Exposure to Secondhand Smoke during Pregnancy and Neonatal-Related Outcomes

Document Type : Original Article

Authors

1 Student Research Committee, Babol University of Medical Sciences, Babol, Iran

2 Department of Pediatrics, School of Medicine, Non-Communicable Pediatric Disease Research Center Health Research Institute Amirkola Hospital Babol University of Medical Sciences, Babol, Iran

3 Department of Medical and Surgical Nursing, School of Nursing and Midwifery, Babol University of Medical Sciences, Babol, Iran

4 Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran

5 Nursing Research Center, Babol University of Medical Sciences, Babol, Iran

6 Amirkola Children's Non-Communicable Disease Research Center, Health Research Center, Babol University of Medical Sciences, Babol, Iran

7 School of Health, Mashad University of Medical Sciences, Mashad, Iran

Abstract

Background: Fetal and neonatal health is of particular importance in pregnant women. Secondhand smoke (SHS) can jeopardize the health of the mother, fetus, and neonate. The present study was conducted to determine the relationship between exposure to secondhand smoke during pregnancy and neonatal-related outcomes.
Methods: This retrospective cohort study was conducted in 2022 on 270 mother-newborn pairs through convenience sampling in two equal groups (n=135), including exposure and non-exposure to SHS at  Rohani Hospital, Babol, Children's Hospital, Amirkola, and Imam Ali Hospital, Amol. In order to collect the data, a checklist including the demographic characteristics, medical variables, questions related to the exposure of mothers to cigarette smoke, the neonatal outcomes questionnaire, and the SNAPPE-II scale were used. Data analysis was performed using STATA statistical software (version 17), and the significance level of all tests was considered less than 0.05.
Results: The mean age of mothers was 28.30±5.83 years, and 61% of births were by cesarean section. The SNAPPE-II score was 8.23​±5.29 in the non-exposure group and 20.68±13.53 in the exposure group (P=0.005). The prevalence of neonates with a birth weight of less than 2500gr was higher in mothers exposed to SHS (P=0.033).  Considering confounding variables, the neonates in the non-exposure group were, on average, 1.46 cm taller than those in the exposure group (P=0.005). Exposure to smoking increases the risk of premature birth by 1.65 times (P=0.032).  
Conclusion: Exposure of pregnant mothers to SHS is associated with adverse neonatal outcomes. Therefore, it is recommended to train families to avoid exposure to cigarette smoke, especially during pregnancy, and also for health centers to pay special attention to this matter in the care of pregnant mothers.
 

