title: Effect measures for behavioral factors adversely affecting fetal growth.
abstract: The purpose of this study was to estimate the proportion of ultrasonically diagnosed fetal growth retardation that may be attributable to potentially remediable factors (for example, cigarette smoking, alcohol use, and drug addition). We computed multivariate odds ratios for fetal growth retardation associated with cigarette smoking and alcohol and illicit drug consumption in 350 singleton pregnancies complicated by fetal growth retardation and 700 controls. The odds ratio of fetal growth retardation among women who smoked throughout pregnancy was 2.61 (95% confidence interval, 1.38 to 4.93) compared to women who claimed to have stopped smoking by the 18th week of gestation. The summary attributable risk of fetal growth retardation associated with behavioral variables measured during the first trimester and thereafter ranged from 18 to 21%. By implication, the maximum proportion of fetal growth retardation that could theoretically be prevented by eliminating these risk factors accounts for about 1% of all births. However, allowance for the limited modifiability of preventable factors and the consistent overlap between them would probably reduce such estimate to less than 1%. We conclude that only interventions to reduce the prevalence of strong risk factors (for example, preeclampsia, sociodemographic variables) may have a substantial effect on the incidence of impaired fetal growth and subsequent infant morbidity.
authors.affiliation: Clinica Ostetrico-Ginecologica, IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Spinillo
authors.forename: E
authors.initials: E
authors.lastname: Capuzzo
authors.forename: G
authors.initials: G
authors.lastname: Piazzi
authors.forename: F
authors.initials: F
authors.lastname: Baltaro
authors.forename: A
authors.initials: A
authors.lastname: Iasci
authors.forename: S
authors.initials: S
authors.lastname: Nicola
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology; D016216:Ultrasonography, Prenatal; D015430:Weight Gain