Maternal and Child Health Journal

, Volume 17, Issue 9, pp 1591–1598 | Cite as

The Influence of Maternal Smoking and Exposure to Residential ETS on Pregnancy Outcomes: A Retrospective National Study

  • Srmena KrstevEmail author
  • Jelena Marinković
  • Snežana Simić
  • Nikola Kocev
  • Susan J. Bondy


In a nationwide study of Serbian births, in 2008, we estimated the influence of maternal prenatal smoking and environmental tobacco smoke (ETS) exposure on birth outcomes. Using stratified two-stage random cluster sampling, 2,721 women were interviewed in-person (response rates 98.1 %), and 2,613 singleton live births were included. Date of birth, gender, birthweight, birth height and head circumference were copied from the official hospital Birth Certificate. Six exposure categories were defined according to mother’s smoking history and exposure to ETS. We calculated adjusted mean values and group differences by analysis of covariance, and adjusted odds ratios for the low birthweight (LBW < 2,500 g). Compared to the reference category (non-smoking, non-exposed to ETS) we observed birthweight reductions in infants whose mothers smoked continuously during the pregnancy and were exposed to ETS (−162.6 g) and whose mothers were not exposed to ETS (−173 g) (p = 0.000, and p = 0.003, respectively), as well as reduction in birth length (−1.01 and −1.06 cm; p = 0.003 and p = 0.000, respectively). Reduction in birthweight and birth length related to exposure categories was not linear. Adjusted OR for LBW was almost tripled for mothers who smoked over the entire pregnancy and were non-exposed to ETS (aOR 2.85; 95 % CI 1.46–5.08), and who were exposed to ETS (aOR 2.68; 95 % CI 1.15–6.25). Our results showed strong effects of smoking throughout the pregnancy on reduced birthweight, birth length and head circumference, and increased risk for LBW. We were not able to detect an effect for ETS exposure alone.


Pregnancy Smoking Exposure to ETS Pregnancy outcomes 



This study was supported by the Government of Canada through the Canadian International Development Agency (CIDA), realized with the help of the Canadian Public Health Association (CPHA), and conducted by the Public Health Association of Serbia, within the project “Strengthening Balkans Civil Society’s Voice for Public Health through Public Health Associations”. The patronage nurses from all over Serbia collaborated enthusiastically in this survey, and without their involvement, as well as without participation of the post-natal women in Serbia; this survey would not be possible. We would like to thank Ms. Anđelka Kotević, Senior Nurse, on exceptional organisation and coordination of patronage nurses’ work, for their education and overall field work. Without her constant involvement, we would not have been able to provide those nice gifts to all our participants in this survey. Preciseness, punctuality and speed of Inga Mijailović and her colleagues Vladana Đurić, Gordana Lazić, and Aleksandra Vučković in gathering, entry and checking up of data, enabled their timely processing. We received valuable support in conducting the study from Mr. James Chauvin and Ms. Sherryl Smith from the Canadian Public Health Association.


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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Srmena Krstev
    • 1
    • 2
    Email author
  • Jelena Marinković
    • 3
    • 2
  • Snežana Simić
    • 4
    • 2
  • Nikola Kocev
    • 3
  • Susan J. Bondy
    • 5
  1. 1.Serbian Institute of Occupational Health “Dr. Dragomir Karajovic”BelgradeSerbia
  2. 2.Public Health Association of SerbiaBelgradeSerbia
  3. 3.Institute of Medical Statistics and Informatics, School of MedicineUniversity of BelgradeBelgradeSerbia
  4. 4.Institute of Social Medicine, School of MedicineUniversity of BelgradeBelgradeSerbia
  5. 5.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada

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