Skip to main content

Advertisement

SpringerLink
Log in

Smoking and Preterm Birth

  • Review
  • Published:
Reproductive Sciences Aims and scope Submit manuscript

Abstract

Premature birth is a significant global problem and the leading cause of newborn deaths. Tobacco smoking has been associated with premature birth for over 50 years. The mechanisms through which smoking exerts its effects on pregnancy outcomes remain unclear. In this review, we discuss rates of prematurity and smoking in pregnancy, the evidence of a causal relationship between tobacco and preterm birth, and proposed biochemical pathways through which the interaction is mediated. The suggested mechanisms include nicotine-induced vasoconstriction, carbon monoxide–induced fetal hypoxia, cadmium disruption of calcium signaling, altered steroid hormone production, disruption of prostaglandin synthesis, and changed responses to oxytocin. The relative importance of each of these pathways is yet to be ascertained. Further research is necessary to explore the mechanisms through which smoking exerts its effect on gestational length and the process of parturition. Moreover, the risks of nicotine replacement in pregnancy should be investigated further.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Blencowe H, Cousens S, Oestergaard MZ, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet. 2012;379(9832):2162–2172.

    Article  PubMed  Google Scholar 

  2. Howson CP KM, Lawn JE, eds. March of Dimes, PMNCH, Save the Children, WHO. Born to Soon: The Global Action Report on Preterm Birth. Geneva: World Health Organization;2012.

  3. Simpson WJ, Linda L. A preliminary report on cigarette smoking and the incidence of prematurity. Am J Obstet Gynecol. 1957;73(4):807–815.

    Article  CAS  PubMed  Google Scholar 

  4. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;371(9606):75–84.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Berkowitz GS, Papiernik E. Epidemiology of preterm birth. Epidemiol Rev. 1993;15(2):414–443.

    Article  CAS  PubMed  Google Scholar 

  6. Lorenz JM, Wooliever DE, Jetton JR, Paneth N. A quantitative review of mortality and developmental disability in extremely premature newborns. Arch Pediatr Adolesc Med. 1998;152(5):425–435.

    Article  CAS  PubMed  Google Scholar 

  7. Henderson JJ MO, Newnham JP, Pennell CE. Preterm birth aetiology 2004–2008. Maternal factors associated with three phenotypes: spontaneous preterm labour, preterm pre-labour rupture of membranes and medically indicated preterm birth. J Matern Fetal Neonatal Med. 2012;25(6):642–647.

    Article  PubMed  Google Scholar 

  8. Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med. 2000;342(20):1500–1507.

    Article  CAS  PubMed  Google Scholar 

  9. Romero R, Espinoza J, Kusanovic JP, et al. The preterm parturition syndrome. BJOG. 2006;113(suppl 3):17–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Smith LK, Draper ES, Manktelow BN, Dorling JS, Field DJ. Socioeconomic inequalities in very preterm birth rates. Arch Dis Child Fetal Neonatal Ed. 2007;92(1):F11-F14.

    Article  CAS  PubMed  Google Scholar 

  11. Kyrklund-Blomberg NB, Cnattingius S. Preterm birth and maternal smoking: risks related to gestational age and onset of delivery. Am J Obstet Gynecol. 1998;179(4):1051–1055.

    Article  CAS  PubMed  Google Scholar 

  12. Castles A, Adams EK, Melvin CL, Kelsch C, Boulton ML. Effects of smoking during pregnancy. Five meta-analyses. Am J Prev Med. 1999;16(3):208–215.

    Article  CAS  PubMed  Google Scholar 

  13. Cnattingius S. The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine Tob Res. 2004;6(suppl 2):S125–S140.

    Article  PubMed  Google Scholar 

  14. World Health Organisation. Report on the Global Tobacco Epidemic - the MPOWER Package. Geneva: World Health Organisation;2008.

    Google Scholar 

  15. Salihu HM, Wilson RE. Epidemiology of prenatal smoking and perinatal outcomes. Early Hum Dev. 2007;83(11):713–720.

    Article  CAS  PubMed  Google Scholar 

  16. Lambers DS, Clark KE. The maternal and fetal physiologic effects of nicotine. Semin Perinatol. 1996;20(2):115–126.

    Article  CAS  PubMed  Google Scholar 

  17. Chan B, Einarson A, Koren G. Effectiveness of bupropion for smoking cessation during pregnancy. J Addict Dis. 2005;24(2):19–23.

