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_ORIGINAL ARTICLE_
Background: Smoking during pregnancy doubles the risk of having a low-birth weight
baby and significantly increases the rate of perinatal morbidity and several other adverse
pregnancy outcomes.
Aim: To study the effects of active and passive smoking on pregnancy outcomes.
Material and methods: A cross-sectional study was conducted in postpartum word
between January and May 2009 at Jordanian private and governmental hospitals.
Consecutive 223 pregnant women delivering a singleton live baby were studied. A predesigned structured questionnaire was used to record the details of smoking, and assess
the effect of smoking on women (during pregnancy / labor) and on their babies. The
studied women were selected purposively to be free from chronic diseases (diabetes
mellitus and pregnancy induced hypertension). Statistically significance is achieved
when the p value is less than 0.05. The relation of "smoking status during pregnancy"
and pregnancy outcome was determined with x2 tests.
Results of the study indicated that 20.2% of the participants were active smokers, 42.1%
were passive smokers, and 37.7% non-smokers. Significant statistical differences were
found among the three groups in term of pregnancy outcome and adverse effect on
labor. Preterm birth was greater for those who active smoker. Mean APGAR score at the
fifth minutes in the active smokers were less as compared to non-smokers (8.38 1.6,
9.10 0.7).
Conclusion: Active and passive smoker's pregnant women are at high risk of having an
adverse outcome during pregnancy and labor. Based on the study results it was
recommended that obstetrician and midwives should educate new and prospective
parents about the risk of tobacco smoke exposure during pregnancy.
Key words: Active smoking, passive smoking, pregnancy, pregnancy outcomes
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CORRESPONDING AUTHOR
area code:
Email
tel. number00962-5-3821120
: Hadayat.amasha@yahoo.com
INTRODUCTION
he term "passive smoking" usually
environmental
passive
smoking
is
"involuntary
tobacco
smoke
(ETS)
who
1957
smoking
pregnancy
(placenta
placenta
Furthermore,
100-300g
smoking,"
because
differences
the
in
person
baby
birth
maternal
increase
that
the
partly
from
the
or
completely
wall).
smoking
preterm
risk
placenta
There
of
of
risk
uterine
cigarette
delivery
during
previa,
is
good
abruptio
Page | 336
smoking
USDHHS
11
during
10
pregnancy .
growth
retardation,
small
head
and
stillbirths
and
neonatal
Stockholm
Blomberg et al.,7
preterm
membranes,
blood,
increase
compared
with
nonsmokers.
19881992,
premature
and
in
Kyrklund-
risk
rupture
late
of
pregnancy
compared
with
nonsmokers.
12
who
smoked.
found
that
placental
an
increased
rate
of
was
The
pregnancy
birth
placenta
during
maternal
abruption
14
reported
1983-1996
smoking
was
found
that
significantly
outcome
variables
complications
previa;
and
include
such
as
intrapartum
labor,
other
adverse
outcome
(intrauterine
caesarean
section
and
fetal
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associations
of
nonsmoking
active,
with
passive
neonatal
and
health
structured
form
researchers
prepared
according
to
by
the
literature
review.
The structured interview form consists
Material and methods:
demographic
(duration
includes:
weight,
Also
congenital
excluded
to
eliminate
age
related
of
data
(age,
pregnancy
newborn
length,
associated
educational
per
weeks,
assessment
head
circumference).
disorders
anomalies
(birth
or
such
any
as
other
after birth.
excluded.
was based on
birth.
knowledge
consent
were
The study
for
participation
and
perceptions
about
Page | 338
to
Gestational
16
passive
age
demonstrated
that,
223
groups:
because
20.2%.
the
best
as
is
defined
Fig.
the
this
is
smoking .
Results
available
non-smokers
37.7%,
passive
birth
was
expulsion
defined
of
the
as
delivery
or
fetus
before
37
16
The
third stage .
working (57.8%),
on
areas
pregnancy
condition,
(preterm
birth,
congenital
fetal
neonatal
(82.2%).The
mean
score
of
550).
(PROM),
malpresentation,
caesarean
section).
(hypertension,
anemia,
abruption
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passive
having
significant
delivery.
smokers
reported
difference
was
found
found
passive
smokers
significant
or
smokers
showed
no
placenta
and
non-
statistically
previa
during
their
between
smoking
status
and
and
to
(53.3%)
gestational
of
active
age
according
smokers
mothers
to
smoking
during
others
(passive
pregnancy
smoking)
from
could
be
highly
significant,
(X2=
Discussion
Smoking
defined
prevalence
as
the
is
percentage
commonly
of
daily
12
fetal
cigarettes17.
significant
differences
in
the
Page | 340
present
the
were
. While a
study
20.
as 13%
revealed
that
19
strong
associations
between
25
maternal smoking.
transfer
growth
recent
that
was
studies
who
smoking
during
associated
with
status21,22.
