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Maternal Cigarette Smoking and Placenta Previa

Obstetrics & Gynecology: May 1996
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Objective To identify the relationship between maternal cigarette smoking and ultrasound-confirmed placenta previa.

Methods A matched case-control design was used. Cases were drawn from the New England Medical Center and Cambridge Hospital from July 1992 through March 1994. Each case was delivered by cesarean after 24 weeks' gestation and had an antenatal ultrasound examination cnfirming placenta previa. Matched controls were obtained by requesting records on the first three deliveries by the referring provider the same month as the index case. Data on potential risk factors were drawn from the records of the initial prenatal visit, before previa was diagnosed. The data were analyzed with conditional logistic regression.

Results Thirty-two cases of ultrasound-documented planceta previa were identified. A number of potential confounders were associated with previa: age (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.05–1.26), gravidity (OR 1.4, 95% CI 1.1–1.7), parity (OR 1.4, 95% CI 1.1–1.9), prior spontaneous abortion (OR 3.1, 95% CI 1.3–7.4), prior elective abortion (OR 3.0, 95% CI 1.2–7.6), and prior cesarean delivery (OR 3.5, 95% CI 1.3–9.9). The crude OR for current smoking was 3.0 (95% CI 1.1–8.6). The OR for smoking ranged from 2.6–4.4, despite controlling for confounders.

Conclusion Current cigarette smoking is associated with a 2.6–4.4-fold incresed risk of placenta previa.

Address reprint requests to: David Chelmow, MD, Department of Obstetrics and Gynecology, New England Medical Center, 750 Washington Street, Box 022, Boston, MA 02111

© 1996 The American College of Obstetricians and Gynecologists