OBJECTIVE--To investigate the effects of smoking, alcohol, and caffeine consumption and socio-economic factors and psychosocial stress on birth weight. DESIGN--Prospective population study. SETTING--District general hospital in inner London. PARTICIPANTS--A consecutive series of 1860 white women booking for delivery were approached. 136 Refused and 211 failed to complete the study for other reasons (moved, abortion, subsequent refusal), leaving a sample of 1513. Women who spoke no English, booked after 24 weeks, had insulin dependent diabetes, or had a multiple pregnancy were excluded. MEASUREMENTS--Data were obtained by research interviewers at booking (general health questionnaire, modified Paykel's interview, and Eysenck personality questionnaire) and at 17, 28, and 36 weeks' gestation and from the structured antenatal and obstetric record. Variables assessed included smoking, alcohol consumption, caffeine consumption, and over 40 indicators of socio-economic state and psychosocial stress, including social class, tenure of accommodations, education, employment, income, anxiety and depression, stressful life events, social stress, social support, personality, and attitudes to pregnancy. Birth weight was corrected for gestation and adjusted for maternal height, parity, and baby's sex. MAIN RESULTS--Smoking was the most important single factor (5% reduction in corrected birth weight). Passive smoking was not significant (0.5% reduction). After smoking was controlled for, alcohol had an effect only in smokers and the effects of caffeine became non-significant. Only four of the socioeconomic and stress factors significantly reduced birth weight and these effects became non-significant after smoking was controlled for. CONCLUSIONS--Social and psychological factors have little or no direct effect on birth weight corrected for gestational age (fetal growth), and the main environmental cause of its variation in this population was smoking.

https://www.bmj.com/content/bmj/298/6676/795.full.pdf

Effects on birth weight of smoking, alcohol, caffeine, socioeconomic factors, and psychosocial stress.

Objective: To determine the effects of environmental tobacco smoke (ETS) exposure on birth outcomes. Design: A systematic review and meta-analysis was performed in accordance with MOOSE guidelines. MEDLINE, EMBASE, CINAHL and LILACS (up to October 2007), were searched and also reviews and reference lists from publications, with no language restrictions. Pooled mean differences and odds ratios (ORs) with 95% confidence intervals were estimated using data extracted from papers, based on random effect models. Setting: Comparative epidemiological studies. Patients: Pregnant women or women who have given birth. Exposures: Maternal exposure to ETS during pregnancy. Main outcome measures: Mean birth weight and proportion of premature infants. Results: 58 studies were included; 53 used cohort designs, 23 ascertaining ETS exposure prospectively and 30 retrospectively; 5 used case–control designs. In prospective studies, ETS exposure was associated with a 33 g (95% CI 16 to 51) reduction in mean birth weight, and in retrospective studies a 40 g (95% CI 26 to 54) reduction. ETS exposure was also associated with an increased risk of low birth weight (birth weight Conclusions: Exposure of non-smoking pregnant women to ETS reduces mean birth weight by 33 g or more, and increases the risk of birth weight below 2500 g by 22%, but has no clear effect on gestation or the risk of being small for gestational age.

https://fn.bmj.com/content/fetalneonatal/93/5/F351.full.pdf

Environmental tobacco smoke and fetal health: systematic review and meta-analysis

Background Intrauterine exposure to tobacco smoke has been discerned as an important risk factor for low birth weight (LBW), small for gestational age (SGA), and preterm birth infants. In this cohort study, we investigated the association of the amount of parental smoking during the different pregnancy stages with birth weight and the incidence of preterm delivery. Methods Our study population was acquired from the Taiwan Birth Cohort Study. Between June 2005 and July 2006, 21,248 postpartum women were interviewed 6 months after their deliveries by a structured questionnaire. The parents were divided into four groups according to the amount of smoking during preconception, the first trimester, and the second and third trimesters. The relationships of parental smoking with gestational age and birth weight during the different pregnancy stages were assessed using multivariate linear regression. Multiple logistic regression analyses were performed to estimate the odds ratios and 95% confidence intervals of preterm delivery, LBW, and SGA infants during the different parental smoking status and the different pregnancy stages. Results After adjusting for the physical and socioeconomic status of the parents and for paternal smoking during the same period, we found that maternal smoking decreased birth weight. Compared with the nonsmoking groups, all the maternal smoking groups had higher incidences of LBW, SGA, and preterm birth infants, especially when the mothers smoked >20 cigarettes/day. The association of paternal smoking with LBW, SGA, and preterm birth infants was insignificant. Conclusion Maternal smoking is responsible for increased incidences of LBW and preterm delivery of babies, and therefore, smoking cessation/reduction should be advised to pregnant women to reduce morbidities in their neonates. Further studies are needed to clarify the correlation of fetal health with passive smoking, including exposure to environmental tobacco smoke and to other smokers in the family.

Parental smoking during pregnancy and its association with low birth weight, small for gestational age, and preterm birth offspring: a birth cohort study.

Smoking during pregnancy has been associated with many adverse pregnancy outcomes. However, debate continues about whether smoking causes these outcomes. This review of the criteria of causation found that the relative risk of having a low-birth-weight baby is nearly doubled in women who smoke during pregnancy compared with nonsmoking women and that the relative risks of spontaneous abortion and perinatal and neonatal mortality are increased by about one-third. The magnitude of the long-term effects of maternal smoking on the physical and mental development of the offspring is small but measurable. The epidemiologic evidence associating maternal smoking with major adverse pregnancy outcomes in prospective and case-control studies displays a high degree of consistency. A dose-response gradient for smoking during pregnancy has not been clearly shown in relation to perinatal and neonatal mortality. However, there is strong support for a dose-response gradient in relation to low birth weight and spontaneous abortion and moderate support for long-term developmental effects. Although a biological causal mechanism has not been clearly delineated, considerable evidence indicates that the chemicals in tobacco smoke are capable of producing deleterious changes in the placenta and fetus.

https://www.jstor.org/stable/pdfplus/41465040.pdf

Effects of maternal smoking on adverse pregnancy outcomes: examination of the criteria of causation.

https://scholarspace.manoa.hawaii.edu/bitstream/10125/3747/1/POPwp114.pdf

Maternal Exposure to Biomass Smoke and Reduced Birth Weight in Zimbabwe

Effect of passive smoking on birth-weight

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Effect of passive smoking on birth-weight