AJOG ReviewsA systematic review and meta-analysis of prospective studies on the association between maternal cigarette smoking and preterm delivery☆
Section snippets
Material and methods
Studies and review articles relating preterm deliveries and maternal smoking were identified with MEDLINE (1966-1997) and by searches of references cited in identified articles. MEDLINE was searched with the subject headings premature labor and smoking , as well as the text words preterm delivery and preterm birth , which resulted in the identification of 104 citations. Any articles containing original data were retrieved in their entirety, with study type ascertained when the full text of the
Results
A total of 64 published articles were identified that reported original data on the association between maternal smoking and preterm delivery. Twenty studies in 21 reports8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28 met all the inclusion criteria and were included for analysis (see Table I). Four studies reported outcomes only in the form of mean gestational age changes for children born to smokers versus nonsmokers. Whereas these data support the association
Comment
A truncated dose-response trend was observed when studies were separated into 3 groups of low, medium, and heavy smoking. It is possible that heterogeneity in design and execution of studies masked a dose-response relationship that, whereas it was apparent within individual studies, was less evident in the pooled groups. The heaviest smokers had an association between smoking and preterm delivery that was essentially the same as that for moderate smokers. An alternate explanation lies in the
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Reprint requests: Michael B. Bracken, PhD, MPH, Department of Epidemiology and Public Health, Yale University, 60 College St, Suite 415, PO Box 208034, New Haven, CT 06520-8034.