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Maternal smoking, passive tobacco smoke, and neural tube defects


  • This project was supported in part by a cooperative agreement between the Centers for Disease Control and Prevention and the Texas Department of State Health Services (DSHS), Texas Center for Birth Defects Research and Prevention (no. UD50/DD613232) and Title V Maternal and Child Health Block grant to the Office of Title V, Community and Family Health Division, DSHS.



Although cigarette smoke is a well-established toxin and harmful to the developing embryo, the evidence for an independent effect on the occurrence of neural tube defects (NTDs) is mixed. In this study, we examined the relation between NTDs and maternal exposures to cigarette smoke, including passive smoke exposure.


We used cases and controls from the large, multistate, population-based National Birth Defects Prevention Study. A total of 1041 NTD cases and 5862 live birth controls, delivered during 1997 to 2004, were available for analyses. Mothers were interviewed by telephone between 6 weeks and 24 months after delivery. Participation rates were 71% for NTD case mothers and 69% for control mothers.


Compared with nonsmokers (and also not exposed to passive cigarette smoke), mothers exposed only to passive smoke had an increased NTD odds ratio (OR, 1.7; 95% confidence interval [CI], 1.4–2.0), adjusted for race–ethnicity, and study center. There was no increased OR for mothers who actively smoked 24 or fewer cigarettes per day. Mothers who smoked 25 or more cigarettes per day had an elevated OR (OR, 1.6; 95% CI, 0.9–3.0), but the OR adjusted for race–ethnicity, and center was compatible with the null.


Results suggest that maternal exposure to passive smoke is associated with NTDs. Women who plan on becoming pregnant should minimize their exposure to passive smoke and refrain from smoking. Birth Defects Research (Part A), 2011. © 2010 Wiley-Liss, Inc.