Maternal smoking and congenital heart defects Article DOI:
Cite this article as: Källén, K. Eur J Epidemiol (1999) 15: 731. doi:10.1023/A:1007671631188 Abstract
The Swedish Child Cardiology Registry (CCR) and the Swedish Medical Birth Registry (MBR) were used to investigate a possible association between maternal smoking during pregnancy and congenital heart defects. Among 1,413,811 infants born in 1983–1996 with known smoking exposure in early pregnancy, 3384 infants with congenital heart defects were selected (458 term infants with persistent ductus arteriosus (PDA) identified from MBR or CCR, and 2926 infants with other heart defects, identified from CCR). After controlling for year of birth, maternal age, parity, and educational level, a weak, statistically significant association between all heart defects and maternal smoking was found (odds ratio (OR): 1.09; 95% confidence interval (CI): 1.01–1.19). When infants with isolated PDA were removed from the case group the significance disappeared (OR: 1.07; 95% CI: 0.98–1.17). For truncus abnormalities (OR: 1.23; 95% CI: 1.02–1.49), atrial septal defects (OR: 1.63; 95% CI: 1.04–2.57), and PDA (OR: 1.30; 95% CI: 1.05–1.62), a rather strong effect of maternal smoking was indicated. The increased OR for PDA remained when gestational duration and intrauterine growth was also controlled for. Further research based on independent data sets is needed to conclude whether the risk estimates for maternal smoking are true and truly differ between the groups. The classification system used (with 24 classes) is described in enough detail to permit a repetition of the study.
Classification Congenital heart defects Malformation Registry Smoking References
Ericson A, Källén B, Westerholm P. Cigarette smoking as an etiologic factor in cleft lip and palate. Am J Obstet Gynecol 1979; 135: 348–351.
Khoury MJ, Weinstein A, Panny S, Holtzman NA, Lindsay PK, Farrel K, Eisenberg M. Maternal cigarette smoking and oral clefts: A population-based study. Am J Public Health 1987; 77: 623–625.
Khoury MJ, Gomez-Farias M, Mulinare J. Does maternal cigarette smoking during pregnancy cause cleft lip and palate in offspring? Am J Dis Child 1989; 143: 333–337.
Keels MA. The role of cigarette smoking during pregnancy in the etiology of cleft lip with or without cleft palate. [Dissertation]. Univ. of North Carolina at Chapel Hill: 1991.
Källén K. Maternal smoking and orofacial clefts. Cleft Palate J 1997; 34: 11–16.
Aro T. Incidence, secular trends and risk indicators of reduction limb defects. Health Services Research by the Helsinki: National Board of Health in Finland, 1984.
Czeizel A, Kodaj I, Lenz W. Smoking during pregnancy and congenital limb deficiency. Br Med J 1994; 308: 1473–1476.
Källén K. Limb reduction malformations and maternal smoking during pregnancy. Am J Public Health 1997; 87: 29–32.
Li DK, Mueller BA, Hickok DE, Daling JR, Fantel AG, Checkoway H, Weiss NS. Maternal smoking during pregnancy and the risk of congenital urinary tract anomalies. Am J Public Health 1996; 86: 249–253.
Källén K. Maternal smoking and urinary organ malformations. Int J Epidemiol 1997; 26: 571–574.
Lilja GMC. Single umbilical artery and maternal smoking. Br Med J 1991; 302: 569–570.
Fedrick J, Alberman ED, Goldstein H. Possible teratogenic effect of cigarette smoking. Nature 1971; 231: 529–530.
Kelsey JL, Dwyer T, Holford TR. Maternal smoking and congenital malformations: An epidemiological study. J Epidemiol Commun Health 1978; 32: 102–107.
Evans DR, Newcombe RG, Campbell H. Maternal smoking habits and congenital malformations: A population study. Br Med J 1979; 2: 171–173.
Christianson RE. The relationship between maternal smoking and the incidence of congenital anomalies. Am J Epidemiol 1980; 112: 684–695.
Malloy MH, Kleinman JC, Bakewell JM, Schramm WF, Land GH: Maternal smoking during pregnancy: No association with congenital malformations in Missouri 1980–1983. Am J Public Health 1989; 79: 1243–1246.
Van den Eeden SK, Karagas MR, Daling JR, Vaughan TL. A case-control study of maternal smoking and congenital malformations. Paedtr Perinatal Epidemiol 1990; 4: 147–155.
Shiono PH, Klebanoff MA, Berendes HW. Congenital malformations and maternal smoking during pregnancy. Teratology 1986; 34: 65–71.
Tikkanen J, Heinonen OP. Maternal exposure to chemical and physical factors during pregnancy and cardiovascular malformations in the offspring. Teratology 1991; 43: 591–600.
Pradat P. A case-control study of major congenital heart defects in Sweden — 1981–1986. Eur J Epidemiol 1992; 8: 789–796.
Pradat P. Epidemiological characteristics of major congenital heart defects [Dissertation]. Lund, Sweden: University of Lund, 1994.
Wasserman CR, Shaw GM, O Malley CD, Tolarova MM, Lammer EJ. Parental cigarette smoking and risk for congenital anomalies of the heart, neural tube, or limb. Teratology 1996; 53: 261–267.
Carlgren LE, Ericson A, Källén B. Monitoring of congenital cardiac defects. Pediatr Cardiol 1987; 8: 247–256.
International Society of Cardiology. Classification of heart disease in childhood. The Netherlands: VRB Offsetdrukkerij, Groningen, 1970.
Cnattingius S, Ericson A, Gunnarskog J, Källén B. A quality study of a medical birth registry. Scand J Soc Med 1990; 18: 143–148.
Källén B. A birth weight for gestational age standard based on data in the Swedish Medical Birth Registry, 1985–1989. Eur J Epidemiol 1995; 11: 601–606.
Miettinen OS. Simple interval estimation of risk ratio. Am J Epidem. 1974; 100: 515–516.
Fyler DC, Buckley LP, Hellenbrand WE, Cohn HE, Kirklin JW, Nadas AS, Cartier JM, Breibart MH. Report of the New England regional infant cardiac program. Pediatrics 1980; 65[suppl]: 375–461.
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