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Smoking during Pregnancy Is Associated with a Decreased Incidence of Obstetric Anal Sphincter Injuries in Nulliparous Women

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  • Sari Räisänen
  • Katri Vehviläinen-Julkunen
  • Mika Gissler
  • Seppo Heinonen

Abstract

Background: Smoking is a modifiable lifestyle factor that has been shown to be associated with adverse perinatal outcomes and to have adverse health and dose-dependent connective tissue effects. The objective of this study was to examine whether smoking during pregnancy was associated with the incidence of obstetric anal sphincter injuries (OASIS) among six birthweight groups in singleton vaginal deliveries, considering nulliparous and multiparous women separately between 1997 and 2007 in Finland. Methodology: A retrospective population-based register study. Populations included women with spontaneous singleton vaginal deliveries, consisting of all 213,059 nulliparous and all 288,391 multiparous women. Incidence of OASIS (n = 2,787) between smoking status groups was adjusted using logistic regression analyses. Principal Findings: Of the nulliparous women, 13.1% were smokers, 3.6% had given up smoking during the first trimester of their pregnancy and 81.1% were non-smokers. Among these groups 0.7%, 0.9% and 1.1%, respectively suffered OASIS (p≤0.001). Nulliparous women who smoked had a 28% (95% CI 16–38%, p≤0.001) lower risk of OASIS compared to non-smokers, when adjusting for background variables. In multiparous women, the overall frequencies of OASIS were much lower (0.0–0.2%). A similar inverse relationship between OASIS rates and smoking was significant in pooled univariate analysis of multiparous women, but multivariate analysis revealed statistically insignificant results between non-smokers and smokers. Conclusions: Nulliparous women who were smokers had a 28% lower incidence of OASIS. However, smoking during pregnancy cannot be recommended since it has shown to be associated with other adverse pregnancy outcomes and adverse health effects. The observed association warrants clinical repetition studies and, if confirmed, also in vitro studies focusing on connective tissue properties at a molecular and cellular level.

Suggested Citation

  • Sari Räisänen & Katri Vehviläinen-Julkunen & Mika Gissler & Seppo Heinonen, 2012. "Smoking during Pregnancy Is Associated with a Decreased Incidence of Obstetric Anal Sphincter Injuries in Nulliparous Women," PLOS ONE, Public Library of Science, vol. 7(7), pages 1-8, July.
    • Handle: RePEc:plo:pone00:0041014
    DOI: 10.1371/journal.pone.0041014
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    References listed on IDEAS

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    1. Jonathan Millar & Soeren Mattke, 2004. "Selecting Indicators for Patient Safety at the Health Systems Level in OECD Countries," OECD Health Technical Papers 18, OECD Publishing.
    2. Jaakkola, N. & Jaakkola, M.S. & Gissler, M. & Jaakkola, J.J.K., 2001. "Smoking during pregnancy in Finland: Determinants and trends, 1987-1997," American Journal of Public Health, American Public Health Association, vol. 91(2), pages 284-286.
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    Cited by:

    1. Sari Räisänen & Rufus Cartwright & Mika Gissler & Michael R Kramer & Seppo Heinonen, 2013. "The Burden of OASIS Increases along with Socioeconomic Position – Register-Based Analysis of 980,733 Births in Finland," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-7, August.

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