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Holopainen LS, Tähtinen HH, Gissler M, Korhonen PE, Ekblad MO. Interaction of maternal smoking and gestational diabetes mellitus on newborn head circumference and birthweight. Acta Obstet Gynecol Scand 2024. [PMID: 39004941 DOI: 10.1111/aogs.14920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/18/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION Maternal smoking during pregnancy and gestational diabetes mellitus (GDM) have opposite effects on fetal growth during pregnancy. The aim of the study was to evaluate the interaction of smoking during pregnancy and gestational diabetes mellitus on head circumference and birthweight of newborns. MATERIAL AND METHODS The study included all primiparous women with singleton pregnancies (n = 290 602) without previously diagnosed diabetes or hypertension in Finland between 2006 and 2018. The information on gestational diabetes mellitus, newborn birthweight and head circumference, and maternal smoking and backgrounds was derived from the Finnish Medical Birth Register. Linear regression models were used in the analyses. RESULTS In total 8.0% of parturients quit smoking during the first trimester and 9.9% continued smoking thereafter. The prevalence of GDM was 8.9% (n = 25 948). Newborns of women who continued smoking had a smaller head circumference (b = -0.24, SE = 0.01, p < 0.0001) and birthweight (b = -0.28, SE = 0.01, p < 0.0001) compared to newborns of women who did not smoke. Head circumference and birthweight were greater in newborns of women with GDM (b = 0.09, SE = 0.01, p < 0.0001 and b = 0.16, SE = 0.01, p < 0.0001, respectively) compared to newborns of women without GDM. In the interaction analyses, head circumference (b = -0.13, SE = 0.01, p < 0.0001) was smaller and birthweight (b = -0.13, SE = 0.02, p < 0.0001) was lower in newborns of women with GDM who continued smoking compared to newborns of women without GDM who did not smoke. CONCLUSIONS Although smoking and GDM have opposite effects on fetal growth, the negative effects of exposure to smoking are also seen in newborns of women with GDM. Compared to smoking after the first trimester of pregnancy, cessation of smoking during the first trimester was associated with greater head circumference and birthweight in newborns.
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Affiliation(s)
- Lotta S Holopainen
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Southwest Finland Wellbeing Services County, Turku, Finland
| | - Hanna H Tähtinen
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Southwest Finland Wellbeing Services County, Turku, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Päivi E Korhonen
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Southwest Finland Wellbeing Services County, Turku, Finland
| | - Mikael O Ekblad
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Southwest Finland Wellbeing Services County, Turku, Finland
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Voutilainen T, Keski-Nisula L, Rysä J, Kärkkäinen O. Parental cigarette smoking before and during pregnancy in a cohort of 21 472 pregnancies. Basic Clin Pharmacol Toxicol 2024; 134:543-555. [PMID: 38378277 DOI: 10.1111/bcpt.13987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/22/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024]
Abstract
Smoking during pregnancy is one of the leading causes for adverse pregnancy outcomes. We studied parental smoking both before and during pregnancy in a retrospective cohort of 21 472 singleton pregnancies. Although most smoking women (74%) ceased tobacco use, there was possible gestational exposure to maternal cigarette smoking in every fifth pregnancy. Continued smoking throughout pregnancy was more prevalent in the partners (22%) than in the pregnant women (7%). The smoking behaviour of the women, especially the number of cigarettes smoked per day (CPD), before and in early pregnancy predicted the continuation of smoking throughout the pregnancy and could be used in identifying high risk groups. In addition, their partner's smoking habits both before and during pregnancy, were associated with the likelihood that the woman would continue to smoke during her pregnancy (rs ≈ 0.4). Furthermore, continued smoking of both parents were associated with decreased birth weight, head circumference and Apgar score, and increased duration of hospital stay and need for special care after birth. Consequently, addressing the lifestyles of both parents in the health care and maternity clinics could help in reducing maternal cigarette smoking during pregnancy and the adverse pregnancy outcomes associated with smoking.
