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Revisiting the Effect of Maternal Smoking during Pregnancy on Offspring Birthweight: A Quasi-Experimental Sibling Analysis in Sweden

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  • Sol Pía Juárez
  • Juan Merlo

Abstract

Maternal smoking during pregnancy (SDP) seems associated with reduced birthweight in the offspring. This observation, however, is based on conventional epidemiological analyses, and it might be confounded by unobserved maternal characteristics related to both smoking habits and offspring birth weight. Therefore, we apply a quasi-experimental sibling analysis to revisit previous findings. Using the Swedish Medical Birth Register, we identified 677,922 singletons born between 2002 and 2010 from native Swedish mothers. From this population, we isolated 62,941 siblings from 28,768 mothers with discrepant habits of SDP. We applied conventional and mother-specific multilevel linear regression models to investigate the association between maternal SDP and offspring birthweight. Depending on the mother was light or heavy smoker and the timing of exposition during pregnancy (i.e., first or third trimester), the effect of smoking on birthweight reduction was between 6 and 78 g less marked in the sibling analysis than in the conventional analysis. Sibling analysis showed that continuous smoking reduces birthweight by 162 grams for mothers who were light smokers (1 to 9 cigarettes per day) and 226 g on average for those who were heavy smokers throughout the pregnancy in comparison to non-smoker mothers. Quitting smoking during pregnancy partly counteracted the smoking-related birthweight reduction by 1 to 29 g, and a subsequent smoking relapse during pregnancy reduced birthweight by 77 to 83 g. The sibling analysis provides strong evidence that maternal SDP reduces offspring birthweight, though this reduction was not as great as that observed in the conventional analysis. Our findings support public health interventions aimed to prevent SDP and to persuade those who already smoke to quit and not relapse throughout the pregnancy. Besides, further analyses are needed in order to explain the mechanisms through which smoking reduces birthweight and to identify other maternal characteristics that are common causes of both birthweight reduction and maternal smoking.

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  • Sol Pía Juárez & Juan Merlo, 2013. "Revisiting the Effect of Maternal Smoking during Pregnancy on Offspring Birthweight: A Quasi-Experimental Sibling Analysis in Sweden," PLOS ONE, Public Library of Science, vol. 8(4), pages 1-7, April.
    • Handle: RePEc:plo:pone00:0061734
    DOI: 10.1371/journal.pone.0061734
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    References listed on IDEAS

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    1. Shiono, P.H. & Rauh, V.A. & Park, M. & Lederman, S.A. & Zuskar, D., 1997. "Ethnic differences in birthweight: The role of lifestyle and other factors," American Journal of Public Health, American Public Health Association, vol. 87(5), pages 787-793.
    2. William J. Browne & Fiona Steele & Mousa Golalizadeh & Martin J. Green, 2009. "The use of simple reparameterizations to improve the efficiency of Markov chain Monte Carlo estimation for multilevel models with applications to discrete time survival models," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 172(3), pages 579-598, June.
    3. Merlo, Juan & Ohlsson, Henrik & Chaix, Basile & Lichtenstein, Paul & Kawachi, Ichiro & Subramanian, S.V., 2013. "Revisiting causal neighborhood effects on individual ischemic heart disease risk: A quasi-experimental multilevel analysis among Swedish siblings," Social Science & Medicine, Elsevier, vol. 76(C), pages 39-46.
    4. Kahn, R.S. & Certain, L. & Whitaker, R.C., 2002. "A reexamination of smoking before, during, and after pregnancy," American Journal of Public Health, American Public Health Association, vol. 92(11), pages 1801-1808.
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    1. Jeffrey E. Harris & Ana Balsa & Patricia Triunfo, 2014. "Campaña antitabaco en Uruguay:Impacto en la decisión de dejar de fumar durante el embarazo y en el peso al nacer," Documentos de Trabajo (working papers) 0114, Department of Economics - dECON.
    2. Leah K. Lakdawala & David Simon, 2016. "The Intergenerational Consequences of Tobacco Policy," Working papers 2016-27, University of Connecticut, Department of Economics.
    3. Aurélie Nakamura & Olivier François & Johanna Lepeule, 2021. "Epigenetic Alterations of Maternal Tobacco Smoking during Pregnancy: A Narrative Review," IJERPH, MDPI, vol. 18(10), pages 1-19, May.
    4. Hajdu, Tamás & Hajdu, Gábor, 2018. "Smoking ban and health at birth: Evidence from Hungary," Economics & Human Biology, Elsevier, vol. 30(C), pages 37-47.
    5. Jeffrey E. Harris & Ana Inés Balsa & Patricia Triunfo, 2014. "Tobacco Control Campaign in Uruguay: Impact on Smoking Cessation during Pregnancy," NBER Working Papers 19878, National Bureau of Economic Research, Inc.
    6. Pramesh Raj Ghimire & Julie Mooney & Louise Fox & Lorraine Dubois, 2021. "Smoking Cessation during the Second Half of Pregnancy Prevents Low Birth Weight among Australian Born Babies in Regional New South Wales," IJERPH, MDPI, vol. 18(7), pages 1-14, March.
    7. Harris, Jeffrey E. & Balsa, Ana Inés & Triunfo, Patricia, 2015. "Tobacco control campaign in Uruguay: Impact on smoking cessation during pregnancy and birth weight," Journal of Health Economics, Elsevier, vol. 42(C), pages 186-196.

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