9LE

TABLE A31.--Summary of methods used in retrospective studies of tobacco use and cancer of the esophagus (cont.)

 

 

 

 

 

 

Auer Cases Controls
country, +
reference Sex Number Method of selection Number Method of selection Collection of data
Schwartz et al., M.- 362 Admissions to hospitals in Paris and a 362 Healthy individuals admitted to same hos- Interviewed by team of
1961, few large provincial cities since 1954. pital because of work or traffie acci- specially trained inter-
France (249). dents—matched by 5 year age group viewers who interviewed
and time of admission. the largest proportion
possible of all cancer
patients. Cases and
matched controls inter-
viewed by same person
Wynder and M. 150 Cancer patients seen in Memorial Hospi- 150 Patients seen in same hospitals during Data collected by trained
Bross, tal, New York City, and Kingsbridge same time period with other tumors. interviewers.
1961, and Brooklyn VA _ Hospitals during 64%-malignant tumor; 36%-benign con-
U.S.A. (810). 1950-59 (86% white). ditions. Matched by age with cancer
patients.
FR, 37 Same hospitals and same time period as 37 Same as with regard to male controls.
male patients (86% white). 43% had malignant and 57% benign
tumors.
Wynder and M. 67 Admitted to Tata Memorial Hospital Bom- 134 Patients with other forms of cancer ex- Interviewed by one per-
Bross, F. 27 bay. cept for oral cavity and lungs; as well son.
1961, as various benign diseases. 10% of male and 4% of
India (810). female cancer cases
histologically confirmed.
Takano et al., M. 167 Patients with esophageal cancer. 167 Patients with cancerous and non-can- Interviews at various
1968, F. 33 33 cerous diseases of non-digestive organs, hospitals. Cases and

Japan (272).

controls age-matched.

 
ZLE

TABLE A31.—Summary of methods used in retrospective studies of tobacco use and cancer of the esophagus (econt.)

 

 

 

 

 

 

Author,
year, Cases Controls
country, al -
reference Sex Number Method of selection Number Method of selection Collection of data
Bradshaw and M. 98 Patients with esophageal cancer. 341 Patients with non-malignant disease. Hospital interviews by
Schonland, trained African social
1969, workers.
South Africa
(41).
Martinez, M. 120 Patients with confirmed epidermoid eso- 360 120 male, 59 female patients in same hos- Interviews by trained
1969, F, 59 phageal cancer diagnosed in 1966. VW pital with non-cancerous diagnoses.
Puerto Rico

personnel,
240 male, 118 female members from same
(188).

community.
BLE

TABLE A3la—Summary of results of retrospective studies of tobacco use and cancer of the esophagus

 

Relative risk ratio.

 

 

 

 

 

 

 

 

 

 

 

Author, Percent inhalers All smokers to
year, Percent nonsmokers Percent heavy smokers among smokers nonsmokers
country, Cases Controls All Heavy
reference Cases Controls Cases Controls smokers smokers
Sadowsky et al., 1953, 3.8 13.2 — _ — _ ~ 4.0 —
U.S.A. (282).
Sangvhi et al, 5.5 17.3 Average number of —- — 3.6 —
1955, bidis smoked
India (241). 15.3 14.1
Wynder et al., M 13.0 24.0
1957, F (about) 85.0 (about) 92.0 — _ _ _ 2.1 —
Sweden (322). —_ _ _ _— 2.0 _
Staszewski, _ 18.0 95.8 59.0 87.5 80.0 —_ _
i960,
Poland (260).
Schwartz et al., 3.0 17.0 Total amount amoked 39.0 38.0 6.6 —_
1961, daily (cigarettes)
France (249). 16.8 16.0
Wynder and Bross, American males 5.0 15.0 48.0 33.0 — _— 3.4 44
1961, U.S.A. and American females 41.0 78.0 27.0 16.0 — —_ 5.1 3.2
India (310). Indian males 13.0 28.0 — _ —_ —_ 2.6 _
Indian females 78.0 94.0 oo — _ _ 4.5 _
Takano et al., 17.0 23.0 — — — — 1.3 —_—
1963,
Japan (272).
Bradshaw and Schonland, 15.3 31.7 31.6 5.9 _— —_— 2.6 11.1
1969,
South Africa (41).
Martinez, 1969, 14.0 23.5 17.9 8.6 —_— — 1.8 3.5

Puerto Rico (183).

