Cigarette smoking during pregnancy and preeclampsia risk: a systematic review and meta-analysis of prospective studies
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Jun Wei1, Cai-Xia Liu1, Ting-Ting Gong1, Qi-Jun Wu2, Lang Wu3
1Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
2Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
3Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
Qi-Jun Wu, e-mail: [email protected]
Keywords: cigarette smoking, meta-analysis, preeclampsia, risk factor
Received: August 13, 2015 Accepted: October 06, 2015 Published: October 20, 2015
Although evidence from epidemiological studies evaluating the association between cigarette smoking during pregnancy and preeclampsia risk has been systematically reviewed, the findings have been out of date. To further clarify the relationship, we conducted this comprehensive meta-analysis of prospective studies. We searched PubMed and Web of Science up to August 2015 to identify prospective studies that evaluated the association between cigarette smoking during pregnancy and preeclampsia risk. Random-effects models were used to estimate summarized relative risk (RR) and 95% confidence intervals (CIs). Seventeen prospective studies involving 62,089 preeclampsia patients from a total of approximately 1.8 million subjects were included. Overall, there was a significant negative association between smoking during pregnancy and incidence of preeclampsia (RR = 0.67, 95% CI: 0.60–0.75), with significant heterogeneity (I2 = 91.7%). Such an inverse association was also detected in strata of subgroup analyses according to study location, study sample size, parity of populations, singleton pregnancy, and adjustment for potential confounders including maternal age, diabetes mellitus, chronic hypertension, body mass index, and gender of infant. In summary, this meta-analysis suggests that smoking during pregnancy is inversely associated with incidence of preeclampsia. Further large scale multi-center prospective studies are warranted to validate our findings.
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