SynthesisHuman reproduction update
Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls.
Synthesis in Human reproduction update. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 274 papers, 18 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Assessing the Impact of Smoke-free Legislation on Perinatal Health in the Netherlands
The Role of the Gut Microbiome in Post-smoking Weight Gain
Who cites it
274 citing papers in PubMed, 18 syntheses or guidelines pooled it.
- Secondhand smoke exposure and human health: an umbrella review.Nature human behaviour · 2026Pooled it
- Evidence-based behaviour change techniques to aid smoking cessation for pregnant women with mental illness: a systematic review.BMC pregnancy and childbirth · 2026Pooled it
- Association between prenatal environmental tobacco smoke exposure and preterm birth: A systematic review and meta-analysis.Acta obstetricia et gynecologica Scandinavica · 2025Pooled it
- Maternal modifiable factors and risk of congenital heart defects: systematic review and causality assessment.BMJ open · 2024Pooled it
- A meta-analysis of the effects of vitamin C supplementation for pregnant smokers on the pulmonary function of their offspring.BMC pregnancy and childbirth · 2024Pooled it
- Maternal Cigarette Smoking and Cleft Lip and Palate: A Systematic Review and Meta-Analysis.The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association · 2022Pooled it
- Maternal smoking status during pregnancy and low birth weight in offspring: systematic review and meta-analysis of 55 cohort studies published from 1986 to 2020.World journal of pediatrics : WJP · 2022Pooled it
- Health outcomes of smoking during pregnancy and the postpartum period: an umbrella review.BMC pregnancy and childbirth · 2021Pooled it
- Environmental Risk Factors and Congenital Heart Disease: An Umbrella Review of 165 Systematic Reviews and Meta-Analyses With More Than 120 Million Participants.Frontiers in cardiovascular medicine · 2021Pooled it
- Association between active tobacco use during pregnancy and infant respiratory health: a systematic review and meta-analysis.BMJ open · 2020Pooled it
- Pooled it
- Association between maternal smoking and child bone mineral density: a systematic review and meta-analysis.Environmental science and pollution research international · 2020Pooled it
- Interventions for congenital talipes equinovarus (clubfoot).The Cochrane database of systematic reviews · 2020Pooled it
- Folate, vitamin B12, and homocysteine in smoking-exposed pregnant women: A systematic review.Maternal & child nutrition · 2019Pooled it
- Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2017.Journal of atherosclerosis and thrombosis · 2018Guideline
- The etiology of idiopathic congenital talipes equinovarus: a systematic review.Journal of orthopaedic surgery and research · 2018Pooled it
- Exposure to Nitrogen Oxide in the First Trimester and Risk of Cardiovascular-Related Malformations: A Dose-Response Meta-Analysis of Observational Studies.BioMed research international · 2018Pooled it
- Maternal Use of Opioids During Pregnancy and Congenital Malformations: A Systematic Review.Pediatrics · 2017Pooled it
- Examining characteristics associated with quitting smoking during pregnancy and relapse postpartum.Addictive behaviors · 2018Trial
- Trial
214 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND ; There is uncertainty over whether maternal smoking is associated with birth defects. We conducted the first ever comprehensive systematic review to establish which specific malformations are associated with smoking. METHODS ; Observational studies published 1959-2010 were identified (Medline), and included if they reported the odds ratio (OR) for having a non-chromosomal birth defect among women who smoked during pregnancy compared with non-smokers. ORs adjusted for potential confounders were extracted (e.g. maternal age and alcohol), otherwise unadjusted estimates were used. One hundred and seventy-two articles were used in the meta-analyses: a total of 173 687 malformed cases and 11 674 332 unaffected controls. RESULTS ; Significant positive associations with maternal smoking were found for: cardiovascular/heart defects [OR 1.09, 95% confidence interval (CI) 1.02-1.17]; musculoskeletal defects (OR 1.16, 95% CI 1.05-1.27); limb reduction defects (OR 1.26, 95% CI 1.15-1.39); missing/extra digits (OR 1.18, 95% CI 0.99-1.41); clubfoot (OR 1.28, 95% CI 1.10-1.47); craniosynostosis (OR 1.33, 95% CI 1.03-1.73); facial defects (OR 1.19, 95% CI 1.06-1.35); eye defects (OR 1.25, 95% CI 1.11-1.40); orofacial clefts (OR 1.28, 95% CI 1.20-1.36); gastrointestinal defects (OR 1.27, 95% CI 1.18-1.36); gastroschisis (OR 1.50, 95% CI 1.28-1.76); anal atresia (OR 1.20, 95% CI 1.06-1.36); hernia (OR 1.40, 95% CI 1.23-1.59); and undescended testes (OR 1.13, 95% CI 1.02-1.25). There was a reduced risk for hypospadias (OR 0.90, 95% CI 0.85-0.95) and skin defects (OR 0.82, 0.75-0.89). For all defects combined the OR was 1.01 (0.96-1.07), due to including defects with a reduced risk and those with no association (including chromosomal defects). CONCLUSIONS ; Birth defects that are positively associated with maternal smoking should now be included in public health educational materials to encourage more women to quit before or during pregnancy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.