|
|
Table 3.1
Studies of Birthweight and ETS Exposure
Defined by paternal Smoking Status
Authors (year)
Country |
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 maternalsmoking2: -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
-120g/pack
|
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)
Country |
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)
any other smokers >10/day
adj made no difference2
no dose effect |
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)
Location |
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.
4 n.s. indicates lack of statistical significance at p = 0.05.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)
Country(study size 1) |
ETS Level
(% Exposed) |
Difference in Mean Weight |
IUGR/LBW
OR (95% CI) |
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
1.4 (0.33-5.9) LBW
if worked full-time
|
| Fortier et al. (1994) Canada (Quebec)
(n = 4,644 non smokers)
Interview within few months post partum |
Home only
(13%)----------------------------
Work only
(28%)
----------------------------
Home and Work
(8%) |
------------------------------- ------------------------------- |
0.98 (0.67- 1.44) IUGR ------------------------
1.18 (0.90-1.56) IUGR
------------------------
0.94(0.60-1.49) IUGR |
1 The study size (n) presented is for term births to
nonsmokers, not the total study size.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)
Country (study size1
ETS Ascertainment |
ETS Level
(% Exposed) |
Difference in Mean Weight |
IUGR/LBW3
OR (95% CI) |
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) IUGRwork only:
1.0 (0.39, 2.6) IUGR
home only:
0.5 (0.13, 1.8) IUGR |
Roquer et al. (1995)
Spain (n=129)
Interview at delivery |
"Significant"
defined as exposed to
³ 20 cigarettes/day |
-192 (-365, -19), crude |
- (0.57, 6.1)
- IUGR
- 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) |
- - |
1 The study size (n) presented is for term births to
nonsmokers, not the total study size.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)
Location |
Design
(size) |
Biomarker
Levels1 |
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)
no statistics or numbers provided |
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)
Location |
Design
(study size) |
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)
Location |
Design
(study size) |
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 |
Authors (year)
|
Species
|
Exposure Period
|
Fetal Weight
at Term |
| 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
|
