title: Smoking during pregnancy is associated with a decreased incidence of obstetric anal sphincter injuries in nulliparous women.
abstract: BACKGROUND
  Smoking is a modifiable lifestyle factor that has been shown to be associated with adverse perinatal outcomes and to have adverse health and dose-dependent connective tissue effects. The objective of this study was to examine whether smoking during pregnancy was associated with the incidence of obstetric anal sphincter injuries (OASIS) among six birthweight groups in singleton vaginal deliveries, considering nulliparous and multiparous women separately between 1997 and 2007 in Finland.
  
  
  METHODS
  A retrospective population-based register study. Populations included women with spontaneous singleton vaginal deliveries, consisting of all 213,059 nulliparous and all 288,391 multiparous women. Incidence of OASIS (n = 2,787) between smoking status groups was adjusted using logistic regression analyses.
  
  
  RESULTS
  Of the nulliparous women, 13.1% were smokers, 3.6% had given up smoking during the first trimester of their pregnancy and 81.1% were non-smokers. Among these groups 0.7%, 0.9% and 1.1%, respectively suffered OASIS (p≤0.001). Nulliparous women who smoked had a 28% (95% CI 16-38%, p≤0.001) lower risk of OASIS compared to non-smokers, when adjusting for background variables. In multiparous women, the overall frequencies of OASIS were much lower (0.0-0.2%). A similar inverse relationship between OASIS rates and smoking was significant in pooled univariate analysis of multiparous women, but multivariate analysis revealed statistically insignificant results between non-smokers and smokers.
  
  
  CONCLUSIONS
  Nulliparous women who were smokers had a 28% lower incidence of OASIS. However, smoking during pregnancy cannot be recommended since it has shown to be associated with other adverse pregnancy outcomes and adverse health effects. The observed association warrants clinical repetition studies and, if confirmed, also in vitro studies focusing on connective tissue properties at a molecular and cellular level.
authors: Department of Nursing, Savonia University of Applied Sciences, Iisalmi, Finland. sari.raisanen@savonia.fi
authors: Sari
authors: S
authors: Räisänen
authors: Katri
authors: K
authors: Vehviläinen-Julkunen
authors: Mika
authors: M
authors: Gissler
authors: Seppo
authors: S
authors: Heinonen
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D001724:Birth Weight; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods; D004841:Episiotomy; D005260:Female; D006801:Humans; D015994:Incidence; D015233:Models, Statistical; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology*; D010298:Parity; D011247:Pregnancy; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D012306:Risk; D012907:Smoking