title: Cigarette smoking and risk of gestational diabetes: a systematic review of observational studies.
abstract: BACKGROUND
  Gestational diabetes is a prevalent disease associated with adverse outcomes of pregnancy. Smoking as been associated with glucose intolerance during pregnancy in some but not all studies. Therefore, we aimed to systematically review all epidemiological evidence to examine the association between cigarette smoking during pregnancy and risk of developing gestational diabetes mellitus.
  
  
  METHODS
  We conducted a systematic review of articles published up to 2007, using PubMed, Embase, LILACS e CINAHL to identify the articles. Because this review focuses on studies of smoking during pregnancy, we excluded studies evaluating smoking outside pregnancy. Two investigators independently abstracted information on participant's characteristics, assessment of exposure and outcome, and estimates for the association under study. We evaluated the studies for publication bias and performed heterogeneity analyses. We also assessed the effect of each study individually through sensitivity analysis.
  
  
  RESULTS
  We found and critically reviewed 32 studies, of which 12 met the criteria for inclusion in the review. Most of the studies provided only unadjusted measurements. Combining the results of the individual studies, we obtained a crude odds ratio of 1.03 (99% CI 0.85-1.25). Only 4 studies presented adjusted measurements of association, and no association was found when these alone were analyzed (OR 0.95; 99% CI 0.85-1.07). Subgroup analysis could not be done due to small sample size.
  
  
  CONCLUSIONS
  The number of studies is small, with major heterogeneity in research design and findings. Taken together, current data do not support an association between cigarette smoking during pregnancy and the risk of gestational diabetes.
authors.affiliation: Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. eliana.wendland@ufrgs.br
authors.forename: Eliana M
authors.initials: EM
authors.lastname: Wendland
authors.forename: Maria Eugênia
authors.initials: ME
authors.lastname: Pinto
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Duncan
authors.forename: José M
authors.initials: JM
authors.lastname: Belizán
authors.forename: Maria Inês
authors.initials: MI
authors.lastname: Schmidt
mesh_terms: D016640:Diabetes, Gestational / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D014943:Global Health; D006801:Humans; D015994:Incidence; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology