Smoking during pregnancy and congenital limb deficiency

BMJ 1994;308:1473-1476 (4 June)

Papers

Smoking during pregnancy and congenital limb deficiency

A E Czeizel, I Kodaj, W Lenz

Department of Human Genetics and Teratology, National Institute of Hygiene - WHO Collaborating Centre for Community Control of Hereditary Diseases, Budapest, Hungary Department of Gynaecology and Obstetrics, State Hospital, Budapest, Hungary Institut fur Humangenetik, Westfalische Wilhelms University, Munster, Germany Correspondence to: Dr Czeizel, OKI, Gyali ut 2-6, Budapest, 1966-Hungary.

Abstract

Objective : To examine genetic and environmental factors inthe origin of isolated congenital limb deficiencies.
Design : Case-control study with questionnaire at a familyinterview of cases of isolated congenital limb deficiencies(six types), negative controls (matched for age, sex, and placeof residence), and positive controls (cases of sentinel anomalies).
Setting : The database of the Hungarian Congenital AbnormalityRegistry, 1975-84, complemented by three other sources of ascertainment(1575 904 births).
Subjects : 537 case-control pairs; 392 positive controls.
Main outcome measures : Smoking during pregnancy, congenitallimb deficiencies.
Results : The adjusted rate of smoking during pregnancy wassignificantly higher in the mothers of cases of terminal transversedefect (relative odds 1.48; 95% confidence interval 0.98 to2.23; P=0.017). This finding supports the hypothesis of vasculardisruption as a cause of congenital limb deficiency.
Conclusions : Maternal smoking during pregnancy raises therelative odds for terminal transverse20limb deficiencies.

Clinical implications

Clinical implications
About one fifth of Hungarian women smoke during pregnancy
Maternal smoking during pregnancy causes lower birth weight and a higher rate of perinatal mortality, but the teratogenic effect has not been proved
In this case-control study six groups of cases with validated congenital limb deficiency were evaluated
Smoking during pregnancy was 60% more common among mothers of children with terminal transverse defect
The relative odds ratio of 1.5 reflects an important public health contribution in such a common exposure as smoking

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Relevant Article

Smoking during pregnancy and congenital limb deficiency: P Lee
BMJ 1994 309: 476. [Extract] [Full Text]

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Lee, P (1994). Smoking during pregnancy and congenital limb deficiency. BMJ 309: 476a-476 [Full text]