Skip to main content
American Journal of Public Health logoLink to American Journal of Public Health
. 1997 Jan;87(1):29–32. doi: 10.2105/ajph.87.1.29

Maternal smoking during pregnancy and limb reduction malformations in Sweden.

K Källén 1
PMCID: PMC1380760  PMID: 9065222

Abstract

OBJECTIVE: This study was undertaken to investigate a possible connection between different types of limb reduction defects and maternal smoking during pregnancy. METHODS: With the use of the Swedish health registries, 610 cases of limb reduction malformations were selected from among 1 109 299 infants born between 1983 and 1993 with known smoking exposure in early pregnancy. Confounders such as maternal age and parity were controlled for with the use of the Mantel-Haenszel technique. RESULTS: The odds ratio for any maternal smoking among all cases of limb reductions was 1.26 (95% confidence interval = 1.06, 1.50). The main subgroups of limb reduction defects showed similar odds ratios, but in longitudinal reduction defect, only unilateral cases showed an association with maternal smoking. CONCLUSIONS: This study supports an association between maternal smoking and limb reduction malformations, but further work is needed before a causal inference can be made.

Full text

PDF
29

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Chasnoff I. J., Chisum G. M., Kaplan W. E. Maternal cocaine use and genitourinary tract malformations. Teratology. 1988 Mar;37(3):201–204. doi: 10.1002/tera.1420370304. [DOI] [PubMed] [Google Scholar]
  2. Christianson R. E. The relationship between maternal smoking and the incidence of congenital anomalies. Am J Epidemiol. 1980 Nov;112(5):684–695. doi: 10.1093/oxfordjournals.aje.a113041. [DOI] [PubMed] [Google Scholar]
  3. Clarren S. K., Smith D. W. The fetal alcohol syndrome. N Engl J Med. 1978 May 11;298(19):1063–1067. doi: 10.1056/NEJM197805112981906. [DOI] [PubMed] [Google Scholar]
  4. Cnattingius S., Ericson A., Gunnarskog J., Källén B. A quality study of a medical birth registry. Scand J Soc Med. 1990 Jun;18(2):143–148. doi: 10.1177/140349489001800209. [DOI] [PubMed] [Google Scholar]
  5. Cnattingius S., Haglund B., Meirik O. Cigarette smoking as risk factor for late fetal and early neonatal death. BMJ. 1988 Jul 23;297(6643):258–261. doi: 10.1136/bmj.297.6643.258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Czeizel A. E., Kodaj I., Lenz W. Smoking during pregnancy and congenital limb deficiency. BMJ. 1994 Jun 4;308(6942):1473–1476. doi: 10.1136/bmj.308.6942.1473. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Ericson A., Gunnarskog J., Källén B., Otterblad-Olausson P. Surveillance of smoking during pregnancy in Sweden, 1983-1987. Acta Obstet Gynecol Scand. 1991;70(2):111–117. doi: 10.3109/00016349109006191. [DOI] [PubMed] [Google Scholar]
  8. Ericson A., Källén B., Westerholm P. Cigarette smoking as an etiologic factor in cleft lip and palate. Am J Obstet Gynecol. 1979 Oct 1;135(3):348–351. doi: 10.1016/0002-9378(79)90703-8. [DOI] [PubMed] [Google Scholar]
  9. Evans D. R., Newcombe R. G., Campbell H. Maternal smoking habits and congenital malformations: a population study. Br Med J. 1979 Jul 21;2(6183):171–173. doi: 10.1136/bmj.2.6183.171. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Froster U. G., Baird P. A. Amniotic band sequence and limb defects: data from a population-based study. Am J Med Genet. 1993 Jun 15;46(5):497–500. doi: 10.1002/ajmg.1320460507. [DOI] [PubMed] [Google Scholar]
  11. Froster U. G., Jackson L. Limb defects and chorionic villus sampling: results from an international registry, 1992-94. Lancet. 1996 Feb 24;347(9000):489–494. doi: 10.1016/s0140-6736(96)91136-8. [DOI] [PubMed] [Google Scholar]
  12. Hemminki K., Mutanen P., Saloniemi I. Smoking and the occurrence of congenital malformations and spontaneous abortions: multivariate analysis. Am J Obstet Gynecol. 1983 Jan 1;145(1):61–66. doi: 10.1016/0002-9378(83)90340-x. [DOI] [PubMed] [Google Scholar]
  13. Hoyme H. E., Jones K. L., Dixon S. D., Jewett T., Hanson J. W., Robinson L. K., Msall M. E., Allanson J. E. Prenatal cocaine exposure and fetal vascular disruption. Pediatrics. 1990 May;85(5):743–747. [PubMed] [Google Scholar]
  14. Hoyme H. E., Jones K. L., Van Allen M. I., Saunders B. S., Benirschke K. Vascular pathogenesis of transverse limb reduction defects. J Pediatr. 1982 Nov;101(5):839–843. doi: 10.1016/s0022-3476(82)80343-0. [DOI] [PubMed] [Google Scholar]
  15. Janerich D. T., Piper J. M., Glebatis D. M. Oral contraceptives and congenital limb-reduction defects. N Engl J Med. 1974 Oct 3;291(14):697–700. doi: 10.1056/NEJM197410032911403. [DOI] [PubMed] [Google Scholar]