 
6Z€

TABLE A32,.—Atypical nuclei in basal cells of epithelium of esophagus of

males, by smoking habits and age

 

 

 

   

 

 

 

Never smoked Current
regularly Cigarettes Ex-cigarettes Pipe, cigar Other
Atypical nuclei
Num- Per- Num- Per- Num- Per- Num- Per- Num- Per-
ber cent ber cent ber cent ber cent ber cent
. Allmen:
Number men ...................... 91 _ 779 _ 181 ~ 89 _— 62 _
Total sections! 2.0... eee eee, 787 100.0 6,752 100.0 1,586 100.0 766 100.0 522 100.0
No atypical nuclei ................, 733 93.1 167 2.5 770 48.5 53 6.9 195 37.4
Some but <60 percent atypical ..... 52 6.6 5,389 79.8 165 48.3 688 89.8 37 60.7
60 percent or more atypical ........ 2 0.3 1,196 17.7 51 3.2 25 3.3 10 19
. Men under age 50:
Numbermen ..............0.....0. 26 _— 236 _ 28 —_ 9 _ 7 —_
Total sections ...................., 223 100.0 2,059 100.0 258 100.6 V7 100.0 53 100.0
No atypical nuclei ................. 190 85.2 V1 3.4 56 21.7 1 1.3 4 5
Some but <60 percent atypical ...., 33 14.8 1,853 90.0 195 75.6 V4 96.1 46 86.8
60 percent or more atypical ......... —_— —_— 135 6.6 7 2.7 2 2.6 3 5.7
. Men aged 50-69:
Numbermen ................. 0.005 44 —_ 445 cod 109 7 38 — 31 a
Total sections os 379 100.0 3,853 100.0 953 100.0 310 100.0 256 100.0
No atypical nuclei 373 98.4 83 2.2 461 48.4 37 11.9 74 28.9
Some but <60 percent atypical 4 li 2,915 75.6 452 ATA 261 84.2 178 69.5
60 percent or more atypical 2 0.5 855 22.2 40 4.2 12 3.9 4 1.6
- Men aged 70 or older:
Number men....... 21 —_— 98 _— 44 —_— 42 —_— 24 _
Total sections ..... : 185 100.0 840 100.0 375 100.0 379 100.0 213 100.0
No atypical nuclei 170 91.9 13 1.5 253 67.4 15 4.0 117 54.9
Some but <60 percent atypical 15 8.1 621 74.0 118 31.5 353 93.1 93 43.7
60 percent or more atypical _ _— 206 24.5 4 Ll MW 2.9 3 1.4

 

‘Sections with some epithelium present.
Source: Auerbach, O. et al. (15).
ose

 

TABLE A33.—Atypical nuclei in basal cells of cpithelium of esophagus of males, by anoint of smoking and age

 

 

 

Current cigarette smokers

 

 

 

 

 

 

 

Never smoked regularly <1 pack 1-2 packs >2 packs
Cells with atypical nuelet ee RR TTT ee
Number Percent Number Percent Number Pervent Number Percent
. Allages . 91 see 179 413 _— 187 _
Total sections! 20... eee ee ete T87 100.0 1,544 100.0 3,629 100.0 1,579 100.0
No atypical nuclei... --. eee ee 733 93.1 89 5.8 39 1.1 139 2.5
Some but <60 percent atypical ....- 52 6.6 1,341 86.8 2,957 81.5 1,091 69.1
60 percent or more atypical .......- 2 0.3 114 TA 633 17.4 449 28.4
. Men under age 50:
Number men 2.0... 0. eee eee 26 a 9 —_— 132 _— 55 -
Total sections! 0.2... -. 6 ee eee eee 223 100.0 433 100.0 1,169 100.0 AST 100.0
No atypical nuclei ....---. eee ee ee 190 85.2 48 111 21 1.8 2 0.4
Some but <{60 percent atypical... 33 14.8 382 88.2 1,089 93.2 382 83.6
60 percent or more atypical .....--- tae wae 3 0.7 59 5.0 73 16.0
. Men aged 50-69:
Number men... ee eee eee 44 ee 92 _ 240 a 113 —_
Total sections ! pee eee ee eee 379 100.0 789 100.0 2,116 100.0 948 100.0
No atypieal nuclei... 6.0. eee eee 3738 98.4 30 38 18 30.9 35 387
Some but <60 pereent atypical 4 lat 694 87.9 1,607 15.9 614 64.8
60 percent or more atypical 2 0.5 65 8.3 491 23.2 299 31.5
. Meu aged 70 or older:
Number men... - eee eee eee 21 a 3s 41 _ 19 —_
Total sections! 0... ee ee eee eee 185 100.0 322 100.0 344 100.0 174 100.0
No atypical nuclei... 6. eee eee 170 91.9 11 3.4 —_ ~~ 2 12
Some but <60 percent atypical ....- 15 &.1 265 82.5 261 75.9 95 54.7
60 percent or more atypical .....--- a tae 46 14.3 Ks 24.1 q7 44.2

 

1 Sections with some epithelium present.
Souree: Auerbach, O. et al. (15)

 

 
l8¢e

TABLE A35.—Summary of methods used in retr

ospective studies of smoking and cancer of the bladder

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Author,

year, Cases Controls
country, — Te =
reference Sex Number Method of selection Number Method of selection

Lilienfeld et al., M. 321 Admissions to Roswell Park Memorial Institute. 337, No disease patients.