Heaman
mentioned
pregnancy
low
socio-economic
and
Chalmers23
of
amino
acids
impairment27.
across
Also,
the
the
In this
pregnancy
increase
prevalence.
malformation,
smokers
had
non-
premature
membrane
and
significantly
passive
higher
smokers
risks
rupture
of
than
results
in
significant
congenital
neonatal
fetal
in
distress,
poor
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of
nicotine and CO
in
pregnancies
observed
smoking,
preterm
though
most
women
also
in
birth,
our
breech
study.
In
presentation,
score.
statistically
related
and
to
educational
socioeconomic
factors
that
and
influence
Furthermore,
or
fetal
there
significant
were
differences
presentation
(cephalic/
breach).
It
among
North
women
was
women
pregnant
believed
women
that
in
smoking
adds
to
to
an
increasing
minimize
body
of
environmental
urgent
attitudes
especially
increased
validity
toward
in
our
during
of
women
smoking
countries
recent
self-reported
have
years,
for
comprehensive
smoking in Jordan.
the
smoking
need
Acknowledgments:
We would like to thank Dr. Ream El
Safadi for her valuable advices.
Page | 342
and
birth
outcome--overview
of
BIBLIOGRAPHY
NB,
Granath
F,
367-71.
adverse
pregnancy
outcomes:
doi:10.1080/0001634500324241.
9. Ng SP, Zelikoff JT. Smoking during
pregnancy:
Offspring
3. Ingvarsson
RF,
Dagbjartsson
A,
Bjarnason
AO,
Hardardottir
H,
Subsequent
immune
effects
competence
on
and
Toxico.
2007;
23:428-437.
doi:
10.1016/j.reprotox.2006.11.008.
outcome
in
pregnancy.
Journal
of
CQ,
L,
during
Windsor
RA,
pregnancy.
Perkins
JAMA
1993;
269(12):1519-1524.
www.hsj.gr
Promotion,
Office
of
Smoking
and
Health.
12.Cnattingius
S.
The
smoking during
epidemiology
pregnancy:
of
Smoking
university
2004;6(2):
2002;9(8):793802.
125-140.
doi:
10.1080/14622200410001669187.
students
in
Jordan.
history:
surveys.
625632.
Epidemiology.2005;19(2),88-
of
to
placental
abruption
cigarette
hypertensive
smoking
disorders
pregnancy:
observational
studies.
in
K.
The
national
Paediatric
perinatal
and
Perinatal
96.doi:10.1111/j.13653016.2005.00639.x
and
during
meta-analysis
of
Obstetrics and
French
impact
of
maternal
1016/j.puhe.2008.02.011.
16.Stedmans
Medical
Spellchecker.
Available
from:
http://www.wrongdiagnosis.com/medical/
intrapartum_period.htm.
Accessed
on
NT,
Goldenberg
RL.
1/4/2006.
17.Khader YS., Alsadi AA. Smoking habits
among university students in Jordan:
prevalence
22.Nagahawatte
and
associated
factors.
Sci.2008;
1136:80-85.
doi:10.1196/annals. 1425.016.
23.Heaman MI, Chalmers K. Prevalence and
correlates of smoking during pregnancy:
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2005;
7659.2005.00387.x.
Worsens
Pregnancy
32:
299-305.doi:10.1111/j.0730-
Journal of
Association.
the
American
Heart
2008;April,
Doi:
10.116/HYPERTENSIONAHA.107.10655
9.
30.Andres
RL,
Day
MC.
Perinatal
SF,
Secher
NJ.
Exposure
to
Am
Journal
Epidemiol.
2001;
154(4):322-327.
doi:
10.1093/aje/154.4.322.
26.Pastrakuljic A, Derewlany L, Koren G.
Maternal
cocaine
use
and
cigarette
RF,
Dagbjartsson
Bjarnason
A,
AO,
Hardardottir
H,
on factors
Rodriguez
A:
Smoking
during
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ANNEX
Fig 1
Type of respondent
Non-Smoker
Active Smoker
Passive Smoker
37.7%
20.2%
42.1%
Page | 346
Smoking Status
Active Smoking
Passive Smoking
Non-smoking
n = 45
n =94
N=84
20 25
14 (31.1)
33 (35.1)
33 (39.3)
26 30
11(24.4)
36 (38.3)
30 (35.7)
31 35
20 (44.5)
25 (26.6)
21 (25.0)
22 (48.9)
48 (51.1)
49 (58.3)
- Basic &secondary
13 (28.9)
39 (41.5)
19 (22.6)
- High Education
10 (22.2 )
07 (07.4)
16 (19.1)
Housewife
26 (57.8)
