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#Grand Rounds

Does Prenatal Smoking Increase the Risk of GDM?

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BACKGROUND AND PURPOSE:

  • Smoking is an independent risk factor for type 2 diabetes
  • Bar-Zeev et al. (Obstetrics & Gynecology, 2020) investigated whether there is an association between prenatal smoking and gestational diabetes mellitus (GDM)

METHODS:

  • Secondary data analysis of the Pregnancy Risk Assessment Monitoring System (2009-2015)
    • CDC and state health departments surveillance project
  • Participants
    • Representative sample of U.S. women with recent live births
  • Study design
    • Data extraction on smoking status during pregnancy
      • Nonsmoker
      • Quit smoking
      • Reduced the amount smoked
      • Smoked the same or more
    • Multivariable logistic regression analyses to estimate the association between prenatal smoking and GDM status
    • Adjusted for confounders, including
      • Maternal age | Race–ethnicity | Prepregnancy BMI | Gestational weight gain
    • Overall associations were estimated | Stratification conducted using prepregnancy BMI and gestational weight gain subgroups
  • Primary outcomes
    • Self-reported GDM

RESULTS:

  • 222,408 women included
    • GDM: 5.3%
    • Excessive weight gain: 43.1%  
  • Smoking status
    • Nonsmokers for >2 years before pregnancy: 75.0%
    • Quit before pregnancy: 2.8%
    • Quit during pregnancy: 11.8%
    • Reduced number of cigarettes smoked: 6.7%  
    • Number of cigarettes same or more: 3.5%
  • There was a significant association between prenatal smoking and GDM
    • Smoked the same or greater number of cigarettes during pregnancy
      • Adjusted odds ratio (aOR) 1.46 (95% CI, 1.25 to 1.71)
    • Reduced the number of cigarettes smoked during pregnancy
      • aOR 1.22 (95% CI, 1.08 to 1.38)
  • Subgroup analysis
    • Association between smoking the same or more cigarettes was associated with higher odds of GDM in all subgroup of prepregnancy BMI or gestational weight gain

CONCLUSION:

  • Prenatal smoking is associated with a higher risk for GDM, and remained an independent risk factor after adjustment for confounders and weight stratification
    • Study strengths include large sample size and rigorous data collection from multiple states
  • Authors recognize study limitations including
    • Secondary analysis of database and therefore not all confounders were accounted for (e.g., family history of diabetes and activity levels)
  • The authors suggest that “reducing smoking rates may reduce the risk of GDM” and as a modifiable risk factor, this study provides further evidence to discourage smoking during pregnancy

Learn More – Primary Sources:

Association Between Prenatal Smoking and Gestational Diabetes Mellitus

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Does Smoking During Pregnancy Affect the Fetal Immune System?

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