Tuba Saygın Avşar1, Hugh McLeod2,3, Louise Jackson4. 1. Health Economics Unit, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. T.SayginAvsar@bham.ac.uk. 2. Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 2NT, UK. 3. National Institute for Health Research Applied Research Collaboration (NIHR ARC) West at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK. 4. Health Economics Unit, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
Abstract
BACKGROUND: Smoking during pregnancy (SDP) and the postpartum period has serious health outcomes for the mother and infant. Although some systematic reviews have shown the impact of maternal SDP on particular conditions, a systematic review examining the overall health outcomes has not been published. Hence, this paper aimed to conduct an umbrella review on this issue. METHODS: A systematic review of systematic reviews (umbrella review) was conducted according to a protocol submitted to PROSPERO ( CRD42018086350 ). CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, CRD Database and HMIC databases were searched to include all studies published in English by 31 December 2017, except those focusing exclusively on low-income countries. Two researchers conducted the study selection and quality assessment independently. RESULTS: The review included 64 studies analysing the relationship between maternal SDP and 46 health conditions. The highest increase in risks was found for sudden infant death syndrome, asthma, stillbirth, low birth weight and obesity amongst infants. The impact of SDP was associated with the number of cigarettes consumed. According to the causal link analysis, five mother-related and ten infant-related conditions had a causal link with SDP. In addition, some studies reported protective impacts of SDP on pre-eclampsia, hyperemesis gravidarum and skin defects on infants. The review identified important gaps in the literature regarding the dose-response association, exposure window, postnatal smoking. CONCLUSIONS: The review shows that maternal SDP is not only associated with short-term health conditions (e.g. preterm birth, oral clefts) but also some which can have life-long detrimental impacts (e.g. obesity, intellectual impairment). IMPLICATIONS: This umbrella review provides a comprehensive analysis of the overall health impacts of SDP. The study findings indicate that while estimating health and cost outcomes of SDP, long-term health impacts should be considered as well as short-term effects since studies not including the long-term outcomes would underestimate the magnitude of the issue. Also, interventions for pregnant women who smoke should consider the impact of reducing smoking due to health benefits on mothers and infants, and not solely cessation.
BACKGROUND: Smoking during pregnancy (SDP) and the postpartum period has serious health outcomes for the mother and infant. Although some systematic reviews have shown the impact of maternal SDP on particular conditions, a systematic review examining the overall health outcomes has not been published. Hence, this paper aimed to conduct an umbrella review on this issue. METHODS: A systematic review of systematic reviews (umbrella review) was conducted according to a protocol submitted to PROSPERO ( CRD42018086350 ). CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, CRD Database and HMIC databases were searched to include all studies published in English by 31 December 2017, except those focusing exclusively on low-income countries. Two researchers conducted the study selection and quality assessment independently. RESULTS: The review included 64 studies analysing the relationship between maternal SDP and 46 health conditions. The highest increase in risks was found for sudden infant death syndrome, asthma, stillbirth, low birth weight and obesity amongst infants. The impact of SDP was associated with the number of cigarettes consumed. According to the causal link analysis, five mother-related and ten infant-related conditions had a causal link with SDP. In addition, some studies reported protective impacts of SDP on pre-eclampsia, hyperemesis gravidarum and skin defects on infants. The review identified important gaps in the literature regarding the dose-response association, exposure window, postnatal smoking. CONCLUSIONS: The review shows that maternal SDP is not only associated with short-term health conditions (e.g. preterm birth, oral clefts) but also some which can have life-long detrimental impacts (e.g. obesity, intellectual impairment). IMPLICATIONS: This umbrella review provides a comprehensive analysis of the overall health impacts of SDP. The study findings indicate that while estimating health and cost outcomes of SDP, long-term health impacts should be considered as well as short-term effects since studies not including the long-term outcomes would underestimate the magnitude of the issue. Also, interventions for pregnant women who smoke should consider the impact of reducing smoking due to health benefits on mothers and infants, and not solely cessation.
Entities:
Keywords:
Health outcomes; Partner smoking; Smoking during pregnancy; Systematic review; Umbrella review
Authors: G Banderali; A Martelli; M Landi; F Moretti; F Betti; G Radaelli; C Lassandro; E Verduci Journal: J Transl Med Date: 2015-10-15 Impact factor: 5.531
Authors: Sue Kyung Park; Daehee Kang; Katherine A McGlynn; Montserrat Garcia-Closas; Yeonju Kim; Keun Young Yoo; Louise A Brinton Journal: Breast Cancer Res Date: 2008-01-21 Impact factor: 6.466
Authors: Yuxia Wei; Tomas Andersson; Jessica Edstorp; Josefin E Löfvenborg; Mats Talbäck; Maria Feychting; Sofia Carlsson Journal: BMC Med Date: 2022-08-12 Impact factor: 11.150
Authors: Erica Cruvinel; Kimber P Richter; Kathryn I Pollak; Edward Ellerbeck; Nicole L Nollen; Byron Gajewski; Zoe Sullivan-Blum; Chuanwu Zhang; Elena Shergina; Taneisha S Scheuermann Journal: Int J Environ Res Public Health Date: 2022-08-17 Impact factor: 4.614
Authors: Farah Nawabi; Franziska Krebs; Laura Lorenz; Arim Shukri; Adrienne Alayli; Stephanie Stock Journal: Int J Environ Res Public Health Date: 2022-01-07 Impact factor: 3.390