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American Journal of Epidemiology Advance Access originally published online on June 4, 2007
American Journal of Epidemiology 2007 166(3):289-295; doi:10.1093/aje/kwm073
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American Journal of Epidemiology © The Author 2007. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Influence of Maternal Smoking on Placental Abruption in Successive Pregnancies: A Population-based Prospective Cohort Study in Sweden

Cande V. Ananth1 and Sven Cnattingius2

1 Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ
2 Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden

Correspondence to Professor Cande V. Ananth, Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, 125 Paterson Street, New Brunswick, NJ 08901 (e-mail: cande.ananth{at}umdnj.edu).

Received for publication December 15, 2006. Accepted for publication January 31, 2007.

The authors examined associations between cumulative smoking during a woman's first and second pregnancies and risk of placental abruption in the second pregnancy. They performed a population-based prospective cohort study of 526,690 women who delivered their first two consecutive singletons in Sweden in 1983–2001. Using logistic regression models, the authors found that, among women without placental abruption in the first pregnancy, smoking was associated with increased risk of abruption in the second pregnancy; however, this effect was confined to exposure occurring during the second pregnancy (adjusted odds ratio (OR) = 1.8, 95% confidence interval (CI): 1.4, 2.3) but not the first (adjusted OR = 1.1, 95% CI: 0.9, 1.3). Among women with a prior abruption, the risk of repeating abruption was increased irrespective of smoking habits. When women smoked during both pregnancies, there was an almost 11-fold increase in risk (adjusted OR = 10.9, 95% CI: 7.3, 16.3). These findings suggest that women who quit smoking before pregnancy may benefit from reduced risk of abruption. The observation that the recurrence of abruption is substantially increased regardless of changes in smoking habits suggests that factors other than smoking may influence the recurrence of placental abruption.

abruptio placentae; pregnancy; recurrence; risk; smoking

Abbreviations: ICD, International Classification of Diseases; SGA, small-for-gestational-age


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