Maternal and Child Health Journal

, Volume 22, Issue 10, pp 1418–1429 | Cite as

Does Maternal Exposure to Secondhand Tobacco Smoke During Pregnancy Increase the Risk for Preterm or Small-for-Gestational Age Birth?

  • Adrienne T. Hoyt
  • Mark A. Canfield
  • Paul A. Romitti
  • Lorenzo D. Botto
  • Marlene T. Anderka
  • Sergey V. Krikov
  • Marcia L. Feldkamp


Introduction While associations between active smoking and various adverse birth outcomes (ABOs) have been reported in the literature, less is known about the impact of secondhand smoke (SHS) on many pregnancy outcomes. Methods We examined the relationship between maternal exposure to SHS during pregnancy and preterm (< 37 weeks gestation) and small-for-gestational age (SGA; assessed using sex-, race/ethnic-, and parity-specific growth curves) singleton births using non-smoking controls from the National Birth Defects Prevention Study (1997–2011). Multivariable logistic regression models for household, workplace/school, and combined SHS exposure—controlled for maternal education, race/ethnicity, pre-pregnancy body mass index, and high blood pressure—were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Interaction was assessed for maternal folic acid supplementation, alcohol use, age at delivery, and infant sex. Results Infants of 8855 mothers were examined in the preterm birth analysis with 666 (7.5%) categorized as preterm, 574 moderately preterm (32–36 weeks), and 92 very preterm (< 32 weeks). For the SGA analysis, infants of 8684 mothers were examined with 670 (7.7%) categorized as SGA. The aORs for mothers reporting both household and workplace/school SHS were elevated for preterm (aOR 1.99; 95% CI 1.13–3.50) and moderately preterm birth (32–36 weeks) (aOR 2.17; 95% CI 1.22–3.88). No results for the SGA analysis achieved significance, nor was evidence of interaction evident. Conclusion The findings suggest an association between SHS from multiple exposure sources and preterm birth, but no evidence for association with SGA births. Continued study of SHS and ABOs is needed to best inform public health prevention programs.


Preterm birth Small-for-gestational age Environmental tobacco smoke Secondhand smoke Passive smoking 



This publication was supported in part through a cooperative agreement (Grant No. U01DD000494) between the Centers for Disease Control and Prevention and the Texas Department of State Health Services (DSHS). The creation of caffeine variables used was supported by Grant No. DK56350 from the Nutrition Epidemiology Core of the University of North Carolina Clinical Nutrition Research Center. The authors thank the assistance of Dr. Michele L. Herdt and Mr. Jean-Pierre Munsie, funded by the New York State Department of Health, who provided assistance with code used to select working mothers and students in the NBDPS. We also thank the assistance of Mr. Shady Al-Sayyed and Ms. Van Le who assisted with preparing the manuscript for journal submission. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Adrienne T. Hoyt
    • 1
  • Mark A. Canfield
    • 1
  • Paul A. Romitti
    • 2
  • Lorenzo D. Botto
    • 3
  • Marlene T. Anderka
    • 4
  • Sergey V. Krikov
    • 3
  • Marcia L. Feldkamp
    • 3
  1. 1.Birth Defects Epidemiology and Surveillance BranchTexas Department of State Health ServicesAustinUSA
  2. 2.Department of Epidemiology, College of Public HealthThe University of IowaIowa CityUSA
  3. 3.Division of Medical Genetics, Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUSA
  4. 4.Massachusetts Center for Birth Defects Research and PreventionMassachusetts Department of Public HealthBostonUSA

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