Cryptorchidism and maternal alcohol consumption during pregnancy

BACKGROUND: Prenatal exposure to alcohol can adversely affect the fetus. We investigated the association between maternal alcohol consumption during pregnancy and cryptorchidism (undescended testis) among newborn boys. METHODS: We examined 2,496 boys in a prospective Danish-Finnish birth cohort study for cryptorchidism at birth (cryptorchid/healthy: 128/2,368) and at 3 months of age (33/2,215). Quantitative information on alcohol consumption (average weekly consumption of wine, beer, and spirits and number of binge episodes), smoking, and caffeine intake was obtained by questionnaire and/or interview once during the third trimester of pregnancy, before the outcome of the pregnancy was known. For a subgroup (n = 465), information on alcohol consumption was obtained twice during pregnancy by interviews. RESULTS: We investigated maternal alcohol consumption both as a continuous variable and categorized. The odds for cryptorchidism increased with increasing weekly alcohol consumption. After adjustment for confounders (country, smoking, caffeine intake, binge episodes, social class, maternal age, parity, maturity, and birth weight) the odds remained significant for women with a weekly consumption of five or more alcoholic drinks (odds ratio = 3.10; 95% confidence interval, 1.05-9.10). CONCLUSIONS: Regular alcohol intake during pregnancy appears to increase the risk of congenital cryptorchidism in boys. The mechanisms for this association are unknown. Counseling of pregnant women with regard to alcohol consumption should also consider this new finding.     

The contribution of prenatal maternal factors to maternal gestational weight gain

Data from 807 mothers in Iran delivering a singleton live infant and their offspring—during the last 2 years up to August 2014—were collected from eight public health care centers and analyzed. Of the women, 46.2% gained weight within the recommended range, 29.4% had inadequate gestational weight gain (GWG), and 24.4% had excessive GWG. Excessive GWG was more common among overweight and obese women, whereas inadequate GWG was prevalent among 50% of under and normal weight women. A significant correlation was found between maternal anthropometric characteristics, folic acid intake during pregnancy, and birth order with GWG. Maternal GWG was positively correlated with neonates' weight and height.     

Stressful events, smoking exposure and other maternal risk factors associated with gestational diabetes mellitus

The incidence of gestational diabetes mellitus (GDM) has increased significantly in the last few decades in the US. Understanding its risk factors is imperative for the prevention of GDM and its sequelae, but the roles of behavioural risk factors such as stressful events and smoking on GDM are generally not well understood. Using data obtained from the New York State (NYS) Pregnancy Risk Assessment Monitoring System survey for 2004-06 and the NYS birth certificates, we examined relationships between GDM, stressful events and smoking among 2690 women who had live singleton births and did not have pre-pregnancy diabetes. After adjustment for risk factors such as maternal age, race/ethnicity, pre-pregnancy body mass index, hypertension, as well as smoking exposure, education, parity, and gestation at first visit for prenatal care, we found that having five or more stressful events 12 months before the baby was born was significantly associated with GDM (OR = 2.49, [95% CI 1.49, 4.16]). In another model, having any stressful event(s) other than 'moved to a new address' 12 months before the baby was born was also moderately associated with GDM (OR = 1.38, [95% CI 1.04, 1.85]). Smoking exposure, assessed by combining maternal smoking and second-hand smoke exposure into six levels, had no significant association with GDM, and did not show a dose-response pattern. The present study suggests that stressful events during pregnancy may be an independent risk factor for GDM. Future studies of GDM should include this common, but potentially modifiable risk factor in analyses.     

