European Journal of Epidemiology

, Volume 31, Issue 10, pp 999–1009 | Cite as

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

  • Maria Morales-Suárez-VarelaEmail author
  • Ellen A. Nohr
  • Bodil H. Bech
  • Chunsen Wu
  • Jørn Olsen


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.


Cohort study Danish National Birth Cohort Pregnancy Mother/father’s smoking Foetal programming Foetal death 



Body mass index


Confidence interval


Danish Medical Birth Registry


Danish National Birth Cohort


General practitioner


Hazard ratio


Adjusted hazard ratio


Interaction contrast ratio

M+− and F+−

Smoking status among mothers and fathers


National Hospital Discharge Register



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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

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


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Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Maria Morales-Suárez-Varela
    • 1
    • 2
    • 3
    Email author
  • Ellen A. Nohr
    • 4
  • Bodil H. Bech
    • 5
  • Chunsen Wu
    • 5
  • Jørn Olsen
    • 5
  1. 1.Unit of Public Health and Environmental Care, Department of Preventive MedicineUniversity of ValenciaBurjasotSpain
  2. 2.CIBER Epidemiology and Public Health (CIBERESP)MadridSpain
  3. 3.Centre for Public Health Research (CSISP-FISABIO)ValenciaSpain
  4. 4.Research Unit for Gynaecology and Obstetrics, Institute of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
  5. 5.Section for Epidemiology, Department of Public HealthUniversity of AarhusAarhusDenmark

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