title: Does smoking in pregnancy modify the impact of antenatal steroids on neonatal respiratory distress syndrome? Results of the Epipage study.
abstract: OBJECTIVE
  To assess the relation between cigarette smoking during pregnancy and neonatal respiratory distress syndrome (RDS) in very preterm birth, and to analyse the differential effect of antenatal steroids on RDS among smokers and non-smokers.
  
  
  METHODS
  A population based cohort study (the French Epipage study).
  
  
  METHODS
  Regionally defined births in France.
  
  
  METHODS
  A total of 858 very preterm liveborn singletons (27-32 completed weeks of gestation) of the French Epipage study were included in this analysis. The odds ratio for RDS in relation to smoking in pregnancy was estimated using a logistic regression to control for gestational age. The odds ratio for RDS in relation to antenatal steroids was estimated taking into account an interaction between antenatal steroids and cigarette smoking, using multiple logistic regression to control for gestational age, birthweight ratio, main causes of preterm birth, mode of delivery, and sex.
  
  
  RESULTS
  The odds ratio for RDS in relation to smoking in pregnancy adjusted for gestational age (aOR) was 0.59 (95% confidence interval (CI) 0.44 to 0.79). The aOR for RDS in relation to antenatal steroids was 0.31 (95% CI 0.19 to 0.49) in babies born to non-smokers and 0.63 (95% CI 0.38 to 1.05) in those born to smokers; the difference was significant (p = 0.04).
  
  
  CONCLUSIONS
  Cigarette smoking during pregnancy is associated with a decrease in the risk of RDS in very preterm babies. Although antenatal steroids reduce the risk of RDS in babies born to both smokers and non-smokers, the reduction is smaller in those born to smokers.
authors.affiliation: Department of Neonatology, University Hospital, Besançon, France. a.burguet@chu-poitiers.fr
authors.forename: A
authors.initials: A
authors.lastname: Burguet
authors.forename: M
authors.initials: M
authors.lastname: Kaminski
authors.forename: P
authors.initials: P
authors.lastname: Truffert
authors.forename: A
authors.initials: A
authors.lastname: Menget
authors.forename: L
authors.initials: L
authors.lastname: Marpeau
authors.forename: M
authors.initials: M
authors.lastname: Voyer
authors.forename: J C
authors.initials: JC
authors.lastname: Roze
authors.forename: B
authors.initials: B
authors.lastname: Escande
authors.forename: G
authors.initials: G
authors.lastname: Cambonie
authors.forename: J M
authors.initials: JM
authors.lastname: Hascoet
authors.forename: H
authors.initials: H
authors.lastname: Grandjean
authors.forename: G
authors.initials: G
authors.lastname: Breart
authors.forename: B
authors.initials: B
authors.lastname: Larroque
mesh_terms: D005260:Female; D005865:Gestational Age; D006306:Health Surveys; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D016017:Odds Ratio; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D011297:Prenatal Exposure Delayed Effects; D012127:Respiratory Distress Syndrome, Newborn / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D012907:Smoking; D013256:Steroids / Q000627:therapeutic use*
chemical_list: D013256:Steroids