics, 11(3), 193–206.
Petrou, S., Hockley, C., Mehta, Z., & Goldacre, M. (2005). The association between smoking during pregnancy and hospital inpatient costs in childhood. Social Science and Medicine, 60(5), 1071–1085.
Acknowledgments
The authors thank helpful comments of Arnie Aldridge, Albert Baernstein, Meghan Bailey, Sarah W. Ball, Jimin Ding, Bart Hamilton, Tim McBride, Karen Norberg, Michelle D. Hoersch, Longjian Liu, Bob Pollak, Robin H. Pugh-Yi, Stanley Sawyer, Mary A. Steiner, Emma Winter, and other participants of seminars in Washington University in Saint Louis and 2011 American Public Health Association Annual Meeting.
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Yan, J., Groothuis, P.A. Timing of Prenatal Smoking Cessation or Reduction and Infant Birth Weight: Evidence from the United Kingdom Millennium Cohort Study. Matern Child Health J 19, 447–458 (2015). https://doi.org/10.1007/s10995-014-1516-x
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DOI: https://doi.org/10.1007/s10995-014-1516-x