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Am J Public Health. 2000 March; 90(3): 395–400.
PMCID: PMC1446170

Maternal smoking and adverse birth outcomes among singletons and twins.


OBJECTIVES: This study assessed the effects of maternal smoking on birth outcomes among singletons and twins. METHODS: An algorithm was developed to link twins with their siblings in the 1995 Perinatal Mortality Data Set. A random-effects logistic regression model was then used to estimate the association between maternal smoking and several adverse outcomes for a random sample of singletons and for all twins with available maternal smoking information. RESULTS: The algorithm successfully linked sibling pairs for 91% of the twin sample. Maternal smoking was associated with a significantly increased risk of low birthweight, very low birthweight, and gestation of less than 33 weeks for both singletons and twins and with an increased risk of gestation of less than 38 weeks, infant mortality, and placental abruption for singletons. Among smokers, negative impacts on the risk of low birthweight, very low birthweight, and extreme premature delivery were significantly higher for women carrying twins. CONCLUSIONS: Some of the negative effects of smoking on low birthweight and preterm delivery are greater for twins than for singletons. Women carrying twins should be warned that smoking increases their already high risk of serious infant health problems.

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Selected References

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  • Hoyert DL. Medical and life-style risk factors affecting fetal mortality, 1989-90. Vital Health Stat 20. 1996 Aug;(31):1–32. [PubMed]
  • Floyd RL, Rimer BK, Giovino GA, Mullen PD, Sullivan SE. A review of smoking in pregnancy: effects on pregnancy outcomes and cessation efforts. Annu Rev Public Health. 1993;14:379–411. [PubMed]
  • Ananth CV, Savitz DA, Luther ER. Maternal cigarette smoking as a risk factor for placental abruption, placenta previa, and uterine bleeding in pregnancy. Am J Epidemiol. 1996 Nov 1;144(9):881–889. [PubMed]
  • Floyd RL, Zahniser SC, Gunter EP, Kendrick JS. Smoking during pregnancy: prevalence, effects, and intervention strategies. Birth. 1991 Mar;18(1):48–53. [PubMed]
  • Ness RB, Grisso JA, Hirschinger N, Markovic N, Shaw LM, Day NL, Kline J. Cocaine and tobacco use and the risk of spontaneous abortion. N Engl J Med. 1999 Feb 4;340(5):333–339. [PubMed]
  • Lambers DS, Clark KE. The maternal and fetal physiologic effects of nicotine. Semin Perinatol. 1996 Apr;20(2):115–126. [PubMed]
  • Guyer B, Martin JA, MacDorman MF, Anderson RN, Strobino DM. Annual summary of vital statistics--1996. Pediatrics. 1997 Dec;100(6):905–918. [PubMed]
  • Luke B, Keith LG. The contribution of singletons, twins and triplets to low birth weight, infant mortality and handicap in the United States. J Reprod Med. 1992 Aug;37(8):661–666. [PubMed]
  • Olsen J, Bønnelykke B, Nielsen J. Tobacco smoking and twinning. Acta Med Scand. 1988;224(5):491–494. [PubMed]
  • James WH. An hypothesis on the association between maternal smoking and dizygotic twinning. Hum Reprod. 1997 Jul;12(7):1391–1392. [PubMed]
  • Rydhstroem H, Källén K. The effect of maternal smoking on birth weight in twin pregnancies. Early Hum Dev. 1996 Sep 20;46(1-2):43–53. [PubMed]
  • Orlebeke JF, Boomsma DI, Van Baal GC, Bleker OP. Effect of maternal smoking on birth weight of twins: a study from the Dutch Twin Register. Early Hum Dev. 1994 Jun;37(3):161–166. [PubMed]
  • Luke B, Leurgans S. Maternal weight gains in ideal twin outcomes. J Am Diet Assoc. 1996 Feb;96(2):178–181. [PubMed]
  • Mushinski M. Trends in multiple births. Stat Bull Metrop Insur Co. 1994 Jul-Sep;75(3):28–35. [PubMed]
  • Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986 Mar;42(1):121–130. [PubMed]
  • Rockhill B, Newman B, Weinberg C. Use and misuse of population attributable fractions. Am J Public Health. 1998 Jan;88(1):15–19. [PMC free article] [PubMed]
  • Zhang J, Yu KF. What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998 Nov 18;280(19):1690–1691. [PubMed]
  • Kogan MD, Alexander GR, Kotelchuck M, Nagey DA. Relation of the content of prenatal care to the risk of low birth weight. Maternal reports of health behavior advice and initial prenatal care procedures. JAMA. 1994 May 4;271(17):1340–1345. [PubMed]
  • O'Campo P, Davis MV, Gielen AC. Smoking cessation interventions for pregnant women: review and future directions. Semin Perinatol. 1995 Aug;19(4):279–285. [PubMed]
  • Marks JS, Koplan JP, Hogue CJ, Dalmat ME. A cost-benefit/cost-effectiveness analysis of smoking cessation for pregnant women. Am J Prev Med. 1990 Sep-Oct;6(5):282–289. [PubMed]
  • Kendrick JS, Zahniser SC, Miller N, Salas N, Stine J, Gargiullo PM, Floyd RL, Spierto FW, Sexton M, Metzger RW, et al. Integrating smoking cessation into routine public prenatal care: the Smoking Cessation in Pregnancy project. Am J Public Health. 1995 Feb;85(2):217–222. [PMC free article] [PubMed]
  • Weissfeld JL, Holloway JJ, Kirscht JP. Effects of deceptive self-reports of quitting on the results of treatment trials for smoking: a quantitative assessment. J Clin Epidemiol. 1989;42(3):231–243. [PubMed]

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