Keywords


  1. Mahmoodabad SSM, Karimiankakolaki Z, Kazemi A, Mohammadi NK, Fallahzadeh H. Exposure to secondhand smoke in Iranian pregnant women at home and the related factors. Tob Prev Cessation. 2019;5:7.
  2. World Health Organization. WHO report on the global tobacco epidemic 2015: raising taxes on tobacco. 2015. Available from: https://books. google.com/books?hl=en&lr=&id=3k80DgAAQBAJ&oi=fnd&pg=PP1&dq=WHO+report+on+the+global+tobacco+epidemic+2015:+raising+taxes+on+tobacco&ots=Ed43O3_Hru&sig=l3GNXsv0tCTEFvcw31o-8-58tmk#v=onepage&q=WHO%20report%20on%20the%20global%20tobacco%20epidemic%202015%3A%20raising%20taxes%20on%20tobacco&f=false
  3. John RM, Sinha P, Munish VG, Tullu FT. Economic Costs of Diseases and Deaths Attributable to Tobacco Use in India, 2017–2018. Nicotine Tob Res. 2021;23(2):294-301.
  4. Carreras G, Lugo A, Gallus S, Cortini B, Fernández E, López MJ, et al. Burden of disease attributable to second-hand smoke exposure: a systematic review. Prev Med. 2019;129:105833.
  5. Vu AT, Taylor KM, Holman MR, Ding YS, Hearn B, Watson CH. Polycyclic aromatic hydrocarbons in the mainstream smoke of popular US cigarettes. Chem Res Toxicol. 2015;28(8):1616-26.
  6. Timur Taşhan S, Hotun Sahin N, Omaç Sönmez M. Maternal smoking and newborn sex, birth weight and breastfeeding: a population-based study. J Matern Fetal Neonatal Med. 2017;30(21):2545-50.
  7. Majid H, Shahid S, Shakeel S. A critical analysis of second-hand tobacco smoke and nicotine levels on pregnancy outcomes and infant health. Int J Adv Biotechnol. 2019;10(2):5-9.
  8. Radin RG, Hatch EE, Rothman KJ, Mikkelsen EM, Sørensen HT, Riis AH, et al. Active and passive smoking and fecundability in Danish pregnancy planners. Fertil Steril. 2014;102(1):183-91.
  9. Service GS. Statistics on Smoking England: 2018. NHS Digital Leeds, UK. 2018.
  10. Fitzpatrick KE, Gray R, Quigley MA. Women’s longitudinal patterns of smoking during the pre-conception, pregnancy and postnatal period: evidence from the UK infant feeding survey. PLoS One. 2016;11(4):e0153447.
  11. Varmaghani M, Sharifi F, Mehdipour P, Sheidaei A, Djalalinia S, Gohari K, et al. Prevalence of smoking among Iranian adults: findings of the national STEPs survey 2016. Arch Iran Med. 2020;23(6):369-77.
  12. Janjani H, Nabizadeh R, Kashani H, Shamsipour M, Aghaei M, Yunesian M. Spatiotemporal variability of exposure to secondhand smoke in Iran during 2009–2020: a systematic review. Environ Sci Pollut Res. 2021;28: 46838-51.
  13. Yawer RA, Swidan A. Effect of secondhand smoke exposure during pregnancy on anthropometric measurements of term infants. Iraqi Journal of Community Medicine. 2015;28(1):49-55.
  14. Leonardi-Bee J, Britton J, Venn A. Secondhand smoke and adverse fetal outcomes in nonsmoking pregnant women: a meta-analysis. Pediatrics. 2011;127(4):734-41.
  15. Chamberlain C, O'Mara‐Eves A, Porter J, Coleman T, Perlen SM, Thomas J, et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev. 2017;(2):1-427.
  16. Beal MA, Yauk CL, Marchetti F. From sperm to offspring: Assessing the heritable genetic consequences of paternal smoking and potential public health impacts. Mutat Res Rev Mutat Res. 2017;773:26-50.
  17. Özturk O, Ünal M, Özturk G, Fidanci İ, Kiziltas Ö. Awareness of Pregnants About the Harms of Smoking to Baby-Multi-centered Primary Care Research. Turk J Fam Med Prim Care. 2018;12(4):233-8.
  18. Lucagbo MDC. Effects of household use of biomass fuel and kerosene on birth weight of babies in the philippines. Philip Statis. 2014;63(1):75-92.
  19. Marufu TC, Ahankari A, Coleman T, Lewis S. Maternal smoking and the risk of still birth: systematic review and meta-analysis. BMC Public Health. 2015;15(1):1-15.
  20. Hoyt AT, Canfield MA, Romitti PA, Botto LD, Anderka MT, Krikov SV, et al. Associations between maternal periconceptional exposure to secondhand tobacco smoke and major birth defects. Am J Obstet Gynecol. 2016;215(5):613-e1.
  21. Mittal S. Smoking and tobacco use: ill effects on Reproductive, Maternal, Newborn, Child Health, and Adolescent (RMNCHA) Program—a review. Ann Natl Acad Med Sci. 2019;55(2):065-73.
