Tobacco exposure and risk of spontaneous abortion, a dose-dependent association: A systematic review and meta-analysis.

IF 1.9 4区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Tobacco Induced Diseases Pub Date : 2025-08-01 eCollection Date: 2025-01-01 DOI:10.18332/tid/207156

Xuefei Yuan, Fang Zhang, Yan Lv, Baohua Zhao, Hongbin Zhang, Limin Chen, Hongli Yan, Xiaojiao Hao, Zhiyu Dong

{"title":"Tobacco exposure and risk of spontaneous abortion, a dose-dependent association: A systematic review and meta-analysis.","authors":"Xuefei Yuan, Fang Zhang, Yan Lv, Baohua Zhao, Hongbin Zhang, Limin Chen, Hongli Yan, Xiaojiao Hao, Zhiyu Dong","doi":"10.18332/tid/207156","DOIUrl":null,"url":null,"abstract":"Introduction: This systematic review and meta-analysis aimed to quantify the dose-dependent association between tobacco exposure (active and passive smoking) and the risk of spontaneous abortion (SA), incorporating subgroup analyses to evaluate the influence of study design.Methods: Following PRISMA guidelines, we conducted a systematic search of PubMed, Embase, and Cochrane Library databases for English-language observational studies published between 1991 and 2023. Studies were included if they reported on the association between active or passive tobacco exposure during pregnancy and SA risk (defined as pregnancy loss before 20 weeks of gestation). Studies involving induced abortion, ectopic pregnancy, or molar pregnancy were excluded. Eligible participants included pregnant women with documented smoking status. Methodological quality was assessed using MMAT, NOS, and GARD. Data were analyzed using fixed-effects or random-effects models, with heterogeneity assessed using I2 statistics. Interaction p-values were reported to evaluate heterogeneity between study designs.Results: Fourteen studies (5 cohort, 7 case-control, 2 nested case-control) with a combined sample size of 741698 pregnancies met the inclusion criteria. Active smoking was significantly associated with increased SA risk (OR=1.35; 95% CI: 1.18-1.55; I2=46.8%), with the highest risk observed among individuals consuming ≥20 cigarettes/day (OR=1.45; 95% CI: 1.04-2.03). Secondhand smoke exposure also elevated SA risk (OR=1.32; 95% CI: 1.14-1.55; I2=37.6%). Significant heterogeneity was observed between cohort and case-control studies (interaction p=0.001). No significant interaction was found between active and passive smoking (interaction p=0.842), but a dose-dependent interaction was observed (interaction p=0.049).Conclusions: Tobacco exposure is associated with increased SA risk, particularly at higher levels. Interventions targeting heavy smokers and those exposed to secondhand smoke are needed. Limitations include imprecise smoking exposure measurement and incomplete adjustment for confounders. Future research should focus on biomarker-guided cessation strategies and explore underlying mechanisms.Systematic Review Registration: The protocol was registered in PROSPERO.ID: CRD42023406664.","PeriodicalId":23202,"journal":{"name":"Tobacco Induced Diseases","volume":"23 ","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12316102/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Tobacco Induced Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.18332/tid/207156","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: This systematic review and meta-analysis aimed to quantify the dose-dependent association between tobacco exposure (active and passive smoking) and the risk of spontaneous abortion (SA), incorporating subgroup analyses to evaluate the influence of study design.

Methods: Following PRISMA guidelines, we conducted a systematic search of PubMed, Embase, and Cochrane Library databases for English-language observational studies published between 1991 and 2023. Studies were included if they reported on the association between active or passive tobacco exposure during pregnancy and SA risk (defined as pregnancy loss before 20 weeks of gestation). Studies involving induced abortion, ectopic pregnancy, or molar pregnancy were excluded. Eligible participants included pregnant women with documented smoking status. Methodological quality was assessed using MMAT, NOS, and GARD. Data were analyzed using fixed-effects or random-effects models, with heterogeneity assessed using I² statistics. Interaction p-values were reported to evaluate heterogeneity between study designs.