Disparities in hypertension control advice according to smoking status

ObjectivesHypertension is the most common modifiable cardiovascular risk factor. Blood pressure (BP) reduction, particularly among smokers, is highly effective at preventing cardiovascular diseases. We examined the association between patient smoking status and hypertension management advice.MethodsAdults who participated in the 2007 Behavioral Risk Factor Surveillance System with self-reported hypertension were examined (n = 51,063). Multivariable logistic regression analysis controlling for age, gender, race/ethnicity, education, marital status, insurance status, body mass index, alcohol use, self-reported general health and survey design were conducted to examine the association between smoking status (never, former, or current) and receipt of hypertension control advice.ResultsAfter controlling for potential confounders, being a current smoker was significantly associated with lower odds of receiving advice to lower salt intake (Adjusted Odds Ratio, AOR, 0.91 [95% confidence interval = 0.84–0.99]), exercise (AOR 0.89 [0.80–0.98]), and to take hypertensive medication (AOR 0.80 [0.66–0.98]) compared to never smokers. However, hypertensive smokers had greater odds of receiving advice to reduce alcohol consumption (AOR 1.23 [1.10–1.45]).ConclusionsAlthough healthcare providers are in an optimal position to provide patient education to improve BP control, hypertensive smokers may be less likely to receive important BP control lifestyle modification messages from their healthcare provider than non-smokers.     

Costs of maternal conditions attributable to smoking during pregnancy

Context: Despite known adverse health effects, many women continue to smoke during pregnancy. Public attention has now focused on the economic as well as health effects of this behavior.Objective: To estimate health care costs associated with smoking-attributable cases of placenta previa, abruptio placenta, ectopic pregnancy, preterm premature rupture of the membrane (PPROM), pre-eclampsia, and spontaneous abortion.Design: Pooled odds ratios were used with data on total cases to estimate smoking-attributable cases. Estimated average costs for cases of ectopic pregnancy and spontaneous abortion were used to estimate smoking-attributable health care costs for these conditions. Incremental costs, or costs above those for a “normal” delivery, were used to estimate smoking-attributable costs of placenta previa, abruptio placenta, PPROM, and pre-eclampsia associated with delivery.Setting: National estimates for 1993.Participants: Data from the National Hospital Discharge Survey (NHDS) and claims data from a sample of large, self-insured employers across the country.Results: Smoking-attributable costs ranged from $1.3 million for PPROM to $86 million for ectopic pregnancy. Smoking during pregnancy apparently protects against pre-eclampsia and saves between $36 and $49 million, depending on smoking prevalence. Over all conditions smoking-attributable costs ranged from $135 to $167 million.Conclusions: Smoking during pregnancy is a preventable cause of higher health care costs for the conditions studied. While smoking during pregnancy was found to be protective against pre-eclampsia and, hence, saves costs, the net costs were still positive and significant. Effective smoking-cessation programs can reduce health care costs but clinicians will perhaps need to manage increased cases of pre-eclampsia in a cost-effective manner.     

胎龄别新生儿体质指数分析

目的 建立以人群为基础的胎龄别新生儿体质指数(body mass index, BMI)百分位数修匀曲线。方法 对2009年11月1日-2011年1月21日期间在北京市顺义区医院和顺义区妇幼保健院出生的新生儿进行体重和身长的标准化测量, 采用偏度-中位数-变异系数法修匀其出生BMI百分位数, 并进行不同地区研究间的比较。结果 获得顺义区胎龄别新生儿BMI修匀曲线, 不同性别间差异无统计学意义(P＞0.05), BMI随胎龄增长呈现升高-平缓-轻微降低的趋势, 中国新生儿BMI正常范围低于巴西新生儿。结论 本研究建立了北京市顺义区胎龄别新生儿BMI百分位数修匀曲线, 可以为新生儿出生体格发育评价提供新的参考依据。     

