title: Association of tobacco use and other determinants with pregnancy outcomes: a multicentre hospital-based case-control study in Karachi, Pakistan.
abstract: The study aimed to identify the effects of maternal tobacco consumption during pregnancy and other factors on birth outcomes and obstetric complications in Karachi, Pakistan.
  
  
  
  A multicentre hospital-based case-control study.
  
  
  
  Four leading maternity hospitals of Karachi.
  
  
  
  A random sample of 1275 women coming to the gynaecology and obstetric department of selected hospitals for delivery was interviewed within 48 hours of delivery from wards. Cases were women with adverse birth outcomes and obstetric complications, while controls were women who had normal uncomplicated delivery.
  
  
  
  Adverse birth outcomes (preterm delivery, low birth weight, stillbirth, low Apgar score) and obstetric complications (antepartum haemorrhage, caesarean section, etc).
  
  
  
  Final multiple logistic regression analysis revealed that with every 1 year increase in age the odds of being a case was 1.03 times as compared with being a control. Tobacco use (adjusted OR (aOR): 2.24; 95% CI 1.56 to 3.23), having no slits in the kitchen (proxy indicator for indoor air pollution) (aOR=1.90; 95% CI 1.05 to 3.43), gravidity (aOR=0.83; 95% CI 0.73 to 0.93), non-booked hospital cases (aOR=1.87; 95% CI 1.38 to 2.74), history of stillbirth (aOR=4.06; 95% CI 2.36 to 6.97), miscarriages (aOR=1.91; 95% CI 1.27 to 2.85) and preterm delivery (aOR=6.04; 95% CI 2.52 to 14.48) were significantly associated with being a case as compared with control.
  
  
  
  This study suggests that women who had adverse pregnancy outcomes were more likely to have exposure to tobacco, previous history of adverse birth outcomes and were non-booked cases. Engagement of stakeholders in tobacco control for providing health education, incorporating tobacco use in women in the tobacco control policy and designing interventions for tobacco use cessation is warranted. Prenatal care and health education might help in preventing such adverse events.
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan.
authors.forename: Shafquat
authors.initials: S
authors.lastname: Rozi
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Zahid Ahmad
authors.initials: ZA
authors.lastname: Butt
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan.
authors.forename: Nida
authors.initials: N
authors.lastname: Zahid
authors.affiliation: Faculty of Biostatistics, College of Science and Health Professions, King Saud Bin Abdulaziz University, Riyadh, Saudi Arabia.
authors.forename: Saba
authors.initials: S
authors.lastname: Wasim
authors.affiliation: School of Public Health, Dow University of Health Sciences, Karachi, Sindh, Pakistan Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK.
authors.forename: Kashif
authors.initials: K
authors.lastname: Shafique
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D015984:Causality; D015897:Comorbidity; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D010154:Pakistan / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology*; D064424:Tobacco Use / Q000453:epidemiology*; D055815:Young Adult
keywords: Maternal tobacco use; Other risk factors; Pregnancy outcome