1956, 1945-55 over 45 years of age.
U.S.A. (171). F. 116 Same as males ........00..000.00..000000000., 109 Benign bladder conditions.
317 No disease patients.

Schwartz et al., M. 214 Admissions to hospitals in Paris and a few 214 Healthy individuals admitted to same hospital
1961, large provincial cities since 1954, because of work or traffic accident, matched
France (249). by 5 year age group.

Lockwood, M. 282 All bladder tumors reported to Danish Cancer 282 A. From election rolls matched with cases ac-
1961, F. 87 Register during 1942-56 and living at time RT cording to sex, age, marital status, occupa-
Denmark (175). of interview in Copenhagen and Fredericks- tion, and residence.

burg. (Includes bladder papillomas). B. Another control group obtained from sam-
ple of Danish Morbidity Survey (1952, 1953,
and 1954) compared with respect to smok-
ing histories.

Wynder, M. 200 First phase: 200
1963, F. 50 Admission to several hospitals in New 50 Admission to same hospitals (excluded cancer
U.S.A. (826). York City during January 1957-Decem- of respiratory system, upper alimentary tract,

ber 1960. myocardial infarction) matched by sex and
Second phase: age.
M. 100 Admission to same hospitals during 1961. 100 Same as above.
F, 20 20
Cobb and Ansell, M. 136 Patients admitted to VA Hospital in Seattle 342 120 patients with eancer of sigmoid colon, 222

1965,
U.S.A. (57).

1951-61.

 

patients with non-neoplastic pulmonary dis-

ease.
zee

TABLE A36.—Summary of methods used in retrospective studies of smoking and cancer of the bladder (cont.)

 

 

 

 

 

 

 

 

Author,

year, Cases Controls
country, - ~
reference Sex Number Method of selection Number Method of selection

Staszewski, M. 159 Patients with histologically confirmed bladder 750 Undefined source age-matched.
1966, carcinoma.

Poland (261).

Deeley and Cohen, M. 127 Patients with histologically confirmed bladder 127 Patients in same hospital with non-cancerous
1966, carcinoma. or pulmonary disease matched for age.
England (66).

Yoshida et al., M. 163 Patients with bladder cancer, 163 “Comparison cases.”

1968, F. 29 59
Japan ($30).

Kida et a)., M. 88 Admissions to 15 hospitals in North Fukuoka 88 Selected from patients hospitalized in same re-
1968, F. 26 prefecture. 26 region for non-urinary ailments and age-
Japan (144). matched

Dunham et al., M. 334 Admissions to New Orleans hospitals with his- 350 Admissions to same hospitals with non-neoplas-
1968, F. 159 tologic diagnosis of bladder carcinoma. 177 tic diseases and diseases unrelated to geni-
U.S.A. (85). tourinary tract.

Anthony and Thomas, M. 381 Patients with papilloma and cancer of bladder 275 Surgical patients without cancer previously in-

1970,
England (3).

at Leeds betweeen 1958-67.

terviewed for lung cancer study.

 
ese

TABLE A35a.—Summary of results of retrospective studies of

Percent cigarettes

smoking and cancer of the bladder

Relative risk ratio:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Author, Percent nonsmokers Percent heavy smokers smoked All smokers to nonsmokers
year, — -
country, All Heavy Cigarette Comments
reference Sex Cases Controls Cases Controls Cases Contrels smokers smokers smokers
Lilienfeld et al., M. 15.0 29.0 61.0 44.0 2.3 wee 2.9 Cigarette and other.
1956, F 87.0 83.0 1.4
U.S.A. (172).
Schwartz et al., M 11.0 20.0 83.0 70.0 2 2.2 Cigarette only.
1961,
France (249).
Lockwood, M. 9:0 13.4 30.0 15.0 30.0 15.0 1.6 3.0 3.0 Cigarettes main mode of
1961, F. 56.0 66.0 4.0 4.0 1.5 1.2 smoking.
Denmark (175).
Wonder et al., M. 7.0 18.0 47.0 23.0 85.0 63.0 29 5.2 3.8 Phases A and B com-
1963, F, 61.0 86.0 6.0 3.9 tee wee bined.
U.S.A. (826).
Cobb and Ansell, M. 4.6 25.8 79.4 43.3 7.3 10.3
1965,
ULS.A. (87).
Staszewski, M. 6.7 16.0 85.7 65.7 87.1 72.2 24 3.1 2.9 Cigarettes only.
1966,
Poland (261).
Decley and Cohen, M. 2.4 TA 3.1

1966,
England (66).

 
bee

TABLE A35a.—Summary of results of retrospective studies of smoking and cancer of the bladder (cont.)