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Affiliation(s)
- Taija Voutilainen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Leea Keski-Nisula
- Department of Obstetrics and Gynaecology, Kuopio University Hospital, Finland, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jaana Rysä
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olli Kärkkäinen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Akselrod S, Banerjee A, Collins TE, Acharya S, Artykova N, Askew I, Berdzuli N, Diorditsa S, Eggers R, Farrington J, Jakab Z, Ferreira-Borges C, Mikkelsen B, Azzopardi-Muscat N, Olsavszky V, Park K, Sobel H, Tran H, Vujnovic M, Weber M, Were W, Yaqub N, Berlina D, Dunlop CL, Allen LN. Integrating maternal, newborn, child health and non-communicable disease care in the sustainable development goal era. Front Public Health 2023; 11:1183712. [PMID: 37483915 PMCID: PMC10362386 DOI: 10.3389/fpubh.2023.1183712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/06/2023] [Indexed: 07/25/2023] Open
Abstract
Noncommunicable diseases (NCDs) and maternal newborn and child health (MNCH) are two deeply intertwined health areas that have been artificially separated by global health policies, resource allocations and programming. Optimal MNCH care can provide a unique opportunity to screen for, prevent and manage early signs of NCDs developing in both the woman and the neonate. This paper considers how NCDs, NCD modifiable risk factors, and NCD metabolic risk factors impact MNCH. We argue that integrated management is essential, but this faces challenges that manifest across all levels of domestic health systems. Progress toward Sustainable Development targets requires joined-up action.
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Affiliation(s)
| | - Anshu Banerjee
- Maternal, Newborn, Child and Adolescent Health, and Ageing, World Health Organization, Geneva, Switzerland
| | - Téa E. Collins
- Global NCD Platform, World Health Organization, Geneva, Switzerland
| | - Shambhu Acharya
- Country Strategy and Support, World Health Organization, Geneva, Switzerland
| | - Nazira Artykova
- WHO European Region Country Office in Kyrgyzstan, Bishkek, Kyrgyzstan
| | - Ian Askew
- Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Nino Berdzuli
- Division of Country Health Programmes, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Sergey Diorditsa
- WHO Representative's Office, WHO European Region Country Office in Belarus, Minsk, City of Minsk, Belarus
| | - Rudolf Eggers
- Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Jill Farrington
- Deputy Director-General Office, World Health Organization, Geneva, Switzerland
| | - Zsuzsanna Jakab
- Deputy Director-General Office, World Health Organization, Geneva, Switzerland
| | - Carina Ferreira-Borges
- Division of Country Health Programmes, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Bente Mikkelsen
- NCD Department, World Health Organization, Geneva, Switzerland
| | - Natasha Azzopardi-Muscat
- Division of Country Health Policies and Systems, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Victor Olsavszky
- WHO European Region Tajikistan Country Office, Dushanbe, Tajikistan
| | - Kidong Park
- Data, Strategy and Innovation Group, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Howard Sobel
- WHO Regional Office for the Western Pacific Country Office in the Solomon Islands, Manila, Philippines
| | - Huong Tran
- Division of Programmes for Disease Control, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Melita Vujnovic
- WHO European Region Office for the Russian Federation, Moscow, Russia
| | - Martin Weber
- Division of Country Health Policies and Systems, World Health Organization Regional Office for Europe Country Office in Greece, Copenhagen, Denmark
| | - Wilson Were
- Child Health and Development, World Health Organization, Geneva, Switzerland
| | - Nuhu Yaqub
- Child Health and Development, World Health Organization, Geneva, Switzerland
| | - Daria Berlina
- Global NCD Platform, World Health Organization, Geneva, Switzerland
| | - Catherine L. Dunlop
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Luke N. Allen
- Global NCD Platform, World Health Organization, Geneva, Switzerland
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Wallin HP, Gissler M, Korhonen PE, Ekblad MO. New insights into smoking and urinary tract infections during pregnancy using pregnancy-pair design: A population-based register study. Acta Obstet Gynecol Scand 2022; 102:25-32. [PMID: 36263583 PMCID: PMC9780712 DOI: 10.1111/aogs.14473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/03/2022] [Accepted: 09/28/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Pregnancy itself predisposes to urinary tract infections (UTI). There appears to be a higher prevalence of infections and genitourinary diseases among pregnant smokers than among non-smokers. The present study is a retrospective observational register study aiming to investigate whether maternal smoking is associated with the prevalence of UTIs during pregnancy by