title: Maternal exposure to second-hand tobacco smoke and pregnancy outcome among couples undergoing assisted reproduction.
abstract: BACKGROUND
  Exposure to second-hand tobacco smoke is preventable, yet common. This study assessed relationships between maternal exposure to second-hand tobacco smoke and adverse pregnancy outcomes.
  
  
  METHODS
  We measured cotinine (a biomarker of tobacco smoke) in urine from 921 women undergoing assisted reproductive technologies (ARTs) between 1994 and 1998. We also collected information on self-reported exposure to second-hand smoke at home or at work, in addition to parental smoking during the women's childhood.
  
  
  RESULTS
  In crude analysis, creatinine-adjusted cotinine levels were associated with a slight decrease in implantation rate among non-smoking women (11.1% in the lowest cotinine quintile versus 8.2% in the highest cotinine quintile; P=0.13). However, in multivariate logistic regression, cotinine levels above the median were not associated with failed fertilization, failed implantation or spontaneous abortion, nor was there evidence of a dose-response relationship among cotinine quintiles. After excluding women in couples diagnosed with male factor infertility, there were increased odds of having a spontaneous abortion among non-smoking women who reported that both parents smoked while they were children growing up compared with women reporting that neither parent smoked [adjusted odds ratio (OR) = 4.35; 95% confidence interval (CI) = 1.04-18.1].
  
  
  CONCLUSIONS
  Female exposure to second-hand smoke as a child or in utero may be associated with an increased risk of spontaneous abortion in adulthood. However, this may be a chance finding due to multiple comparisons. Similar associations should be explored in additional studies with more refined estimates of childhood and in utero exposure to tobacco smoke.
authors.affiliation: Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA. meekerj@umich.edu
authors.forename: J D
authors.initials: JD
authors.lastname: Meeker
authors.forename: S A
authors.initials: SA
authors.lastname: Missmer
authors.forename: D W
authors.initials: DW
authors.lastname: Cramer
authors.forename: R
authors.initials: R
authors.lastname: Hauser
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology; D000328:Adult; D003367:Cotinine / Q000652:urine; D005260:Female; D006801:Humans; D018811:Maternal Exposure / Q000009:adverse effects*; D011247:Pregnancy; D011256:Pregnancy Outcome; D027724:Reproductive Techniques, Assisted; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
chemical_list: D014028:Tobacco Smoke Pollution; D003367:Cotinine