 

 

 

 

 

 

 

Percent cigarettes Relative risk ratio:
Author, Percent nonsmokers Percent heavy smokers smoked All smokers to nonsmokers
year, : -
country, All Heavy Cigarette Comments
reference Sex Cases Contrlos Cases Controls Cases Controls smokers smokers smokers
Yoshida et al., M &.0 22.7 43.4 33.0 mo _ 3.4 3.7 _
1968, F. 62.1 86.4 _ _ _ _ _ —_ _
Japan (330).
Kida et al., M. 11.0 11.0 32.0 29.0 _ — 1.0 —_ _
1968, F. 16.0 21.0 —_ _— _ —_ 1.4 _ —_
Japan (144).
Dunham et al., M. 8.6 14.5 _ _ 49.4 45.4 1.8 _ 1.8 Cigarettes only.
1968, F. 62.2 61.5 _ _— 32.0 28.2 1.0 _ 11
U.S.A, (85).
Anthony and F. 6.3 6.3 —_ —_ 36.5 29.1 1.0 _ 1.3 Cigarettes only.
Thomas, More than 15 a day.
1970,

England (3).

 
CHAPTER 5

 

 

Pregnancy
Contents

Introduction 20... 0... cece eee eee eens
Effect on birthweight ........ 00.00.0000 0c cece ccc eae
Effect on outcome of pregnancy ................. 0000 0c
Experimental studies ......0.0 0.000.000 ccc eee neces
Summary ... cece ce eter een ene nens

References 0.0.0... ccc cece eee ete nee e venus

LIST OF TABLES

1. Summary of methods used in study of smoking and human

PrEQNANCY 22... ee eee
2. Maternal smoking and infant weight ................
. Maternal smoking and prematurity ................0.
4, Comparison of abortion, stillbirth, and neonatal death in
smoking and nonsmoking mothers ................00.
Human experimental] data on smoking and pregnancy ..
6. Animal experimental data on the effect of smoking and

nicotine on pregnancy ....... 0.0... c cece cece eves

ae

oO

Page
389

389
390
407
415
415

391
397
400

405
408

411
INTRODUCTION

In recent years, there has been increased research on environ-
mental factors which may adversely affect the unborn child. The
potential effect of maternal smoking on the fetus has been of par-
ticular interest because of the large number of pregnant women
who smoke and because smoking is an environmental influence
which could be controlled. Based on 1970 surveys of smoking
habits in representative samples of the U.S. population, it is
estimated that one-third of American women in the child-bearing
age group of 15 to 44 years are cigarette smokers. What propor-
tion of these give up smoking or cut down substantially on their
smoking during pregnancy is not known.

EFFECT ON BIRTHWEIGHT

Epidemiological and experimental studies have supported the
view that maternal smoking during pregnancy exerts a retarding
influence on fetal growth (tables 2, 6). Analvsis of over 100,000
births shows that the infants of mothers who smoke during preg-
nancy have a mean birthweight of 6.1 ounces less than the infants
born to nonsmoking mothers (table 2). Several studies have docu-
mented that this effect is independent of other factors known to
exert a negative influence on infant birthweight, such as elevated
maternal] blood pressure and small maternal size (1, 36, 39). The
reduction in infant birthweight is greater among heavy smoking
mothers than light smoking mothers (12, 21, 23,80, 41,50, 58), and
has been found in pregnancies terminating in each trimester (22,
16, 28, 40, 51,54). In a study of more than 48,000 women, Under-
wood, et al. (51) demonstrated that infants born to women who
smoked during part of their pregnancy were significantly smaller
than infants born to nonsmokers, and that infants born to women
who smoked throughout their pregnancy were significantly smaller
than the infants born to women who smoked during part of their
pregnancy. Russell, et al. (39) have presented evidence that al-
though infants born to smoking mothers weighed less than those
of nonsmoking mothers, they grew more rapidly during the first
six months of life. At one year of age, children born to smoking
mothers weighed nearly the same as those born to nonsmoking
mothers. They concluded that smoking exerts a retarding influence

389
on fetal growth and that after delivery this is largely compensated
for by a period of more rapid growth.

As documented in more than 15 prospective and retrospective
studies, smoking mothers have significantly more infants who are
premature, as defined by weight alone (<2,500) grams, than do non-
smoking mothers (table 3). Buncher (4) studied the mean dura-
tion of pregnancy in smokers and nonsmokers in a survey which
included 49,897 live births. He found that women smoking 20
cigarettes a day had a mean length of gestation which was approxi-
mately one day shorter than that of nonsmoking women. He calcu-
lated that this shortening cf gestation is enough to account for only
10 percent of the known reduction in birthweight that is associated
with maternal smoking.