utilizing a pregnancy-pair analysis. MATERIAL AND METHODS Information about pregnancies and maternal smoking was obtained from the Finnish Medical Birth Register. The study sample consisted of all singleton pregnancies (n = 723 433) of women giving birth between January 2006 and December 2018 in Finland. Information on maternal smoking was collected in three categories: (1) non-smoking; (2) quit smoking during the first trimester; and (3) continued smoking throughout the pregnancy. Information about maternal UTI diagnoses during pregnancy was received from the Hospital Discharge Register and the Medical Birth Register. UTIs were categorized as lower and upper UTIs according to the International Statistical Classification of Diseases and Related Health Problems (ICD)-10 diagnosis codes. Risks were calculated as odds ratios (OR) by logistic regression with 95% confidence intervals (CI) further adjusted for maternal characteristics (aOR). Finally, pregnancy-pair analyses were performed: mothers who had changed smoking status (no smoking/any smoking) between consecutive pregnancies (n = 27 246 pregnancy-pairs) were analyzed as one cluster and compared with non-smokers. RESULTS Smokers had UTIs more often compared with the non-smokers. The association was even stronger among those who continued to smoke (aOR 1.60, 95% CI 1.51-1.70) than among those who smoked only during the first trimester (aOR 1.27, 95% CI 1.18-1.37) compared with non-smokers. In pregnancy-pair analysis, smoking was associated with upper UTIs during pregnancy (OR 1.49, 95% CI 1.05-2.12) compared with non-smokers, but after the adjustments this association was attenuated (aOR 1.27, 95% CI 0.88-1.82). No association in lower UTIs was observed in the pregnancy-pair design. CONCLUSIONS Maternal smoking was associated with a higher prevalence of UTIs during pregnancy in the standard comparison. The observed association was fully attenuated in the pregnancy-pair analysis, in which smoking was dichotomized. This study suggests that the association between maternal smoking during pregnancy and adverse maternal health effects might be more complex than previously thought.
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Affiliation(s)
- Hanna P. Wallin
- Department of General Practice, Institute of Clinical MedicineUniversity of Turku and Turku University HospitalTurkuFinland,KESSOTE Central Satakunta Health Federation of MunicipalitiesHarjavaltaFinland
| | - Mika Gissler
- THL Finnish Institute for Health and WelfareHelsinkiFinland,Research Centre for Child PsychiatryUniversity of TurkuTurkuFinland,Academic Primary Health Care CentreRegion Stockholm and Karolinska InstituteStockholmSweden
| | - Päivi E. Korhonen
- Department of General Practice, Institute of Clinical MedicineUniversity of Turku and Turku University HospitalTurkuFinland
| | - Mikael O. Ekblad
- Department of General Practice, Institute of Clinical MedicineUniversity of Turku and Turku University HospitalTurkuFinland
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Ekblad MO, Gissler M, Korhonen PE. New theory about the pathophysiology of preeclampsia derived from the paradox of positive effects of maternal smoking. J Hypertens 2022; 40:1223-1230. [PMID: 35703884 DOI: 10.1097/hjh.0000000000003142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate if maternal height affects the link between the inverse association on smoking during pregnancy and preeclampsia. STUDY DESIGN The study population consisted of all women with singleton pregnancies (n = 803 698) in Finland during the years 2004-2018, excluding women with unknown smoking and diagnosis of prepregnancy chronic hypertension. Information on smoking and background factors were derived from the Finnish Medical Birth Register. Smoking was categorized in three classes: no, quitted in the first trimester and continued throughout the pregnancy. Information on preeclampsia was derived from the Finnish Hospital Discharge Register and the Finnish Medical Birth Register. Multiple logistic regression models were used to estimate first the association between smoking and preeclampsia, and finally whether maternal height modified the association. RESULTS In the standard comparison, we found evidence of an association between preeclampsia and continued smoking [adjusted odds ratio = 0.74, 95% confidence interval (95% CI) = 0.67-0.81], but no association was found between quitted smoking and preeclampsia. Thus, the interaction of continued smoking and maternal height by z-scores was estimated. Among taller mothers, continued smoking was associated with a higher risk for preeclampsia than in smoking mothers with average height (β = 0.33, SE = 0.14, P = 0.02). CONCLUSION Our results partly challenge the smoking-preeclampsia paradox: smoking seems not to protect tall mothers against preeclampsia. We speculate the findings through a new theory about the pathophysiology of preeclampsia. It seems that tall pregnant smokers must raise their blood pressure aggressively to ensure perfusion in the dysfunctional placenta.
