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Category: Volume 07 Issue 04 April 2019
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Title: Second hand smoke exposure in pregnancy and the risk of still birth – a case control study in a tertiary care centre in Kerala

Authors: Nirmala.C, Raji.S, K.T Shenoy

 DOI: https://dx.doi.org/10.18535/jmscr/v7i4.165

Abstract

Introduction: Second hand smoke exposure also known as passive smoking is a global health problem with profound impact on the expectant mother and her unborn baby. Still birth, the absence of life at birth, is a major obstetric problem. Ending preventable stillbirth is a global priority and hence assessing the causes is important. Association between second hand smoke exposure in pregnancy and stillbirth is hypothesized. But little is known about the role of second hand smoke and antepartum stillbirths in Kerala where the prevalence smoking among men is high.

Aims and Objectives: Primary Objective was to find the association between passive smoke exposure and the risk of still birth.

Methodology: This is a case control study conducted in the department of Obstetrics & Gynaecology, Govt. Medical College, Trivandrum, a tertiary care teaching hospital. 64 cases of sonologically confirmed antepartum still birth was compared with 128 live births (case control ratio 1: 2). Exposure to passive smoking was assessed by structured questionnaire and self report of passive smoking was quantified by estimating salivary continine which is a byproduct of nicotine using ELISA test. Salivary cotinine assay has a high sensitivity and specificity and is a non invasive test.

Results: The risk of antepartum stillbirth was 7 times higher among prenatal women exposed to second hand smoke as compared to those without exposure  (OR – 7.97, 95% CI – 4.01 to 15.84). There is a linear relationship between the duration and extent of exposure. Other risk factors are age > 30 years, lower socio economic status, increased BMI, gestational hypertension .On logistic regression analysis for confounding variables, second hand smoke exposure was found to have an independent association with stillbirth (P value < 0.001).

Conclusion: Based on our study we conclude that there is an association between prenatal second hand smoke exposure and risk of stillbirth.  This study is first of its kind in a state of Kerala, with a high rate of smoking among men .The results of this study shows that there is an urgent need for smoking cessation thereby avoiding passive smoke exposure to women and their unborn babies.

Keywords: second hand smoke, stillbirth, intrauterine death.

References

  1. International Classification of Diseases 10th revision (ICD-10). 2010. http://www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf?ua=1
  2. World Health Organization. Implementing Smoke-free Environments. Rep Glob Tob Epidemic. 2009;  WHO. Report on the Global Tobacco Epidemic. Implementing Smoke‐free Environments. World Health Organization, 2009.Google Scholar
  3. Centers for Disease Control and Prevention (US), U.S. Department of Health and Human The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Publications and Reports of the  Surgeon General. 2006. 727 p.
  4. Wipfli H, Avila Tang E, Yuavan J, et al. Second hand smoke exposure among women and children : evidence from 31 countries. Am. J Public Health 2008;98:672-9
  5. Grant SG; Quantitatively and Qualitatively similar effects of active and passive maternal tobacco use exposure: BMC Paediatrics 2005;5:20
  6. The Partnership for Maternal, Newborn & Child Health. Consultations on updating the Global Strategy for Women’s, Children’s and Adolescents’ Health: round 2—feedback on the zero draft of the Global Strategy. Geneva: The Partnership for Maternal, Newborn & Child Health, 2015
  7. Saving lives protecting futures—progress report on the global strategy for women’s and children’s health. 2015. http://www.everywoman everychild.org/global-strategy-2/gs2-progress-report
  8. The Lancet. The Lancet’s Stillbirth Series. 2011. http://www. thelancet.com/series/stillbirth (accessed April 20, 2015).
  9. T Shenoy, Richard Peto : Non communicable disease and tuberculosis burden in an urban cohort of 1,18772 subjects in Kerala , India
  10. Ray JG, Urquia ML. Risk of stillbirth at extremes of birth weight between 20 to 41 weeks gestation. J Perinatol. 2012;32(11): 829–36.
  11. Rakesh, P., Lalu, J. S., & Leelamoni K. Prevalence of Exposure to Secondhand Smoke among Higher Secondary School Students in Ernakulam District, Kerala, Southern India. Journal of Pharmacy & Bioallied Sciences, 9(1), Rakesh, P., Lalu, J. S., & Leelamoni, K. (2017). Prevalence of Exposure to Sec. J Pharm Bioallied Sci. 2017;9(1):44–47.
  12. Thankappan KR1 TC. Tobacco use & social status in Kerala. Indian J Med Res. 2007;126(4):300–8.
  13. Leonardi-Bee J, Britton J, Venn A. Secondhand Smoke and Adverse Fetal Outcomes in Nonsmoking       Pregnant Women: A   Meta-analysis. Pediatrics [Internet] 2011;127(4):734–41. Available from: http://pediatrics. aappublications. org/cgi/doi/10.1542/peds.2010-3041
  14. Miyake Y, Tanaka K, Arakawa M. Active and passive maternal smoking during pregnancy and birth outcomes: the Kyushu Okinawa Maternal and Child Health Study. BMC Pregnancy Childbirth [Internet]. 2013;13(1):157. Available from: http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-13-157
  15. Dejmek J, Solansḱ y I, Podrazilová K, Šrám RJ. The exposure of nonsmoking and smoking mothers to environmental tobacco smoke during different gestational phases and fetal growth. Environ Health Perspect. 2002;110(6):601–6.
  16. Subramoney S, Tursan d’Espaignet E, Chandra Gupta P. Higher risk of stillbirth among lower and middle income women who do not use tobacco, but live with smokers. Acta Obstet Gynecol Scand . 2010;89(4):572–7.

Corresponding Author

Dr C. Nirmala

Department of Obstetrics and Gynecology, SAT Hospital, Govt. Medical College, Trivandrum