EFFECT ON OUTCOME OF PREGNANCY

Some controversy has surrounded the question of whether ma-
ternal smoking during pregnancy is associated with an increased
risk of spontaneous abortion, stillbirth, and neonatal death. Table
4 summarizes the studies which have dealt with this question, Some
of the studies did not demonstrate such an increased risk (7, 34,
50, 51), while others did (12, 23, 33, 58). Many of these reports
(7, 23, 83, 34, 41, 49, 58) were based on retrospective studies and
included women delivering their infants in hospitals and infants
whose names appeared on listings of newborn children (table 1).
As Russell, et al. (39) have pointed out, such studies may be sub-
ject to selective bias since they tend to underrepresent women who
have aborted. These retrospective studies also did not systemat-
ically control for maternal social class, parity, and maternal age,
all of which are related to the outcome of pregnancy and also are
related to smoking in some populations. In a prospective study of
more than 2,000 pregnant women, Russell, et al. (39) have demon-
strated a significantly higher percentage of unsuccessful pregnan-
cies (that is, abortion, stillbirth, or neonatal death) among women
who smoked during their pregnancy than among those who did
not. He interpreted his findings to mean that 20 percent of “. .. un-
successful pregnancies in women who smoke regularly would have
been successful if the mother had not been a regular smoker” (38).

The Second Report of the 1958 British Perinatal Mortality Sur-
vey published in 1969 is one of the largest prospective studies to
deal with this question (5). It included 98 percent of the total births
registered during one week in March 1958 throughout England,
Seotland, and Wales. In this study, a large amount of obstetric and
sociobiologic information was obtained on 17,000 singleton births.
This study reported that “the mortality in babies of smokers was
significantly higher than in those of nonsmokers.” The increase in

390
16€

TABLE 1.—Summary of methods used in study of smoking and human pregnancy

 

 

 

 

 

 

 

 

Author,
year, Retrospective Number
country, or ° Data collection Case selection Comments
reference prospective persons
Simpson, R. 7,499 Questionnaire was filled out 48 hours Multiple births excluded. The county hospital population
1957, after delivery for all patients at was different, with 50.6 per-
U.S.A. (44). San Bernardino County Hospital cent of the births being
for 3 years. Same form used for “Mexican’’.
2 years at St. Bernardines Hos-
pital and Loma Linda Hospital.
Lowe, R. 2,042 Questionnaire was filled out for every Non-Europeans and women with Social workers performed
1959, woman delivering at one of six twin births were excluded. interviews.
England (28). Birmingham hospitals over a 5-
month period.
Frazier et al., P. 2,736 (a) Interview. All Negro women seen at Baltimore Nonsmokers include occasional
1961, (b) Prenatal clinic history. Maternity Interviewing Service in smokers.
U.S.A, (12). (¢c) Birth and stillbirth certificates. 1959 who were scheduled for de-
livery at Baltimore City Hospital
and who received prenatal care in
elinic of Baltimore City Health
Department.
Herriot et al., R. 2,745 Questionnaire filled out for Aber-
1962, deen city residents who were de-
Scotland (16). livered in Aberdeen City Hospital
over a l-year period.
Savel and R, 1,415 1,500 consecutive patients admitted Included were private and ward pa- Women were considered
Roth, to Newark Beth Israel Hospital tients, Negro and white patients, smokers even if they smoked
1962, were interviewed. primigravidas, and  multiparas; only 1 cigarette per day.
U.S.A. (41). Cesarean sections, elective indue-

tions, and multiple pregnancies
were excluded.
c6E

Author,

TABLE 1.—Summary of methods used in study of smoking and human pregnancy (cont.)

 

 

 

 

 

 

 

year, Retrospective Number
country, or of Data collection Case selection Comments
reference prospective persons

Yerushalmy, P. 982 Form questionnaire. Pregnancies terminating in abortion
1962, were excluded.

U.S.A. (53).

Murdoch, R. 500 Personal interview by author. All mothers delivering at Nebraska
1963, Methodist Hospital from Septem-

U.S.A. (80). ber 1962 to January 1963.

O’Lane, R. 1,031 Standard U.S. Naval Obstetrical Code 1,031 Caucasian women who had “Smokers” defined as those
iyo, Sheet was used with supplemental single pregnancies delivered va- smoking regularly each day.
U.S.A. (93). questions. Additional information ginally over a 6-month period.

was obtained from prenatal his-
tory.

Zabriskie, R. 2,000 History was obtained during the Twin deliveries were omitted.

1963, postpartum period from 2,000 con-
U.S.A. (58), secutive births over a 6-month
period.

Yerushalmy, BP, 6,800 Personal interview. All women were members of Kaiser 5,381 whites 1,419 Negroes.
1964, Foundation Health Plan. Only
U.S.A. (54). pregnancies terminating in single,

live births included. All races ex-
cept whites and Negroes were ex-
cluded.
MacMahon et al., R. 12,192 Mail questionnaire. Mothers of single, white, legitimate Birthweight based on birth

1965,
U.S.A. (24).

live births. Mothers were residents
of Massachusetts and delivered in
May or June of 1963.

certificate.

 
c6e

TABLE 1.—Summary of methods used in study of smoking and human pregnancy (cont.)