  16. Keeler R. F. Congenital defects in calves from maternal ingestion of Nicotiana glauca of high anabasine content. Clin Toxicol. 1979;15(4):417–426. doi: 10.3109/15563657908989896. [DOI] [PubMed] [Google Scholar]
  17. Kelsey J. L., Dwyer T., Holford T. R., Bracken M. B. Maternal smoking and congenital malformations: an epidemiological study. J Epidemiol Community Health. 1978 Jun;32(2):102–107. doi: 10.1136/jech.32.2.102. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Khoury M. J., Gomez-Farias M., Mulinare J. Does maternal cigarette smoking during pregnancy cause cleft lip and palate in offspring? Am J Dis Child. 1989 Mar;143(3):333–337. doi: 10.1001/archpedi.1989.02150150091023. [DOI] [PubMed] [Google Scholar]
  19. Khoury M. J., Weinstein A., Panny S., Holtzman N. A., Lindsay P. K., Farrel K., Eisenberg M. Maternal cigarette smoking and oral clefts: a population-based study. Am J Public Health. 1987 May;77(5):623–625. doi: 10.2105/ajph.77.5.623. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Kleinman J. C., Pierre M. B., Jr, Madans J. H., Land G. H., Schramm W. F. The effects of maternal smoking on fetal and infant mortality. Am J Epidemiol. 1988 Feb;127(2):274–282. doi: 10.1093/oxfordjournals.aje.a114803. [DOI] [PubMed] [Google Scholar]
  21. Kramer M. S. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ. 1987;65(5):663–737. [PMC free article] [PubMed] [Google Scholar]
  22. Källén B. Maternal epilepsy, antiepileptic drugs and birth defects. Pathologica. 1986 Nov-Dec;78(1058):757–768. [PubMed] [Google Scholar]
  23. Källén B. Search for teratogenic risks with the aid of malformation registries. Teratology. 1987 Feb;35(1):47–52. doi: 10.1002/tera.1420350108. [DOI] [PubMed] [Google Scholar]
  24. Källén B., Winberg J. Dealing with suspicions of malformation frequency increase. Experience with the Swedish register of congenital malformations. Acta Paediatr Scand Suppl. 1979;275:66–74. doi: 10.1111/j.1651-2227.1979.tb06163.x. [DOI] [PubMed] [Google Scholar]
  25. Lenz W., Feldmann U. Unilateral and asymmetric limb defects in man: delineation of the femur-fibula-ulna complex. Birth Defects Orig Artic Ser. 1977;13(1):269–285. [PubMed] [Google Scholar]
  26. Limb-reduction defects and chorion villus sampling. Lancet. 1991 May 4;337(8749):1091–1092. doi: 10.1016/0140-6736(91)91735-D. [DOI] [PubMed] [Google Scholar]
  27. Lubinsky M. S. Explaining certain human limb anomalies and the limb-hematopoiesis community of syndromes using a model of determination. Teratology. 1991 Apr;43(4):295–299. doi: 10.1002/tera.1420430403. [DOI] [PubMed] [Google Scholar]
  28. MANTEL N., HAENSZEL W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959 Apr;22(4):719–748. [PubMed] [Google Scholar]
  29. Malloy M. H., Kleinman J. C., Bakewell J. M., Schramm W. F., Land G. H. Maternal smoking during pregnancy: no association with congenital malformations in Missouri 1980-83. Am J Public Health. 1989 Sep;79(9):1243–1246. doi: 10.2105/ajph.79.9.1243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Menges R. W., Selby L. A., Marienfeld C. J., Aue W. A., Greer D. L. A tobacco related epidemic of congenital limb deformities in swine. Environ Res. 1970 Nov;3(4):285–302. doi: 10.1016/0013-9351(70)90022-8. [DOI] [PubMed] [Google Scholar]
  31. SIMPSON W. J. A preliminary report on cigarette smoking and the incidence of prematurity. Am J Obstet Gynecol. 1957 Apr;73(4):807–815. [PubMed] [Google Scholar]
  32. Sharony R., Garber A., Viskochil D., Schreck R., Platt L. D., Ward R., Buehler B. A., Graham J. M., Jr Preaxial ray reduction defects as part of valproic acid embryofetopathy. Prenat Diagn. 1993 Oct;13(10):909–918. doi: 10.1002/pd.1970131005. [DOI] [PubMed] [Google Scholar]
  33. Stillman R. J., Rosenberg M. J., Sachs B. P. Smoking and reproduction. Fertil Steril. 1986 Oct;46(4):545–566. doi: 10.1016/s0015-0282(16)49628-7. [DOI] [PubMed] [Google Scholar]
  34. Stoll C., Alembik Y., Dott B., Roth M. P. Risk factors in limb reduction defects. Paediatr Perinat Epidemiol. 1992 Jul;6(3):323–338. doi: 10.1111/j.1365-3016.1992.tb00773.x. [DOI] [PubMed] [Google Scholar]
  35. Wang Y., Sassoon D. Ectoderm-mesenchyme and mesenchyme-mesenchyme interactions regulate Msx-1 expression and cellular differentiation in the murine limb bud. Dev Biol. 1995 Apr;168(2):374–382. doi: 10.1006/dbio.1995.1087. [DOI] [PubMed] [Google Scholar]
  36. Werler M. M., Lammer E. J., Rosenberg L., Mitchell A. A. Maternal cigarette smoking during pregnancy in relation to oral clefts. Am J Epidemiol. 1990 Nov;132(5):926–932. doi: 10.1093/oxfordjournals.aje.a115735. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES