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Smoking, physical exercise, BMI and late foetal death: a study within the Danish National Birth Cohort

  • PERINATAL EPIDEMIOLOGY
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Abstract

The aim of this paper was to estimate the effect of maternal and paternal smoking on foetal death (miscarriage and stillbirth) and to estimate potential interactions with physical exercise and pre-pregnancy body mass index. We selected 87,930 pregnancies from the population-based Danish National Birth Cohort. Information about lifestyle, occupational, medical and obstetric factors was obtained from a telephone interview and data on pregnancy outcomes came from the Danish population based registries. Cox regression was used to estimate the hazard ratios (adjusted for potential confounders) for predominantly late foetal death (miscarriage and stillbirth). An interaction contrast ratio was used to assess potential effect measure modification of smoking by physical exercise and body mass index. The adjusted hazard ratio of foetal death was 1.22 (95 % CI 1.02–1.46) for couples where both parents smoked compared to non-smoking parents (miscarriage: 1.18, 95 % CI 0.96–1.44; stillbirth: 1.32, 95 % CI 0.93–1.89). On the additive scale, we detected a small positive interaction for stillbirth between smoking and body mass index (overweight women). In conclusion, smoking during pregnancy was associated with a slightly higher hazard ratio for foetal death if both parents smoked. This study suggests that smoking may increase the negative effect of a high BMI on foetal death, but results were not statistically significant for the interaction between smoking and physical exercise.

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Abbreviations

BMI:

Body mass index

CI:

Confidence interval

DMBR:

Danish Medical Birth Registry

DNBC:

Danish National Birth Cohort

GP:

General practitioner

HR:

Hazard ratio

HRa:

Adjusted hazard ratio

ICR:

Interaction contrast ratio

M+− and F+−:

Smoking status among mothers and fathers

NHDR:

National Hospital Discharge Register

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Acknowledgments

The Danish National Research Foundation has established the Danish Epidemiology Science Centre that initiated and created the Danish National Birth Cohort. The cohort is furthermore a result of a major grant from this Foundation. Additional support for the Danish National Birth Cohort is obtained from the Pharmacy Foundation, the Egmont Foundation the March of the Dimes Birth Defects Foundation, the Augustinus Foundation, and the Health Foundation.

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Authors and Affiliations

  1. Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Avda. Vicente Andrés Estellés s/n, 46100, Burjasot, Valencia, Spain

    Maria Morales-Suárez-Varela

  2. CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain

    Maria Morales-Suárez-Varela

  3. Centre for Public Health Research (CSISP-FISABIO), Valencia, Spain

    Maria Morales-Suárez-Varela

  4. Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark

    Ellen A. Nohr

  5. Section for Epidemiology, Department of Public Health, University of Aarhus, Aarhus, Denmark

    Bodil H. Bech, Chunsen Wu & Jørn Olsen

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  1. Maria Morales-Suárez-Varela
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  2. Ellen A. Nohr
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Correspondence to Maria Morales-Suárez-Varela.

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Informed consent was obtained from all individual participants included in the study.

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Morales-Suárez-Varela, M., Nohr, E.A., Bech, B.H. et al. Smoking, physical exercise, BMI and late foetal death: a study within the Danish National Birth Cohort. Eur J Epidemiol 31, 999–1009 (2016). https://doi.org/10.1007/s10654-016-0190-2

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  • DOI: https://doi.org/10.1007/s10654-016-0190-2

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