Recent stillbirth statistics by Flenady et al was based on a systematic review from high-income countries and four studies were included in the meta-analysis of the association between any smoking in pregnancy and the risk of stillbirth yielding an odds ratio of 1.36 (95% CI 1.27, 1.46). The analysis was based on three studies conducted in two countries, the United States and Sweden. A report by the United States Surgeon General showed a relative risk of stillbirth of 1.2-1.8 within smokers versus non-smokers. Two previous systematic reviews and meta-analyses have estimated the size of effect of smoking during pregnancy and the risk of stillbirth. live births and in the developing world rates are much higher at more than live births in countries like Nigeria and Pakistan. The lowest rates have been observed in Finland with 2. Stillbirth rates widely vary across low, middle and high-income countries. Smoking in pregnancy in developed countries tends to be higher among women who have low income and poor education. Moreover, this decline has not been consistent across all social classes lower rates of decline have been noted across less advantaged socioeconomic groups. In many developed countries, the rates of smoking in pregnancy have been declining over recent decades with current prevalence estimates between 10% – 19%, and data from the UK suggesting that one out of eight women smoke throughout the pregnancy. The harmful effects of tobacco smoke exposure in pregnancy can be avoided and it is one of the most prevalent modifiable risk factors for adverse pregnancy outcomes. Within the current challenging economic climate in many countries, smoking in pregnancy imposes a significant burden on population health and resources, and is associated with a range of poor outcomes for both mother and child, such as ectopic pregnancy, miscarriage, placental abruption, preterm birth and low birth weight. The World Health Organisation (WHO) predicts that this will reach ‘epidemic’ proportions in developing countries in the near future. Smoking in pregnancy is a major public health problem in the developed countries. To minimise the risk of stillbirth, reducing current smoking prevalence in pregnancy should continue to be a key public health high priority. Our review confirms a dose-response effect of maternal smoking in pregnancy on risk of stillbirth. Subsequently, studies defining stillbirth at ≥ 20 weeks demonstrated a 43% increase in odds for smoking mothers compared to mothers who do not smoke, (OR 1.43, 95% CI 1.32, 1.54, p < 0.0001), whereas studies with stillbirth defined at ≥ 24 weeks and ≥ 28 weeks showed 58% and 33% increase in the odds of stillbirth respectively. In subgroup analysis, smoking 1-9 cig/day and ≥10 cig/day was associated with an 9% and 52% increase in the odds of stillbirth respectively.
In meta-analysis smoking during pregnancy was significantly associated with a 47% increase in the odds of stillbirth (OR 1.47, 95% CI 1.37, 1.57, p < 0.0001). Resultsġ766 studies were screened for title analysis, of which 34 papers (21 cohorts, 8 case controls and 5 cross sectional studies) met the inclusion criteria. We included observational studies that measured the association between maternal smoking during pregnancy and the risk of stillbirth. We searched four databases namely MEDLINE, EMBASE, Psych Info and Web of Science for all relevant original studies published until 31 st December 2012. We have conducted a systematic review and meta-analysis to provide contemporary estimates of the association between maternal smoking in pregnancy and the risk of stillbirth.
Smoking in pregnancy is known to be associated with a range of adverse pregnancy outcomes, yet there is a high prevalence of smoking among pregnant women in many countries, and it remains a major public health concern.
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