title: Clustering of socioeconomic, behavioural, and neonatal risk factors for infant health in pregnant smokers.
abstract: BACKGROUND
  Tobacco smoking is a major cause of morbidity and mortality, including during pregnancy. Although effective ways of promoting smoking cessation during pregnancy exist, the impact of these interventions has not been studied at a national level. We estimated the prevalence of smoking throughout pregnancy in the Netherlands and quantified associations of maternal smoking throughout pregnancy with socioeconomic, behavioural, and neonatal risk factors for infant health and development.
  
  
  RESULTS
  Data of five national surveys, containing records of 14,553 Dutch mothers and their offspring were analyzed. From 2001 to 2007, the overall rate of smoking throughout pregnancy fell by 42% (from 13.2% to 7.6%) mainly as a result of a decrease among highly educated women. In the lowest-educated group, the overall rate of smoking throughout pregnancy was six times as high as in the highest-educated group (18.7% versus 3.2%). Prenatal tobacco smoke exposure was associated with increased risk of extremely preterm (<or=28 completed weeks) (OR 7.25; 95% CI 3.40 to 15.38) and small-for-gestational age (SGA) infants (OR 3.08; 95% CI 2.66 to 3.57). Smoking-attributable risk percent in the population (based on adjusted risk ratios) were estimated at 29% for extremely preterm births and at 17% for SGA outcomes. Infants of smokers were more likely to experience significant alcohol exposure in utero (OR 2.08; 95%CI 1.25 to 3.45) and formula feeding in early life (OR 1.91; 95% CI 1.69 to 2.16).
  
  
  CONCLUSIONS
  The rates of maternal smoking throughout pregnancy decreased significantly in the Netherlands from 2001 to 2007. If pregnant women were to cease tobacco use completely, an estimated 29% of extremely preterm births and 17% of SGA infants may be avoided annually.
authors.affiliation: Netherlands Organization of Applied Scientific Research (TNO) Prevention and Health, Leiden, The Netherlands. caren.lanting@tno.nl
authors.forename: Caren I
authors.initials: CI
authors.lastname: Lanting
authors.forename: Simone E
authors.initials: SE
authors.lastname: Buitendijk
authors.forename: Matty R
authors.initials: MR
authors.lastname: Crone
authors.forename: Dewi
authors.initials: D
authors.lastname: Segaar
authors.forename: Jack
authors.initials: J
authors.lastname: Bennebroek Gravenhorst
authors.forename: Jacobus P
authors.initials: JP
authors.lastname: van Wouwe
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology; D016000:Cluster Analysis; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007223:Infant; D041943:Infant Formula; D007229:Infant Welfare / Q000191:economics*; D007231:Infant, Newborn; D016015:Logistic Models; D008425:Maternal Behavior; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D012907:Smoking / Q000191:economics* / Q000453:epidemiology*; D012959:Socioeconomic Factors