 

 

 

 

 

 

Author,

year, Retrospective Wumber
country, or of Data collection Case selection Comments
reference prospective persons

McDonald and P, 177 Interview. White, unmarried primigravidas re-

Lanford, ceiving obstetric care over a 2-
1965, year period.
U.S.A. (26).

Peterson et al., R. 7,740 Cooperative study involving 17 hos- Includes only those multiparas whose
1965, pitals in 18 states, using U.S. Air prior infants weighed ‘>2,500
U.S.A. (34). Force obstetrical code. grams (Caucasians). All preg-

nancies with any complication
were excluded. Cesarean sections
and induced delivery were ex-
cluded.

Robinson, P. 1,614 Interview. Regular attendees at prenatal clinic. 46.8 percent of women smoked
1965, cheroots.

Burma ($7).

Underwood et al., R. 4,440 Interview by obstetrical resident. Puerperal women from Roper Hos- Women from Roper Hospital
1965, Data was obtained on 16,158 preg- pital and Medical College Hospi- were of above average eco-
U.S.A. (50). nancies from the 4,440 women. tal. Only infants weighing >1,000 nomic status. Women from

grams were included. Medical College Hospital in-
cluded Negro and white
patients.

Downing and R. 5,659 Review of clinic records from 1952 Six-year total of obstetrical patients
Chapman, to 1958. at clinic.

1966,
ULS.A. (7).

 
P6e

TABLE 1.—Summary of methods used in study of smoking and human pregnancy (cont.)

 

 

 

 

 

 

 

 

Author,

year, Retrospective Number
eountry, or of Data collection Case selection Comments
reference prospective persons

Ravenholt et al., kh. 2,028 Epidemiologic questionnaire. Much Study population was identified by 95.4 percent of mothers were
1966, data collected over telephone. Ad- the listing of newborn infants in white.

U.S.A. (35). ditional data obtained from birth a Seattle newspaper during May,
certificates. June, and July of 1964. Twins
were excluded.

Reinke and R. 3,156 Registration data of prenatal clinic. Negro women who delivered single,
Henderson live infants from 1962-64.

1966,
U.S.A. (96).

Kizer, 2,095 Interview. Patients receiving care at ‘‘concep-
1967, cion palacias’’ in Caracas.
Venezuela (19).

Underwood et al., Pr. 48,505 Code sheets submitted from 44 world- Women with single pregnancies de-
1967, wide naval installations. Code livered of infants weighing more
U.S.A. (51). sheets were completed by the at- than 500 grams between July 1,

tending physician upon the mo- 1963, and June 30, 1965.
ther’s admission to the labor room.

Duffus and R. 2,648 Antenatalclinic records. All ‘‘booked’” married city primi- The number of cigarettes
MacGillivray, gravidae attending the antenatal smoked was not considered.
1968, clinics during 1960, 1964, and
Seotland, (8). 1965.

Mulcahy and R. 3,681 Hospital record review. Mothers admitted to the Coombe

Knaggs,
1968,
Ireland (28).

Hospital from April 1963 to Oc-
tober 1964.

 
S6E

TABLE 1.—Summary of methods used in study of smoking and human pregnancy (cont.)

 

Author,

year, Retrospective

country,
reference

Russell et al.,
1968,
England (89).

or

prospective

P.

Number
of
persons

2,110

Data collection

Data collected by Senior research
midwives over a 4- to 5-year
period.

Case selection

Women attending the two main ma-
ternity units in Sheffield, who
“comprised a reasonably repre-
sentative sample.” Multiple preg-
nancies were omitted.

Comments

Included some threatened abor-
tions and some with “bad”
obstetrical histories.

 

Tokuhata,
1968,
U.S.A. (49).

2,016

Personal interview or mail question-
naire of surviving family members.

Women selected from Memphis and
Shelby County death registry who
died of cancer of genitalia or
breast since 1950 and who had
been married.

Control group taken from same
registry. They died of causes
other than cancer and were
matched for race, age at
death, and year of death.

 

 

Buncher,
1969,
ULS.A. (4).

49,897

Data obtained from U.S. Navy ob-
stetrical study from 1963 to 1965.

Smoking data obtained by physician
at the time of mother's admission
to labor room.

Women with single pregnancies de-
livered of infants weighing more
than 500 grams between July 1,
1963, and June 30, 1965.

Includes cases reported by
Underwood et al. (47) in
1967.

 

Butler and
Alberman,
1969,

Great Britain (5).

17,000

The British Perinatal Mortality Sur-
vey of 1958 when a large amount
of obstetric and sociobiclogic in-
formation was obtained from birth
attendants, records, and at inter-
view with the mothers.

98 percent of the total births reg-
istered during 1 week in March
1958 throughout England, Scot-
land, and Wales.

Another 7,000 perinatal deaths
were surveyed by identical
methods over a 8-month
period.