66 (70.2)
66 (78.6)
Employed
19 (42.2)
28 (29.8)
18 (21.4)
Rural
08 (17.8)
27 (28.7)
20 (36.1)
Urban
37 (82.2)
67 (71.3)
64 (76.2)
> 300
12 (26.7)
30 (31.9)
31 (36.9)
300 399
05 (11.1)
21(22.3)
20 (23.8)
400 499
08 (17.8)
13 (13.8)
10 (11.9)
500 - 599
13 (28.9)
10 (10.6)
12 (14.3)
600
07 (15.6)
20 (21.3)
11 (13.1)
100%
100%
100%
Age ( years):
Educational Level:
- Illiterate + Read & write
Occupation
Residency
Monthly Income/ JD
Total
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Obstetric History
Smoking Status
Active Smoking
Passive
n = 45
Smoking
Non-smoking
n =94
n=84
Gravidity
13
22 (48.9)
66 (70.2)
62 (73.8)
<3
23 (51.1)
28 (29.8)
22 (26.2)
No Abortion
21 (46.7)
68 (72.4)
66 (78.6)
13
17 (37.8)
18 (19.1)
15 (17.9)
<3
07 (15.5)
08 (08.5)
03 (03.5)
None
00
02 (02.1)
01 (01.2)
13
30 (66.7)
71 (75.5)
63 (73.0)
15 (33.3)
21 (22.3)
20 (23.8)
None
42 (93.3)
37 (94.9%)
35 (97.2%)
03 (06.7)
02 (05.1%)
01 (02.8%)
Previous abortion:
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Smoking Status
Active
Passive
Non-
Smoking
Smoking
smoking
n= 45
n=94
n=84
X2
34.91
0.0001
Antenatal Problem:
NO= 140
14 (31.1)
56(59.6)
70 (83.3)
YES = 83
33 (73.3)
37 (39.4)
14 (16.7)
NO= 184
31 (68.9)
76 (80.9)
77 (91.7)
YES= 39
14 (31.1)
18 (19.1)
07 (08.3)
NO= 188
30 (66.7)
80 (85.1)
78 (92.9)
YES= 35
15 (33.3)
14 (14.9)
42 (93.3)
Gestational
hypertension
10.85
0.004
06 (07.1)
15.27
0.0001
91 (96.8)
84 (100)
5.1
0.077
03 (06.7)
03 (03.2)
00
NO= 210
38 (84.4)
90 (95.7)
82 (97.6)
9.99
0.077
YES= 13
07 (15.6)
04 (04.3)
02 (02.4)
Anemia
Abruptio Placenta
NO= 217
YES= 6
Placenta Previa
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Significance
Items
Active Smoking
Passive Smoking
Non-
n = 45
n =94
smoking
n=84
24( 53.3 )
21 (22.3)
09 (10.7)
X2 =29.314
21 ( 46.7 )
73 ( 77.7)
75 (89.3 )
P= 0.000
No
41 (91.1)
77 (81.9)
80 (95.2)
X2 = 8.21
Yes
04 ( 08.9)
17 (18.1)
04 ( 04.8)
P= 0.016
- No
30 (36.5)
77 (76.3)
74 (68.2)
X2 = 8.86
- Yes
15 (8.5)
17 (17.7)
10 (15.8)
P= 0.012
- No
12(26.7)
47( 50.0)
52(61.9)
X2 = 14.56
- Yes
33( 73.3)
47( 50.0 )
32( 30.1)
P= 0.001
- No
37(82.2)
88 (93.6)
81(96.4)
X2 = 8.75
- Yes
08 (17.8)
06 ( 06.4 )
03 (03.6)
P= 0.013
Increase FHR
Fetal Distress
less than7
13 ( 06.5 )
16 (13.5 )
03 (12.1 )
X2 = 16.23
7+
32 (38.5 )
78 ( 80.5 )
81 (71.9 )
P= 0.000
Mean SD
7.00 1.4
7.36 1.08
7.88 0.9
04 ( 01.4)
02 ( 03.0)
01 ( 02.6 )
X2 = 6.26
- 7+
41 (43.6 )
92 ( 91.0)
83 ( 81.4 )
P= 0.044
Mean SD
8.38 1.6
8.7 0.8
9.10 0.7
less than7
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Items
Smoking Status
Significance
Active
Passive
Smoking
Smoking
Non-
n = 45
n =94
smoking
n=84
Rupture
of
Membrane:
23(51.1)
75(79.8)
69(82.1)
X2 = 23.75
-Mature
22(48.9)
19(20.2)
15(17.9)
P=0.001
- Cephalic
34 ( 75.6)
86 ( 91.5)
81 (96.4)
X2 = 15.26
- Breach / Others
11 ( 24.4)
08 ( 08.5)
03 (03.6)
P = 0.004
-Spontaneous
13(28.9)
41(43.6)
52(61.9)
X2 =13.807
- Induced
32(71.1)
53(56.4)
32(38.1)
P= 0.001
21(46.7)
63(67.0)
61(72.6)
X2 = 8.963
Caesarean 24(53.3)
31(33.0)
23(27.4)
P= 0.011
- PROM
Fetal Presentation
Labor:
Delivery Type:
- Vaginal
section
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Smoking Status
Questions
Significance
Active
Passive
Non-
Smoking
Smoking smoking
n= 45
n=94
n=84
True answer
31(68.9)
59(62.8)
66(78.6)
X2 =5.30
Falls answer
14(31.1)
35(37.2)
18(21.4)
P=0.71
45(100.0) 87(92.6)
81(96.4)
X2 =4.20
00
07(07.4)
03(03.6)
P=0.122
True answer
40(88.9)
79(84.0)
80(92.2)
X2 =5.79
Falls answer
05(11.1)
15(16.0)
04(04.8)
P=0.055
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