    Article  PubMed  Google Scholar 

  18. Been JV, Nurmatov UB, Cox B, Nawrot TS, van Schayck CP, Sheikh A. Effect of smoke-free legislation on perinatal and child health: a systematic review and meta-analysis. Lancet. 2014;383(9928):1549–1560.

    Article  PubMed  Google Scholar 

  19. Mackay DF, Nelson SM, Haw SJ, Pell JP. Impact of Scotland’s smoke-free legislation on pregnancy complications: retrospective cohort study. PLoS Med. 2012;9(3): e1001175.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Page RL II, Slejko JF, Libby AM. A citywide smoking ban reduced maternal smoking and risk for preterm births: a Colorado natural experiment. J Womens Health (Larchmt). 2012;21(6):621–627.

    Article  Google Scholar 

  21. Cox B, Martens E, Nemery B, Vangronsveld J, Nawrot TS. Impact of a stepwise introduction of smoke-free legislation on the rate of preterm births: analysis of routinely collected birth data. BMJ. 2013;346:f441.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bharadwaj P, Johnsen J, Løken K. Smoking Bans, Maternal Smoking and Birth Outcomes. Bonn, Germany: Institute for the Study of Labor (IZA);2012.

    Book  Google Scholar 

  23. Shah NR, Bracken MB. A systematic review and meta-analysis of prospective studies on the association between maternal cigarette smoking and preterm delivery. Am J Obstet Gynecol. 2000;182(2):465–472.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Eliopoulos C, Klein J, Phan MK, et al. Hair concentrations of nicotine and cotinine in women and their newborn infants. JAMA. 1994;271(8):621–623.

    Article  CAS  PubMed  Google Scholar 

  25. Benowitz NL. Cotinine as a biomarker of environmental tobacco smoke exposure. Epidemiol Rev. 1996;18(2):188–204.

    Article  CAS  PubMed  Google Scholar 

  26. Florescu A, Ferrence R, Einarson T, Selby P, Soldin O, Koren G. Methods for quantification of exposure to cigarette smoking and environmental tobacco smoke: focus on developmental toxicology. Ther Drug Monit. 2009;31(1):14–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Patrick DL, Cheadle A, Thompson DC, Diehr P, Koepsell T, Kinne S. The validity of self-reported smoking: a review and meta-analysis. Am J Public Health. 1994;84(7):1086–1093.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Lindqvist R, Lendahls L, Tollbom O, Aberg H, Håkansson A. Smoking during pregnancy: comparison of self-reports and cotinine levels in 496 women. Acta Obstet Gynecol Scand. 2002;81(3):240–244.

    Article  PubMed  Google Scholar 

  29. Bardy AH, Seppälä T, Lillsunde P, et al. Objectively measured tobacco exposure during pregnancy: neonatal effects and relation to maternal smoking. Br J Obstet Gynaecol. 1993;100(8):721–726.

    Article  CAS  PubMed  Google Scholar 

  30. Shipton D, Tappin DM, Vadiveloo T, Crossley JA, Aitken DA, Chalmers J. Reliability of self reported smoking status by pregnant women for estimating smoking prevalence: a retrospective, cross sectional study. BMJ. 2009;339:b4347.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Al-Delaimy WK. Hair as a biomarker for exposure to tobacco smoke. Tob Control. 2002;11(3):176–182.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Al-Delaimy WK, Mahoney GN, Speizer FE, Willett WC. Toenail nicotine levels as a biomarker of tobacco smoke exposure. Cancer Epidemiol Biomarkers Prev. 2002;11(11):1400–1404.

    CAS  PubMed  Google Scholar 

  33. Parazzini F, Davoli E, Rabaiotti M, et al. Validity of self-reported smoking habits in pregnancy: a saliva cotinine analysis. Acta Obstet Gynecol Scand. 1996;75(4):352–354.

    Article  CAS  PubMed  Google Scholar 

  34. Velicer WF, Prochaska JO, Rossi JS, Snow MG. Assessing outcome in smoking cessation studies. Psychol Bull. 1992;111(1):23–41.

    Article  CAS  PubMed  Google Scholar 

  35. Secker-Walker RH, Vacek PM, Flynn BS, Mead PB. Smoking in pregnancy, exhaled carbon monoxide, and birth weight. Obstet Gynecol. 1997;89(5 pt 1):648–653.

