title: Time-to-Pregnancy Associated With Couples' Use of Tobacco Products.
abstract: Previous studies suggest female smoking increases time-to-pregnancy (TTP), a couple-dependent reproductive outcome, while associations with male smoking are more ambiguous. Furthermore, despite small increases in smokeless tobacco use in the United States, no prior study has evaluated TTP among smokeless tobacco users.
  
  
  
  Using population-based sampling in 16 counties in Michigan and Texas, 501 couples discontinuing contraception to become pregnant were followed until positive pregnancy test or 12 months of trying. Participants were interviewed on lifetime and current cigarette, cigar, and chew/snuff (smokeless) use and provided blood samples for quantification of heavy metals and cotinine. Fecundability odds ratios (FORs) and 95% confidence intervals (95% CIs) were estimated, adjusted for demographics/lifestyle. FORs less than 1 reflect longer TTP.
  
  
  
  Eleven percentage of females and 15% of males smoked cigarettes. Among men, 14% smoked cigars, 9% used snuff, and 2% used chew. Compared with never tobacco users, male (FOR: 0.41, 95% CI: 0.24, 0.68) and female (FOR: 0.53, 95% CI: 0.33, 0.85) smoking were individually associated with longer TTP; males' smoking remained significant (FOR: 0.46, 95% CI: 0.27, 0.79) when modeling partners together. Cadmium levels were higher in smokers than smokeless tobacco and never users; adjusting for cadmium attenuated the cigarette-TTP association, particularly among women. TTP was shorter among smokeless tobacco users relative to smokers (FOR: 2.86, 95% CI: 1.47, 5.57).
  
  
  
  Compared with never users, smokeless tobacco did not alter TTP in our cohort; however, TTP was shorter compared with smokers. We observed longer TTP in male and female smokers; cadmium may partially contribute.
  
  
  
  Both partners' preconception smoking contributed to longer TTP, highlighting the importance of both partners' lifestyles in healthy reproduction and underscores the need for couple-based preconception guidance. The male's contribution is a new finding. Higher cadmium levels may partially contribute to longer TTP in smokers, particularly among females. Though we do not observe longer TTP among a small sample of smokeless tobacco users compared with never tobacco users, we observe shorter TTP compared with smokers. Further work is needed to more thoroughly delineate the relationship between smokeless tobacco use and TTP and possible mechanisms of tobacco use's effects on reproduction.
authors.affiliation: Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Sapra
authors.affiliation: Rollins School of Public Health, Emory University , Atlanta, GA.
authors.forename: Dana B
authors.initials: DB
authors.lastname: Barr
authors.affiliation: Glotech, Inc. , Rockville, MD.
authors.forename: José M
authors.initials: JM
authors.lastname: Maisog
authors.affiliation: Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD.
authors.forename: Rajeshwari
authors.initials: R
authors.lastname: Sundaram
authors.affiliation: Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD.
authors.forename: Germaine M
authors.initials: GM
authors.lastname: Buck Louis
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D003367:Cotinine / Q000097:blood; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007246:Infertility / Q000097:blood / Q000209:etiology*; D008297:Male; D008824:Michigan; D008875:Middle Aged; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects*; D013781:Texas; D061685:Time-to-Pregnancy; D014029:Tobacco Use Disorder / Q000150:complications; D014030:Tobacco, Smokeless / Q000009:adverse effects
chemical_list: D015415:Biomarkers; D003367:Cotinine