Multiple malformations and maternal smoking

The Swedish health registries were used to investigate a possible effect of maternal smoking on the incidence of multiple malformations. Among 1413811 infants born in 1983-96 and with known smoking exposure in early pregnancy, 26619 with isolated malformations and 1409 with two or more malformations were selected. After controlling for year of birth, maternal age, parity and educational level, a statistically significant association between maternal smoking and multiple malformations was found (OR 1.15; 95% CI 1.02, 1.29). Among isolated malformations, the estimated OR for maternal smoking was close to unity (OR 1.02; 95% CI 0.99, 1.05), but a strong heterogeneity of the magnitude of the association between maternal smoking and the different malformations was found. Among multimalformed, no such heterogeneity was indicated. The ORs for maternal smoking were calculated for all possible pairwise combinations of 44 selected malformations, but no association between maternal smoking and any specific combination could be detected. The ORs for maternal smoking among probable cases of VATER, CHARGE or OEIS non-random associations, respectively, were estimated, but no association was indicated between maternal smoking and any of the malformation complexes. The results of the present study indicate that maternal smoking is associated with a non-specific increased risk of multiple malformations, but further research is needed before such an inference can be made.     

Relationship of maternal smoking during pregnancy to placenta previa.

Although maternal smoking during pregnancy is reportedly associated with placenta previa, its etiology is unknown. We examined this association by using North Carolina vital records of 1988 and 1989. Among women who smoked 0, 1-9, 10-19, and > or = 20 cigarettes per day during pregnancy, the prevalence of placenta previa at delivery was 3.8, 5.7, 6.3, and 6.7 per 1,000 singleton live births, respectively, in the entire population. However, after the potential confounders (maternal age, race, gravidity, parity, previous pregnancy terminations, previous cesarean section, and gestational age) were controlled by individual matching, the adjusted overall odds ratio (OR) was 1.29 (95% confidence interval [CI] 1.05, 1.58) with slight dose-response gradients. Our study indicates that, although maternal smoking during pregnancy might affect placenta previa, the magnitude is substantially smaller than previously reported. This association may be attributable to other factors, such as detection bias.     

Prevalence of respiratory symptoms in Parisian teenagers according to smoking habits.

The relationship between respiratory symptoms and smoking habits, according to sex, was studied in 2266 teenagers attending secondary school in Paris. Among smokers, the prevalence of usual cough or phlegm, or both, was higher in girls than in boys, whereas such was not the case among non-smokers. That prevalence, as well as the proportion of people with wheezing, were more closely associated with the total number of cigarettes ever smoked by girls than by boys. Moreover, there was a weak but significant association between the total number of cigarettes smoked and respiratory function--FEV1/Ht3 in girls only.     

Association between maternal smoking and breast feeding

Many factors influence the decision to initiate and continue to breastfeed. Our study evaluates the relation between maternal cigarette smoking and prevalence of breastfeeding. A telephone questionnaire was administered by nurses to mothers of 879 newborns from the Quebec City area approximately two weeks after delivery. Among the 666 babies whose mothers did not smoke, 62.6% were breastfed. This proportion declined to 37.5%, 17.7% and 14.6% among babies whose mothers smoked 1 to 10, 11 to 20 and more than 20 cigarettes per day, respectively. The dose-effect association between the prevalence of breastfeeding and the number of cigarettes smoked daily by the mother persisted after adjustment in a binomial regression model for maternal age, education and home district area. Pregnant women who smoke should be strongly encouraged to quit smoking and to breastfeed their babies.     

Risk of gestational diabetes mellitus in relation to maternal egg and cholesterol intake

Higher egg and cholesterol intakes are associated with increased risk of type 2 diabetes mellitus. However, their association with gestational diabetes mellitus (GDM) has not been evaluated. The authors assessed such associations in both a prospective cohort study (1996-2008; 3,158 participants) and a case-control study (1998-2002; 185 cases, 411 controls). A food frequency questionnaire was used to assess maternal diet. Multivariable models were used to derive relative risks and 95% confidence intervals. Compared with no egg consumption, adjusted relative risks for GDM were 0.94, 1.01, 1.12, 1.54, and 2.52 for consumption of ≤1, 2-3, 4-6, 7-9, and ≥10 eggs/week, respectively (P for trend=0.008). Women with high egg consumption (≥7/week) had a 1.77-fold increased risk compared with women with lower consumption (95% confidence interval (CI): 1.19, 2.63). The relative risk for the highest quartile of cholesterol intake (≥294 mg/day) versus the lowest (<151 mg/day) was 2.35 (95% CI: 1.35, 4.09). In the case-control study, the adjusted odds ratio for consuming ≥7 eggs/week versus <7 eggs/week was 2.65 (95% CI: 1.48, 4.72), and the odds of GDM increased with increasing cholesterol intake (P for trend=0.021). In conclusion, high egg and cholesterol intakes before and during pregnancy are associated with increased risk of GDM.     

Tobacco smoking in Brazil: regional inequalities and prevalence according to occupational characteristics

This study describes the prevalence of daily tobacco smoking according to sex, age, per capita household income and occupation of residents aged 15 years or more in Brazil and regions using data from the 2008 National Household Sample Survey (PNAD/IBGE). The analysis was adjusted for the sampling design and included 252.768 individuals. Daily smoking prevalence in Brazil was 15.1%, varying from 12.8% in the North region to 17.4% in the South region, and it was 62% higher in men compared to women. Smoking prevalence was inversely proportional to household income, 18.6% among the poorest 20% and 11.5% among the wealthiest 20%. The same trends for gender, age and income were observed in the different regions of Brazil. Daily smoking was 3% higher among workers compared to non-workers. White collar workers presented a smoking prevalence below 10%, while blue collar workers had rates above 20%. The association between smoking and occupation persisted after the adjustment for sex, age and household income. The inequalities found should be considered when developing effective strategies for smoking reduction. The more exposed occupational groups should have priority in the interventions.     

Dose-response of birth weight to various measures of maternal smoking during pregnancy

Thus far little is known about the dose-response relationship between birth weight and the amount of maternal smoking during pregnancy. The purpose of this report is to describe the effects of smoking intensity, duration, and timing on birth weight with the use of three measures of exposure: self-reported daily consumption, self-reported cumulative consumption, and salivary thiocyanate. Data were obtained on 867 single live-born infants and their mothers who participated in a randomized anti-smoking intervention trial. Smoking was measured for the women at about 15 weeks gestation and again during the eighth month. Although all indicators of dose, as derived from early or late pregnancy smoking measures, were significantly associated with birth weight, whether or not the mother had quit smoking by the time of the 8th month follow-up was almost as predictive as any dose variable. For women who quit smoking before 30 weeks gestation, neither the duration nor the amount of smoking earlier in pregnancy was an important determinant of birth weight.     

Down's syndrome and maternal smoking in early pregnancy

Several previous studies have suggested that maternal smoking is associated with a decreased incidence of trisomy 21. By using the Swedish health registries, 1,321 infants with Down's syndrome (DS) were selected among 1,117,021 infants born in 1983–1993 with known smoking exposure in early pregnancy. No association between maternal smoking and all cases of DS was found [age-adjusted odds ratio (OR) for maternal smoking: 0.98; 95% confidence interval (CI): 0.86–1.11], but heterogeneity over strata existed. A slightly decreased OR (0.91; 95% CI: 0.72–1.15) for any maternal smoking was indicated among primiparas, but among multiparas, no effect of smoking on the incidence of DS could be detected (OR: 1.01; 95% CI: 0.87–1.17). The difference between the OR for smoking ≥10 cigarettes per day among primiparas (OR: 0.59; 95% CI: 0.38–0.90) and multiparas (OR: 1.06; 95% CI: 0.86–1.31) was statistically significant. If not due to statistical fluctuation, the findings indicate that no direct effect of smoking on DS risk exists but the association observed in primiparas is due to covarying factors. Genet. Epidemiol. 14:77–84,1997. © 1997 Wiley-Liss, Inc.     

Sudden infant death syndrome and maternal smoking.

Data from Missouri for the period 1980 to 1985 suggest a dose-response relationship between smoking during pregnancy and the incidence of sudden infant death syndrome (SIDS). However, data from the National Institute of Child Health and Human Development SIDS Cooperative Epidemiological Study did not support a dose-response relationship. Neither the Missouri data nor the Cooperative Study data support a relationship between the age of occurrence of SIDS and smoking during pregnancy.