    Article  CAS  PubMed  Google Scholar 

  36. Gariti P, Rosenthal DI, Lindell K, et al. Validating a dipstick method for detecting recent smoking. Cancer Epidemiol Biomarkers Prev. 2002;11(10 pt 1):1123–1125.

    PubMed  Google Scholar 

  37. Seidman DS, Paz I, Merlet-Aharoni I, Vreman H, Stevenson DK, Gale R. Noninvasive validation of tobacco smoke exposure in late pregnancy using end-tidal carbon monoxide measurements. J Perinatol. 1999;19(5):358–361.

    Article  CAS  PubMed  Google Scholar 

  38. Jarvis M. Absorption of nicotine and carbon monoxide from passive smoking under natural conditions of exposure. Thorax. 1983;38(11):829–833.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Deveci SE, Deveci F, Açik Y, Ozan AT. The measurement of exhaled carbon monoxide in healthy smokers and non-smokers. Respir Med. 2004;98(6):551–556.

    Article  PubMed  Google Scholar 

  40. Bailey BA. Using expired air carbon monoxide to determine smoking status during pregnancy: preliminary identification of an appropriately sensitive and specific cut-point. Addict Behav. 2013;38(10):2547–2550.

    Article  PubMed  Google Scholar 

  41. Ostrea EM, Knapp DK, Romero A, Montes M, Ostrea AR. Meconium analysis to assess fetal exposure to nicotine by active and passive maternal smoking. J Pediatr. 1994;124(3):471–476.

    Article  CAS  PubMed  Google Scholar 

  42. Stevens KR, Muñoz LR. Cigarette smoking: Evidence to guide measurement. Res Nurs Health. 2004;27(4):281–292.

    Article  PubMed  Google Scholar 

  43. Goldstein H, Goldberg ID, Frazier TM, Davis GE. Cigarette smoking and prematurity. Public Health Rep. 1964;79:553–560.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ. 1987;65(5):663–737.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. McIntosh ID.Smoking and pregnancy: II. Offspring risks. Public Health Rev. 1984;12(1):29–63.

    CAS  PubMed  Google Scholar 

  46. Cnattingius S, Granath F, Petersson G, Harlow BL. The influence of gestational age and smoking habits on the risk of subsequent preterm deliveries. N Engl J Med. 1999;341(13):943–948.

    Article  CAS  PubMed  Google Scholar 

  47. Lumley J, Oliver SS, Chamberlain C, Oakley L. Interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev. 2004;(4):CD001055.

    Google Scholar 

  48. Salmasi G, Grady R, Jones J, McDonald SD, Group KS. Environmental tobacco smoke exposure and perinatal outcomes: a systematic review and meta-analyses. Acta Obstet Gynecol Scand. 2010;89(4):423–441.

    Article  PubMed  Google Scholar 

  49. Kharrazi M, DeLorenze GN, Kaufman FL, et al. Environmental tobacco smoke and pregnancy outcome. Epidemiology. 2004;15(6):660–670.

    Article  PubMed  Google Scholar 

  50. Fantuzzi G, Aggazzotti G, Righi E, et al. Preterm delivery and exposure to active and passive smoking during pregnancy: a case-control study from Italy. Paediatr Perinat Epidemiol. 2007;21(3):194–200.

    Article  PubMed  Google Scholar 

  51. Leonardi-Bee J, Smyth A, Britton J, Coleman T. Environmental tobacco smoke and fetal health: systematic review and metaanalysis. Arch Dis Child Fetal Neonatal Ed. 2008;93(5): F351–F361.

    Article  CAS  PubMed  Google Scholar 

  52. Ward C, Lewis S, Coleman T. Prevalence of maternal smoking and environmental tobacco smoke exposure during pregnancy and impact on birth weight: retrospective study using Millennium Cohort. BMC Public Health. 2007;7:81.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Conde-Agudelo A, Althabe F, Belizán JM, Kafury-Goeta AC. Cigarette smoking during pregnancy and risk of preeclampsia: a systematic review. Am J Obstet Gynecol. 1999;181(4):1026–1035.

    Article  CAS  PubMed  Google Scholar 

  54. Honein MA, Rasmussen SA, Reefhuis J, et al. Maternal smoking and environmental tobacco smoke exposure and the risk of orofacial clefts. Epidemiology. 2007;18(2):226–233.