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Affiliation(s)
- Mikael O Ekblad
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Turku University Hospital, Turku
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Karolinska Institute, Department of Molecular Medicine and Surgery.,Region Stockholm, Academic Primary Healthcare Centre, Stockholm, Sweden
| | - Päivi E Korhonen
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Turku University Hospital, Turku
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Ekblad MO, Marceau K, Rolan E, Palmer RHC, Todorov A, Heath AC, Knopik VS. The Effect of Smoking during Pregnancy on Severity and Directionality of Externalizing and Internalizing Symptoms: A Genetically Informed Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217921. [PMID: 33126697 PMCID: PMC7662383 DOI: 10.3390/ijerph17217921] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022]
Abstract
The objective was to examine the association between maternal smoking during pregnancy (SDP) and (I) severity and (II) directionality of externalizing and internalizing symptoms in a sample of sibling pairs while rigorously controlling for familial confounds. The Missouri Mothers and Their Children Study is a family study (N = 173 families) with sibling pairs (aged 7 to 16 years) who are discordant for exposure to SDP. This sibling comparison study is designed to disentangle the effects of SDP from familial confounds. An SDP severity score was created for each child using a combination of SDP indicators (timing, duration, and amount). Principal component analysis of externalizing and internalizing behavior, assessed with the Child Behavior Checklist and Teacher Report Form, was used to create symptom severity and directionality scores. The variance in severity and directionality scores was primarily a function of differences between siblings (71% and 85%, respectively) rather than differences across families (29% and 15%, respectively). The severity score that combines externalizing and internalizing symptom severity was not associated with SDP. However, a significant within-family effect of SDP on symptom directionality (b = 0.07, p = 0.04) was observed in the sibling comparison model. The positive directionality score indicates that SDP is associated with differentiation of symptoms towards externalizing rather than internalizing symptoms after controlling for familial confounds with a sibling comparison model. This supports a potentially causal relationship between SDP and externalizing behavior.
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Affiliation(s)
- Mikael O. Ekblad
- Department of General Practice, Institute of Medicine, Turku University and Turku University Hospital, 20014 Turku, Finland
- Correspondence:
| | - Kristine Marceau
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN 47906, USA; (K.M.); (V.S.K.)
| | - Emily Rolan
- Department of Psychology, Michigan State University, East Lansing, MI 48824, USA;
| | - Rohan H. C. Palmer
- Department of Psychology, Behavioral Genetics of Addiction Laboratory, Emory University, Atlanta, GA 30322, USA;
| | - Alexandre Todorov
- Department of Psychiatry, Midwest Alcoholism Research Center, Washington University School of Medicine, Saint Louis, MO 63110, USA; (A.T.); (A.C.H.)
| | - Andrew C. Heath
- Department of Psychiatry, Midwest Alcoholism Research Center, Washington University School of Medicine, Saint Louis, MO 63110, USA; (A.T.); (A.C.H.)
| | - Valerie S. Knopik
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN 47906, USA; (K.M.); (V.S.K.)
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