Table 1.
Maternal smoking and congenital heart disease: Main findings from the literature.
| Author Ref. | Article Type | All CHDs or Any CHD Subtypes | Study Limitations |
|---|---|---|---|
| Hackshaw et al. [12] | Systematic review | All CHDs: Pooled OR: 1.09 (25% CI: 1.02, 1.17) | As per Zhang et al. |
| Lee et al. [13] | Meta-analysis | All CHDs: Pooled RR 1.11 (95% CI: 1.02, 1.21) Any SD: Pooled RR 1.44 (95% CI: 1.16, 1.79) |
As per Zhang et al. Some early studies are very small. |
| Zhang et al. [14] | Meta-analysis | All CHDs: Pooled RR 1.1 (95% CI: 1.04, 1.18), TGA: Pooled RR 1.24 (CI: 1.00, 1.54). Any SD: pooled RR 1.21 (CI: 1.01, 1.46). |
Studies have low heterogeneity and generally do not consider effect of genetics, change in smoking volume, all confounding factors, exposure to passive smoking or pregnancy ending in death. |
| Mei-Dan et al. [15] | Retrospective cohort study | All CHDs: 1.5% vs. 0.8%, p < 0.05 | Did not consider genetics or many other confounding factors. |
| Sullivan et al. [16] | Population-based study | All CHDs: OR 1.16 (95% CI: 1.08, 1.24) ASDs: OR 1.22 (25% CI: 1.08, 1.38) |
Possible inadequate classification of CHDs; used self-reported smoking status; likely inadequate confounding factors. |
| Leite et al. [17] | Population-based cohort study | All CHDs: OR 1.13 (95% CI: 1.07, 1.19) | Did not consider genetics or many other confounding factors. |
| Arimandnia et al. [18] | Case control study | All CHDs: No association for maternal smoking gestation days 1–45 | Questionnaire-based study so possible recall bias. |
| Hoyt et al. [19] | Population-based case control study | ASDs: Second hand smoke exposure ORs: 1.37 (95% CI: 1.09, 1.72) | No data on extent of exposure, so no calculation of dose response effect. Interviews conducted some time after the birth—possibility of recall bias. |
| Cresci et al. [20] | Case control study | All CHDs: Paternal smoking: OR 2.1 (95% CI: 1.3, 3.5). Second hand smoke exposure: Maternal OR 2.6 (25% CI: 1.6, 4.2); paternal OR 2.5 (25% CI: 1.6, 3.8); combined OR 4.5 (95% CI: 2.5, 8.3). |
Smoke exposure self-reported. |
| Deng et al. [21] | Hospital-based case control study of paternal smoking | Conotruncal defects: OR 2.23 (95% CI: 1.05, 4.73) Septal defects: OR 2.04 (95% CI: 1.05, 3.98) Left ventricular outflow tract obstruction: OR 13.12 (25% CI 2.55, 67.39) |
Not representative of population. Possible recall bias. Other maternal exposure not excluded. |
Abbreviations: TGA: Transposition of the great arteries; SD: Septal defect; ASD: Atrial septal defect.