Results: Fourteen studies (5 cohort, 7 case-control, 2 nested case-control) with a combined sample size of 741698 pregnancies met the inclusion criteria. Active smoking was significantly associated with increased SA risk (OR=1.35; 95% CI: 1.18-1.55; I²=46.8%), with the highest risk observed among individuals consuming ≥20 cigarettes/day (OR=1.45; 95% CI: 1.04-2.03). Secondhand smoke exposure also elevated SA risk (OR=1.32; 95% CI: 1.14-1.55; I²=37.6%). Significant heterogeneity was observed between cohort and case-control studies (interaction p=0.001). No significant interaction was found between active and passive smoking (interaction p=0.842), but a dose-dependent interaction was observed (interaction p=0.049).

Conclusions: Tobacco exposure is associated with increased SA risk, particularly at higher levels. Interventions targeting heavy smokers and those exposed to secondhand smoke are needed. Limitations include imprecise smoking exposure measurement and incomplete adjustment for confounders. Future research should focus on biomarker-guided cessation strategies and explore underlying mechanisms.Systematic Review Registration: The protocol was registered in PROSPERO.ID: CRD42023406664.

Abstract Image

查看原文本刊更多论文

烟草暴露和自然流产风险：剂量依赖关系：系统回顾和荟萃分析。

本系统综述和荟萃分析旨在量化烟草暴露（主动和被动吸烟）与自然流产（SA）风险之间的剂量依赖关系，并结合亚组分析来评估研究设计的影响。方法：遵循PRISMA指南，我们对PubMed、Embase和Cochrane图书馆数据库进行了系统检索，检索1991年至2023年间发表的英语观察性研究。如果研究报告了怀孕期间主动或被动接触烟草与SA风险（定义为妊娠20周前的妊娠丢失）之间的关系，则将其纳入研究。涉及人工流产、异位妊娠或磨牙妊娠的研究被排除在外。符合条件的参与者包括有吸烟记录的孕妇。采用MMAT、NOS和GARD评估方法学质量。使用固定效应或随机效应模型分析数据，使用I2统计量评估异质性。相互作用p值被用来评估研究设计之间的异质性。结果：14项研究（5项队列研究，7项病例对照研究，2项巢式病例对照研究）的总样本量为741698例妊娠符合纳入标准。积极吸烟与SA风险增加显著相关(OR=1.35；95% ci: 1.18-1.55；I2=46.8%)，吸烟≥20支/天的人群风险最高(OR=1.45；95% ci: 1.04-2.03)。二手烟暴露也会增加SA风险(OR=1.32；95% ci: 1.14-1.55；I2 = 37.6%)。在队列研究和病例对照研究之间观察到显著的异质性（相互作用p=0.001）。主动吸烟与被动吸烟之间无显著交互作用（交互作用p=0.842），但存在剂量依赖性交互作用（交互作用p=0.049）。结论：烟草暴露与SA风险增加有关，特别是在较高水平时。针对重度吸烟者和二手烟暴露者的干预措施是必要的。限制包括不精确的吸烟暴露测量和混杂因素的不完全调整。未来的研究应侧重于生物标志物引导的戒烟策略和探索潜在的机制。系统评价注册：该方案在PROSPERO注册。ID: CRD42023406664。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Tobacco Induced Diseases SUBSTANCE ABUSE-PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

CiteScore

5.30

自引率

5.40%

发文量

审稿时长

12 weeks

期刊介绍： Tobacco Induced Diseases encompasses all aspects of research related to the prevention and control of tobacco use at a global level. Preventing diseases attributable to tobacco is only one aspect of the journal, whose overall scope is to provide a forum for the publication of research articles that can contribute to reducing the burden of tobacco induced diseases globally. To address this epidemic we believe that there must be an avenue for the publication of research/policy activities on tobacco control initiatives that may be very important at a regional and national level. This approach provides a very important "hands on" service to the tobacco control community at a global scale - as common problems have common solutions. Hence, we see ourselves as "connectors" within this global community. The journal hence encourages the submission of articles from all medical, biological and psychosocial disciplines, ranging from medical and dental clinicians, through health professionals to basic biomedical and clinical scientists.