    Article  PubMed  Google Scholar 

  55. Malik S, Cleves MA, Honein MA, et al. Maternal smoking and congenital heart defects. Pediatrics. 2008;121(4):e810–e816.

    Article  PubMed  Google Scholar 

  56. Flenady V, Koopmans L, Middleton P, et al. Major risk factors for stillbirth in high-income countries: a systematic review and metaanalysis. Lancet. 2011;377(9774):1331–1340.

    Article  PubMed  Google Scholar 

  57. Pineles BL, Park E, Samet JM. Systematic review and metaanalysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. Am J Epidemiol. 2014;179(7):807–823.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Andres RL, Day MC. Perinatal complications associated with maternal tobacco use. Semin Neonatol. 2000;5(3):231–241.

    Article  CAS  PubMed  Google Scholar 

  59. Benowitz NL, Dempsey DA, Goldenberg RL, et al. The use of pharmacotherapies for smoking cessation during pregnancy. Tob Control. 2000;9(suppl 3):III91–III94.

    PubMed  PubMed Central  Google Scholar 

  60. Longo LD. The biological effects of carbon monoxide on the pregnant woman, fetus, and newborn infant. Am J Obstet Gynecol. 1977;129(1):69–103.

    Article  CAS  PubMed  Google Scholar 

  61. Bernard C. [Lessons on the effects of toxic and medicinal substances. 1857]. Cah Anesthesiol. 1991;39(1):55–60.

    CAS  PubMed  Google Scholar 

  62. Liu S, Krewski D, Shi Y, Chen Y, Burnett RT. Association between gaseous ambient air pollutants and adverse pregnancy outcomes in Vancouver, Canada. Environ Health Perspect. 2003;111(14):1773–1778.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. George L, Granath F, Johansson AL, Cnattingius S. Self-reported nicotine exposure and plasma levels of cotinine in early and late pregnancy. Acta Obstet Gynecol Scand. 2006;85(11):1331–1337.

    Article  CAS  PubMed  Google Scholar 

  64. Luck W, Nau H, Hansen R, Steldinger R. Extent of nicotine and cotinine transfer to the human fetus, placenta and amniotic fluid of smoking mothers. Dev Pharmacol Ther. 1985;8(6):384–395.

    Article  CAS  PubMed  Google Scholar 

  65. Suzuki K, Minei LJ, Johnson EE. Effect of nicotine upon uterine blood flow in the pregnant rhesus monkey. Am J Obstet Gynecol. 1980;136(8):1009–1013.

    Article  CAS  PubMed  Google Scholar 

  66. Resnik R, Brink GW, Wilkes M. Catecholamine-mediated reduction in uterine blood flow after nicotine infusion in the pregnant ewe. J Clin Invest. 1979;63(6):1133–1136.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Albuquerque CA, Smith KR, Johnson C, Chao R, Harding R. Influence of maternal tobacco smoking during pregnancy on uterine, umbilical and fetal cerebral artery blood flows. Early Hum Dev. 2004;80(1):31–42.

    Article  PubMed  Google Scholar 

  68. Lymperopoulou A, Hainaut F, Crimail P, Durand JL, Locatelli C, Maison C. [Smoking and pregnancy: search for a correlation between cotininemia and Doppler findings]. J Gynecol Obstet Biol Reprod (Paris). 1996;25(8):824–827.

    CAS  Google Scholar 

  69. Krishna K. Tobacco chewing in pregnancy. Br J Obstet Gynaecol. 1978;85(10):726–728.

    Article  CAS  PubMed  Google Scholar 

  70. Gupta PC, Subramoney S, Sreevidya S. Smokeless tobacco use, birth weight, and gestational age: population based, prospective cohort study of 1217 women in Mumbai, India. BMJ. 2004;328(7455):1538.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Coleman T, Cooper S, Thornton JG, et al. A randomized trial of nicotine-replacement therapy patches in pregnancy. N Engl J Med. 2012;366(9):808–818.

    Article  CAS  PubMed  Google Scholar 

  72. England LJ, Levine RJ, Mills JL, Klebanoff MA, Yu KF, Cnattingius S. Adverse pregnancy outcomes in snuff users. Am J Obstet Gynecol. 2003;189(4):939–943.

