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The complex relationship between smoking in pregnancy and very preterm delivery

Results of the Epipage study

  1. Antoine Burguet1,2,*,
  2. Monique Kaminski2,
  3. Laurence Abraham-Lerat1,
  4. Jean-Patrick Schaal3,
  5. Gilles Cambonie4,
  6. Jeanne Fresson5,
  7. Hélène Grandjean6,
  8. Patrick Truffert7,
  9. Loïc Marpeau8,
  10. Marcel Voyer9,
  11. Jean-Christophe Rozé10,
  12. Alain Treisser11,
  13. Béatrice Larroque2,
  14. EPIPAGE Study Group1,
  15. The EPIPAGE Study Group (listed in the Appendix)1

Article first published online: 16 JAN 2004

DOI: 10.1046/j.1471-0528.2003.00037.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 111, Issue 3, pages 258–265, March 2004

Additional Information

How to Cite

Burguet, A., Kaminski, M., Abraham-Lerat, L., Schaal, J.-P., Cambonie, G., Fresson, J., Grandjean, H., Truffert, P., Marpeau, L., Voyer, M., Rozé, J.-C., Treisser, A., Larroque, B., EPIPAGE Study Group and The EPIPAGE Study Group (listed in the Appendix) (2004), The complex relationship between smoking in pregnancy and very preterm delivery. BJOG: An International Journal of Obstetrics & Gynaecology, 111: 258–265. doi: 10.1046/j.1471-0528.2003.00037.x

Author Information

  1. 1

    Department of Neonatology, University Hospital, Besançon, France

  2. 2

    Epidemiological Research Unit on Perinatal and Women's Health, INSERM U149, Villejuif, France

  3. 3

    Department of Obstetrics and Gynaecology, University Hospital, Besançon, France

  4. 4

    Department of Paediatrics, University Hospital Montpellier, France

  5. 5

    Department of Neonatology, University Hospital, Nancy, France

  6. 6

    INSERM U558, Toulouse, France

  7. 7

    Department of Neonatology, University Hospital, Lille, France

  8. 8

    Department of Obstetrics and Gynaecology, University Hospital, Rouen, France

  9. 9

    Department of Neonatology, Institut de Puériculture, Paris, France

  10. 10

    Department of Neonatology, University Hospital, Nantes, France

  11. 11

    Department of Obstetrics and Gynaecology, University Hospital Strasbourg, France

* *Dr A. Burguet, Réanimation Infantile Polyvalente et Prématurés, Hôpital Saint-Jacques, Centre Hospitalier Universitaire, 25030 Besançon cedex, France.

Publication History

  1. Issue published online: 16 JAN 2004
  2. Article first published online: 16 JAN 2004

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Objective  To assess the relationship between cigarette smoking during pregnancy and very preterm births, according to the main mechanisms of preterm birth.

Design  Case–control study (the French Epipage study).

Setting  Regionally defined population of births in France.

Population  Eight hundred and sixty-four very preterm live-born singletons (between 27 and 32 completed weeks of gestation) and 567 unmatched full-term controls.

Methods  Data from the French Epipage study were analysed using a polytomous logistic regression model to control for social and demographic characteristics, pre-pregnancy body mass index and obstetric history. The main mechanisms of preterm delivery were classified as gestational hypertension, antepartum haemorrhage, premature rupture of membranes, spontaneous preterm labour and other miscellaneous mechanisms.

Main outcome measures  Odds ratios for very preterm birth for low to moderate (1–9 cigarettes/day) and heavy (≥10 cigarettes/day) maternal smoking in pregnancy, estimated according to the main mechanisms leading to preterm birth.

Results  Smokers were more likely to give birth to very preterm infants than non-smokers [adjusted odds ratio (aOR) 1.7, 95% confidence interval (CI) 1.3–2.2]. Heavy smoking significantly reduced the risk of very preterm birth due to gestational hypertension (aOR 0.5, 95% CI 0.3–1.0), whereas both low to moderate and heavy smoking increased the risk of very preterm birth due to all other mechanisms (aOR between 1.6 and 2.8).

Conclusion  These data from the Epipage study show that maternal smoking during pregnancy is a risk factor for very preterm birth. The impact of maternal smoking on very preterm birth appears to be complex: it lowers the risk of very preterm birth due to gestational hypertension, but increases the risk of very preterm birth due to other mechanisms. These findings might explain why maternal smoking is more closely related to preterm birth among multiparous women than among nulliparous women.

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