 

Terris and
Gold,

197

Public Health Nurse interviewed each
mother on first or second post-
partum day.

Premature Negro ward births
(<2,500 grams) with no known
cause of prematurity. Controls
were matched by sex, birth order
of infant, age, and marital status
of the mother.

 
96£

TABLE 1.—Summary of methods used in study of smoking and human pregnancy (cont.)

 

 

Author,
year, Retrospective Number
country, or of Data collection Case selection Comments
reference prospective persons
Mulcahy et al., P. 100 Interview by physician. 100 mothers of term infants who
1970, were free from all significant medi-

Treland (29),

ical and obstetrical complications.
All were between 20 and 30 years
of age and were Para III or less.
All had norma! deliveries. Half
were smokers of 10 or more ciga-
rettes per day.
L6E

TABLE 2.—Maternal smoking and infant weight

(Numbers in parentheses indicate absolute number of infants in respective groups)

Infant weight

 

Difference in mean weight
of infant of smoker

Comments

 

 

 

 

 

 

 

Author,
reference Nonsmoker Smoker versus nonsmoker
Lowe (239) <10 cigarettes >10 cigarettes Effect on infant weight was independent
per day per day of maternal age, parity, or complica-
Male .. 7,43 Ibs. (607) 7.18 (187) 7.05 (165) tions of pregnancy.
Female ...... 7.23 Ibs. (539) 6.74 (163) 6.67 (147)
Total - 7.33 Ibs. (1,146) 6.98 (350) 6.87 (312) 170 g. (6 oz.)
Frazier 3,080 g. (1,717) 2,924 ge. (1,019) 156g. (5.5 02.) Nonsmokers include occasional smokers.
etal.,
(12).
Herriot No data ............... (1,478) No data (1,272) 160g. (5.6 0z.) Effect on infant weight was independ-
etal, ent of maternal age, parity, height,
(16). or social class.
Savel and White ........ 3,874 g¢. (383) 3,141 g. (428) 2332. (8.2 02.) Cigarettes
Roth Negro 3,173 g (364) 3,031 g. (240) 142g. (5.0 02.) per day Infant weight
(41). White smokers:
1-10) ............. 8,210. (161)
11-20 ............. 3,198 g. (184)
20 2... eee... 8,010 2. (83)

Negro smokers:
1-10 ............. 8,042 g. (169)
11-20 -. 8,012 g. (57)
>26 . 2,968 g. (14)

Murdoch 7 Ibs. 7.5 oz. (242) 6 Ibs. 15 oz. (258) 8.5 oz. Cigarettes

(30). per day Infant weight
1-10) ............ 7 Ibs. 202.
11-20) ............ 6 Ibs. 11 oz.
2000. ........... 6 Ibs. 10 02.
240 oo... ....... 6 Ibs. 8 oz.
O’Lane 2,978 g. (566) 2,938 g. (465) 40g. (1.4 02.)
(33),

 
86E

TABLE 2.—Maternal smoking and infant weight (cont.)
(Numbers in parentheses indicate absolute number of infants in respective groups)

 

 

 

 

 

 

 

Infant weight Difference in mean weight.
Author, of infant of smoker Comments
reference Nonsmoker Smoker versus nonsmoker
Zabriskie 3,820 ¢. (1,048) 3,091 g. (957) 229g. (8.1 02.) Cigarettes
(58). per day Infant weight
Ee | 3,205 g. (260)
10-20 ............. 8,090 g. (395)
20-30 1.00.22... 2,970 g¢. (264)
>30 «1.2.2... 83,1908. (38)
MacMahon Male ........ 124.0 0z. (8,053) 116.38 oz. (3,178) 7.7 oz. Cigarettes Infant weight
et al., Female ...... 119.9 0z. (2,906) 111.9 oz. (3,011) 8.0 oz. per day (ounces)
(24). Male Female
<ic . 121.2 (658) POL ets!
10-20 . 115.2(1,262) 112.2 (1,259)
20-40 . 114.6(1,165)  108.9(1,088)
>40 . 118.2 (66) 111.7 (49)
McDonald Light smoker Heavy amoker No significant difference be-
and 111.68 oz. (87) 110.83 oz. (42) 109.38 oz. (48) tween mean birthweights.
Lanford
(26).
Underwood Cigarettes
et al., Group: per day For >20 cigarettes per day Patients were divided into 8 groups:
(50). ) 8,522 g. (2,406) <10  ........... 8,849 ge. 353 g. (12.5 0z.) (p<0.001) I....Private patients of above av-
10-20 ........... 3,236 g. ¢ (1,720) erage economic status.
200 ee eee ee 3,169 gr.
Tl ....... 3,304 g. (557) <0 ........... 8,171 g. 212g. (7.50z.) (p<0.001) Il....White patients of average
10-20 ........... 8,146 g¢. (660) economic ,status.
20... 8,092 g.
Ill ....... 3,126 g. (7,775) <10 «02.0.2... 2,988 g. 115g. (4.102.) (p<0.001) III,...Negro patients of low eco-
10-20 ........08. 2,965 g. £ (3,040) nomic status.
200 ........... 8,011 g. + Total for all smokers in each group.
Ravenholt Male ......... 7.80 Ibs. (171) 7.21 Ibs. $(167) .59 Ibs. (9.4 02.) t+ Smoked >4,000 cigarettes during preg-
et al., Female ...... 7.50 Ibs. (150) 7.05 Ibs. (171)  .45 lbs. (7.2 02.) nancy.