  22. Gharaibeh H, Haddad L, Alzyoud S, El-Shahawy O, Baker NA, Umlauf M. Knowledge, attitudes, and behavior in avoiding secondhand smoke exposure among non-smoking employed women with higher education in Jordan. Int J Environ Res Public Health. 2011;8(11):4207-19.
  23. Niranjan H, Jagdish A, Shreeharsha B. SNAPPE-II (score for neonatal acute physiology with perinatal extension) as a predictor of mortality in NICU. Int J Pharm Bio Sci. 2016;7(1):B231-5.
  24. Dalili H, Farrokhzad N, Kavyani Z, Sahebi L, Habibelahi A, Ashrafzadeh M, et al. Determination of Predictive Power of CRIB-II and SNAPPE-II in Mortality Risk of Neonates with Low Gestational Age or Birth Weight Admitted to the Neonatal Intensive Care Unit. Iran J Neonatol. 2020;11(4):74-80.
  25. Anwar W, Ghouri MH, Anwar M, Anjum A, Rao M, Tabassum S, et al. Innocent victims of passive smoking: An institutional experience. Professional Med J. 2020;27(12):2676-8080.
  26. Harsha SS, Archana BR. SNAPPE-II (Score for Neonatal Acute Physiology with Perinatal Extension-II) in predicting mortality and morbidity in NICU. J Clin Diagn Res. 2015;9(10):SC10.
  27. Bendal RB, Afifi AA. Comparison of stopping rules
    in forward regression. J Am Stat Assoc. 1977;72(357):46-53.
  28. Sobh E, Mohammed AM, Adawy Z, Nassef AH, Hasheesh A. The impact of secondhand smoke exposure on the pregnancy outcome: a prospective cohort study among Egyptian community. Egypt J Bronchol. 2021;15(1):1-7.
  29. Bachok NA, Salinah O. The effect of second-hand smoke exposure during pregnancy on the newborn weight in Malaysia. Malays J Med Sci. 2014;21(2):44-53.
  30. Dodds L, Woolcott CG, Weiler H, Spencer A, Forest JC, Armson BA, Giguere Y. Vitamin D status and gestational diabetes: effect of smoking status during Paediatr Perinat Epidemiol. 2016;30(3):229-37.
  31. Kim MK, Han K, You SY, Kwon HS, Yoon KH, Lee SH. Prepregnancy smoking and the risk of gestational diabetes requiring insulin therapy. Sci Rep. 2020;10(1):1-8.
  32. Maddatu J, Anderson-Baucum E, Evans-Molina C. Smoking and the risk of type 2 diabetes. Transl Res. 2017, 184:101–07.
  33. Wang J, Yang W, Xiao W, Cao S. The association between smoking during pregnancy and hypertensive disorders of pregnancy: a systematic review and meta‐ Int J Gynaecol Obstet. 2022;157(1):31-41.
  34. Utami N, Rachmalina R, Irawati A, Sari K. Rosha BC, Amaliah N. Short birth length, low birth weight and maternal short stature are dominant risks of stunting among children aged 0-23 months: Evidence from Bogor longitudinal study on child growth and development, Indonesia. Mal J Nutr 2018;24(1):11-23.
  35. Prince PM, Umman M, Fathima FN, Johnson AR. Secondhand smoke exposure during pregnancy and its effect on birth outcomes: Evidence from a retrospective cohort study in a tertiary care hospital in Bengaluru. Indian J Community Med. 2021;
    46(1):102-06.
  36. Gupta S, Malhotra AK, Verma SK, Deka M, Yadav R, Singh S. Effects of passive smoking (environmental tobacco smoke) on pregnancy outcome at district hospital, Jhansi, Uttar Pradesh. Int J Med Sci Public Health. 2015;4(8):1090-4.
  37. Postolow F, Dakshinamurti S. Fetal Oxygenation during Maternal Hypoxic Illness. Hypoxic Respiratory Failure in the Newborn: From Origins to Clinical Management. 2021:51-6
  38. Crump C. Preterm birth and mortality in adulthood: a systematic review. J Perinatol. 2020;40(6):833-43.
  39. Fantuzzi G, Aggazzotti G, Righi E, Facchinetti F, Bertucci E, Kanitz S, et al. Preterm delivery and exposure to active and passive smoking during pregnancy: a case–control study from Italy. Paediatr Perinat Epidemiol. 2007;21(3):194-200.
  40. Delcroix-Gomez C, Delcroix MH, Jamee A, Gauthier T, Marquet P, Aubard Y. Fetal growth restriction, low birth weight, and preterm birth: Effects of active or passive smoking evaluated by maternal expired CO at delivery, impacts of cessation at different trimesters. Tob Induc Dis. 2022;20(August):70.
  41. Parascandola M, Klein A, Bromberg J. Systematic review and meta-analysis of maternal secondhand smoke exposure and neonatal outcomes. Journal of Health Inequalities. 2019;5(1):53-66.