Cigarette smoking during pregnancy and risk of preeclampsia: A systematic review,☆☆

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Abstract

In this systematic review of the existing evidence regarding the relationship between cigarette smoking during pregnancy and preeclampsia, studies were found through searches of MEDLINE (1966–October 31, 1998), Embase, Popline, CINAHL, Lilacs, bibliographies of identified studies, and proceedings of meetings on preeclampsia, and also through contact with relevant researchers. No language restrictions were imposed. Only cohort and case-control studies dealing with the relationship between cigarette smoking and preeclampsia were considered. Assessment of methodologic quality and data extraction of each study were carried out by 2 authors working independently. Typical relative risks and odds ratios with 95% confidence intervals were calculated for cohort and case-control studies, respectively, with both fixed and random effects models. Twenty-eight cohort studies and 7 case-control studies including a total of 833,714 women were included. All cohort studies reported an inverse association between cigarette smoking during pregnancy and incidence of preeclampsia (typical relative risk, 0.68; 95% confidence interval, 0.67-0.69). The findings were similar for case-control studies (typical odds ratio, 0.68; 95% confidence interval, 0.57-0.81). An inverse dose-response relationship was also found. Pooled data from cohort and case-control studies showed a lower risk of preeclampsia associated with cigarette smoking during pregnancy. (Am J Obstet Gynecol 1999;181:1026-35.)

Section snippets

Data sources

Computerized searches were carried out in MEDLINE (1966 through October 31, 1998), Embase (1974 through October 31, 1998), Popline (1982 through October 31, 1998), CINAHL (1982 through October 31, 1988), and Lilacs (1982 through October 31, 1998) with the following MeSH and key word terms: smoking or tobacco and preeclampsia or eclampsia or gestosis, EPH or pregnancy toxemia or pregnancy-induced hypertension . Index Medicus (1955-1966), proceedings of several international meetings on

Selected studies

A total of 42 publications were found, 8 of which were excluded. Thirty-three were found in the computerized search and 7 were found by reference checking. Two studies were located in abstract form, and their authors provided additional data. Thirty-four articles met our inclusion criteria.5, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50 The overall agreement on the inclusion of articles was 100%. One

Comment

Through analysis of information gathered from cohort and case-control studies published in the worldwide literature, this systematic review confirmed that cigarette smoking during pregnancy decreases the incidence of preeclampsia. Overall, the risk of preeclampsia among pregnant women who smoked was 32% lower than that among nonsmoking pregnant women. This inverse association was remarkably consistent across studies conducted in different population subgroups and countries. In addition, our

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      It is critical to emphasize the chemical composition of tobacco and tobacco smoke is complex which may render CO to be an irrelevant agent [361]. Nevertheless, the Smoker's paradox is an emerging term for the controversial phenomenon where, despite the severe toxicity of cigarettes, smoking may have protective benefits based on the observation of an inverse incidence of diseases such as: acute coronary syndrome mortality [362], ulcerative colitis [358], anxiety and depression [363], obesity [364], pemphigus [366], preeclampsia [367], primary sclerosing cholangitis [368], stroke [369], severe COVID-19 [370], and many other indications [371,435–450]. Cigarette smoking may also enhance clopidogrel efficacy [372].

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    Reprint requests: Agustin Conde-Agudelo, MD, Hospital de Clinicas, piso 16, Casilla de Correo 627, 11000 Montevideo, Uruguay.

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