title: Smoking and adverse maternal and child health outcomes in Brazil.
abstract: BACKGROUND
  Numerous studies from high-income countries document the causal relationship between cigarette smoking during pregnancy and adverse maternal and child health (MCH) outcomes. Less research has been conducted in low and middle income countries, but a burgeoning literature can be found for Brazil.
  
  
  METHODS
  We review Brazilian studies of the prevalence of maternal smoking, the relative risk of smoking-attributable adverse MCH outcomes, and present new estimates for these outcomes, using the attributable fraction method.
  
  
  RESULTS
  We found that Brazilian studies of the relative risks of smoking-attributable adverse MCH outcomes were broadly consistent with previous reviews. Based on a comparison of maternal smoking over time, smoking during pregnancy has declined by about 50% over the last 20 years in Brazil. For 2008, we estimate that 5,352 cases of spontaneous abortion, 10,929 cases of preterm birth, 20,717 cases of low birth weight, and 29 cases of sudden infant death syndrome are attributable to maternal smoking. Between 1989 and 2008, the percent of smoking-attributable adverse MCH outcomes in Brazil was at least halved.
  
  
  CONCLUSIONS
  The results show that over a 20-year period, during which Brazil implemented numerous effective tobacco control measures, the country experienced a dramatic decrease in both maternal smoking prevalence and smoking-attributable adverse MCH outcomes. Countries that implement effective tobacco control measures can expect to reduce both maternal smoking and adverse MCH outcomes, thereby improving the public health.
authors.affiliation: Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC;
authors.forename: David
authors.initials: D
authors.lastname: Levy
authors.forename: Miao
authors.initials: M
authors.lastname: Jiang
authors.forename: Andre
authors.initials: A
authors.lastname: Szklo
authors.forename: Liz Maria
authors.initials: LM
authors.lastname: de Almeida
authors.forename: Mariana
authors.initials: M
authors.lastname: Autran
authors.forename: Michele
authors.initials: M
authors.lastname: Bloch
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002669:Child Welfare; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D018811:Maternal Exposure / Q000009:adverse effects; D008429:Maternal Welfare; D008875:Middle Aged; D011247:Pregnancy; D015995:Prevalence; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D000074606:Smoking Prevention; D055815:Young Adult