(35).
66€

TABLE 2.—Maternal smoking and infant weight (cont.)
(Numbers in parentheses indicate absolute number of infants in respective groups)

 

Infant weight

Difference in mean weight

 

 

 

 

 

 

 

 

 

Author, of infant of smoker Comments
reference Nonsmoker Smoker versus nonsmoker

Reinke and 8,135 g. (1,542) 2,987 g. (1,614) 148g. (5.2 02.) (p<0.001) a
Henderson
(86).

Kizer (19). Data not available Data not available 97g. (3.4 02.) Total number of patients—2,095.

Underwood Cigarettes
etal., per day
(51). 3,395 g. (24,865) 1-10 -. 3,286 g. (7,609) 109g. (3.8 oz.)

11-30 -. 8,196 g, (14,450) 199g. (7.002.)
>30 . 8,182 g. (1,570) 213 ¢. (7.5 02.)

Mulcahy 113.3 oz. Cigarettes
and per day
Knagegs 1- 4 seeees 111.4 02. 1.9 oz.

(28). 5-9 Loe... 102.3 oz. 11.0 oz.
10-14 2... 102.0 oz. 11.3 oz.

15-19 wo... 102.9 oz. 10.4 oz.

>20 - 102.4 oz, 10.9 oz.

Russell BP The effect of maternal smoking on fetal
et al., <140/ 90 117.2 J oz. (984) 107.2 + 1.0 oz. (496) 10.0 oz. weight was independent of maternal
(89). 140/ 90 114.2 + 1.2 oz. (340) 108.9 + 2.4 oz. (117) 5.3 oz. parity, age, height, educational level,

>150/100 99.8 + 2.6 oz. (188) 90.8 + 5.8 oz. (35) 8.5 oz. attitude to pregnancy or work during
pregnancy, father's social class, con-
sort’s social class, and sex of the child
or premature delivery.

Butler and 3,375 g@. (11,145) 3,205 g. (4,660) 170g. (6 072.) Reduction of mean birthweight of babies
Alberman born to smokers was independent of
(5). unduly high proportion of babies born

preterm, and maternal! factors includ-
ing social class and maternal height.

Mulcahy 3.83 kg. (50) 3.43 kg. (50) 396 g. (14 oz.)
et al.,

(29).

 
oor

TABLE 3.—Maternal smoking and prematurity (cont.)
(Figures in parentheses are the absolute number of premature births)

 

Premature by

 

 

 

 

 

 

 

 

Author, — Percent of premature infants Mean duration of pregnancy
reference Duration of — Comments
Weight gestation Nonsmokers Smokers Nonsmokers Smokers

Simpson <2,500 g. Name of hospital: Number and percent of
(44). County .......... 7.77 (144) 11.48 (96) premature infants:

Loma Linda ..... 6.16 (86) 12.13 (49) Nonsmokers .... 6.39 (328)
St. Bernardines .. 5.21 (98) 10.50 (119) Cigarettes per day:

1-5 ....... 7.06 (47)

6-10 .....-11.18 (89)

W1-15 0... 10.86 (31)

16-20 ......18.6 9 (77)

21-30 ......25.0 (11)

>380 ....... 33.3 (9)

Lowe <(260 days 6.4 (57) 10.6 (58) 279.9 days 278.5, days At each week of gestation, the
(23). mean birthweight was lower

in babies of smokers.

Frazier <2,500 g. 11.2 (175) 18.6 (179) 88.7 weeks 38.4 weeks Infants of smokers weighed less
et al., than infants of nonsmokers
(12). for a wide range of preg-

nancy duration.

Herriot No data No data Social class: 2,745 patients in the study.
etal., landIE ......... 4.0 4.8 At each week of gestation, the
(16). TH oo... eee eee OB 6.8 mean birthweight was lower

IVandV ........ 6.3 12.6 in babies of smokers.

Savel and 36 weeks White .............8. 2.6 (10) 4.9 (21) White .39.8 39.4

Roth Negro ...........2-. 18.7 (50) 11.3 (27) Negro .38.8 38.8
4t). -
aad #<(2,500 g. White . 18 (T) 3.7 (16) t+ Premature by weight but ma-

 

Negro ..........-0005 3.6 (13) 8.3 (20) ture by date (>87 weeks).