    Article  PubMed  Google Scholar 

  73. Holm H, Jarvis MJ, Russell MA, Feyerabend C. Nicotine intake and dependence in Swedish snuff takers. Psychopharmacology (Berl). 1992;108(4):507–511.

    Article  CAS  Google Scholar 

  74. Asmussen I, Kjeldsen K. Intimal ultrastructure of human umbilical arteries. Observations on arteries from newborn children of smoking and nonsmoking mothers. Circ Res. 1975;36(5):579–589.

    Article  CAS  PubMed  Google Scholar 

  75. Naeye RL. Effects of maternal cigarette smoking on the fetus and placenta. Br J Obstet Gynaecol. 1978;85(10):732–737.

    Article  CAS  PubMed  Google Scholar 

  76. Hadley CB, Main DM, Gabbe SG. Risk factors for preterm premature rupture of the fetal membranes. Am J Perinatol. 1990;7(4):374–379.

    Article  CAS  PubMed  Google Scholar 

  77. Lopez Bernal A. Mechanisms of labour–biochemical aspects. BJOG. 2003;110(suppl 20):39–45.

    PubMed  Google Scholar 

  78. Hapangama D, Neilson JP. Mifepristone for induction of labour. Cochrane Database Syst Rev. 2009(3):CD002865.

    Google Scholar 

  79. Challis JR, Sloboda DM, Alfaidy N, et al. Prostaglandins and mechanisms of preterm birth. Reproduction. 2002;124(1):1–17.

    Article  CAS  PubMed  Google Scholar 

  80. Piasek M, Laskey JW. Acute cadmium exposure and ovarian steroidogenesis in cycling and pregnant rats. Reprod Toxicol. 1994;8(6):495–507.

    Article  CAS  PubMed  Google Scholar 

  81. Ng SP, Steinetz BG, Lasano SG, Zelikoff JT. Hormonal changes accompanying cigarette smoke-induced preterm births in a mouse model. Exp Biol Med (Maywood). 2006;231(8):1403–1409.

    Article  Google Scholar 

  82. Menon R, Fortunato SJ, Milne GL, et al. Amniotic fluid eicosanoids in preterm and term births: effects of risk factors for spontaneous preterm labor. Obstet Gynecol. 2011;118(1):121–134.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Menon R, Fortunato SJ, Yu J, et al. Cigarette smoke induces oxidative stress and apoptosis in normal term fetal membranes. Placenta. 2011;32(4):317–322.

    Article  CAS  PubMed  Google Scholar 

  84. Egawa M, Yasuda K, Nakajima T, et al. Smoking enhances oxytocin-induced rhythmic myometrial contraction. Biol Reprod. 2003;68(6):2274–2280.

    Article  CAS  PubMed  Google Scholar 

  85. Sipowicz M, Kostrzewska A, Laudanski T, Akerlund M. Effects of cadmium on myometrial activity of the nonpregnant human. Interactions with calcium and oxytocin. Acta Obstet Gynecol Scand. 1995;74(2):93–96.

    Article  CAS  PubMed  Google Scholar 

  86. Nishijo M, Nakagawa H, Honda R, et al. Effects of maternal exposure to cadmium on pregnancy outcome and breast milk. Occup Environ Med. 2002;59(6):394–396; discussion 397.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. Unterscheider J, O’Donoghue K, Malone FD. Guidelines on Fetal Growth Restriction: A Comparison of Recent National Publications [Published online September 13, 2014]. Am J Perinatol. 2014.

  88. Mullen PD. Maternal smoking during pregnancy and evidence-based intervention to promote cessation. Prim Care. 1999;26(3):577–589.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Obstetrics & Gynaecology, St Michael’s Hospital, Southwell St, BS2 8EG, Bristol, United Kingdom

    Rachel Ion MBBCh & Andrés López Bernal MD, DPhil

  2. School of Clinical Sciences, University of Bristol, Bristol, United Kingdom

    Andrés López Bernal MD, DPhil

Authors
  1. Rachel Ion MBBCh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrés López Bernal MD, DPhil
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rachel Ion MBBCh.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ion, R., Bernal, A.L. Smoking and Preterm Birth. Reprod. Sci. 22, 918–926 (2015). https://doi.org/10.1177/1933719114556486

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1177/1933719114556486

Keywords

Search

Navigation