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Neonatal-Perinatal Health Care Delivery: Epidemiology/Health Services Research

Neonatal-Perinatal Health Care Delivery 3: Epi/HSR Antenatal Exposures and Neonatal Outcomes

754 - Association of maternal cigarette smoking with neonatal death

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 754
Publication Number: 754.246

Qiqi Shi, children's hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Ran Wang, Children's hospital of Fuan University, Shanghai, Shanghai, China (People's Republic)

Presenting Author(s)

Qiqi Shi, PhD (he/him/his)

Resident
Children's Hospital of Fudan University
Shanghai, Shanghai, China (People's Republic)

Background: Maternal pregnancy smoking have adverse perinatal outcomes and the relationship between maternal smoking and neonatal death have not been fully elucidated.

Objective: We aimed to examine the risk of neonatal death in relation to maternal smoking and to quantify potential mediators of these associations.

Design/Methods: We did a population-based cohort study using Period Linked Birth-Infant Death data from 2016 to 2019 in the US National Vital Statistics System. All mothers in the database who had a singleton live birth from January 1, 2016, to December 31, 2019, were included. The exposure was maternal smoking status. The main outcome was neonatal death. Association between maternal smoking and neonatal death was estimated through logistic regression. Mediation analysis was performed to assess the extent to which the association between maternal smoking and neonatal death was mediated by neonatal complications.

Results: The final sample consisted of 14717020 mothers with live singleton births. The overall neonatal mortality rate, early neonatal mortality rate and late neonatal mortality rate was 2.2, 1.6 and 0.5 per 1000 live births, respectively. Maternal pregnancy smoking was associated with an increased risk of neonatal death (aOR, 1.33 [95%CI, 1.28-1.38]; P< .001), while smoking cessation during the whole pregnancy showed a comparable risk of neonatal death with non-smokers (aOR,1.06 [95%CI, 0.99-1.14]; P=0.116). In terms of timing and intensity of smoking, significant associations of neonatal death were found for maternal pregnancy smoking during each trimester. Further mediation analysis indicated that the association between pregnancy smoking and neonatal death might be mainly mediated by preterm birth and low Apgar score at 5min.

Conclusion(s): Maternal pregnancy smoking, regardless of pregnancy trimester and intensity, was associated with increased risk of neonatal death. Efforts are needed for policymakers to promote smoking cessation before pregnancy and professional perinatal care should be provided for those who smoked during pregnancy.