title: Associations of lifetime active and passive smoking with spontaneous abortion, stillbirth and tubal ectopic pregnancy: a cross-sectional analysis of historical data from the Women's Health Initiative.
abstract: OBJECTIVE
  To examine the associations between tobacco exposure and adverse pregnancy outcomes using quantitative measures of lifetime active smoking and secondhand smoke (SHS) exposure.
  
  
  METHODS
  Historical reproductive data on 80 762 women who participated in the Women's Health Initiative Observational Study were examined with a cross-sectional analysis. We assessed self-reported lifetime active and passive tobacco smoke exposure, self-reported spontaneous abortions, stillbirths and ectopic pregnancies.
  
  
  RESULTS
  When compared with never-smoking women, participants who were ever active smokers during their reproductive years had ORs (OR) of 1.16 (95% CI 1.08 to 1.26) for 1 or more spontaneous abortions, 1.44 (95% CI 1.20 to 1.73) for 1 or more stillbirths, and 1.43 (95% CI 1.10 to 1.86) for 1 or more ectopic pregnancies. Never-smoking women participants with the highest levels of lifetime SHS exposure, including childhood >10 years, adult home >20 years and adult work exposure >10 years, when compared with never-smoking women with no SHS exposure had adjusted ORs of 1.17 (95% CI 1.05 to 1.30) for spontaneous abortion, 1.55 (95% CI 1.21 to 1.97) for stillbirth, and 1.61 (95% CI 1.16 to 2.24) for ectopic pregnancy.
  
  
  CONCLUSIONS
  Women who were ever-smokers during their reproductive years had significantly greater estimates of risk for spontaneous abortion, stillbirth and tubal ectopic pregnancy. Never-smoking women with the highest levels of lifetime exposure to SHS had significantly increased estimates of risk for spontaneous abortion, stillbirth and tubal ectopic pregnancy.
authors.affiliation: Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Buffalo, Roswell Park Cancer Institute, New York, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hyland
authors.affiliation: Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Buffalo, Roswell Park Cancer Institute, New York, USA.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Piazza
authors.affiliation: Department of Social & Preventive Medicine, University at Buffalo School of Public Health & Health Professions, Buffalo, New York, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Hovey
authors.affiliation: Division of Preventive & Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Judith K
authors.initials: JK
authors.lastname: Ockene
authors.affiliation: University at Buffalo School of Public Health & Health Professions, Department of Biostatistics, Buffalo, New York, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Andrews
authors.affiliation: Department of Health Behavior, Division of Cancer Prevention & Population Sciences, Buffalo, Roswell Park Cancer Institute, New York, USA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Rivard
authors.affiliation: Department of Social & Preventive Medicine, University at Buffalo School of Public Health & Health Professions, Buffalo, New York, USA.
authors.forename: Jean
authors.initials: J
authors.lastname: Wactawski-Wende
mesh_terms: D000022:Abortion, Spontaneous / Q000139:chemically induced / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000139:chemically induced / Q000453:epidemiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D050497:Stillbirth / Q000453:epidemiology*; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D016387:Women's Health; D055815:Young Adult
chemical_list: D014028:Tobacco Smoke Pollution
keywords: Secondhand smoke; Smoking Caused Disease; Surveillance and monitoring