University of Massachusetts Medical School Faculty Publications


Associations of lifetime active and passive smoking with spontaneous abortion, stillbirth and tubal ectopic pregnancy: a cross-sectional analysis of historical data from the Women's Health Initiative

UMMS Affiliation

Department of Medicine, Division of Preventive and Behavioral Medicine; UMass Worcester Prevention Research Center

Publication Date


Document Type



Abortion, Spontaneous; Adult; Aged; Cross-Sectional Studies; Female; Humans; Middle Aged; Pregnancy; Pregnancy, Ectopic; Risk Factors; Smoking; Stillbirth; Tobacco Smoke Pollution; Women's Health; Young Adult


Behavior and Behavior Mechanisms | Female Urogenital Diseases and Pregnancy Complications | Obstetrics and Gynecology | Substance Abuse and Addiction | Women's Health


OBJECTIVE: To examine the associations between tobacco exposure and adverse pregnancy outcomes using quantitative measures of lifetime active smoking and secondhand smoke (SHS) exposure.

METHODS: Historical reproductive data on 80 762 women who participated in the Women's Health Initiative Observational Study were examined with a cross-sectional analysis. We assessed self-reported lifetime active and passive tobacco smoke exposure, self-reported spontaneous abortions, stillbirths and ectopic pregnancies.

RESULTS: When compared with never-smoking women, participants who were ever active smokers during their reproductive years had ORs (OR) of 1.16 (95% CI 1.08 to 1.26) for 1 or more spontaneous abortions, 1.44 (95% CI 1.20 to 1.73) for 1 or more stillbirths, and 1.43 (95% CI 1.10 to 1.86) for 1 or more ectopic pregnancies. Never-smoking women participants with the highest levels of lifetime SHS exposure, including childhood > 10 years, adult home > 20 years and adult work exposure > 10 years, when compared with never-smoking women with no SHS exposure had adjusted ORs of 1.17 (95% CI 1.05 to 1.30) for spontaneous abortion, 1.55 (95% CI 1.21 to 1.97) for stillbirth, and 1.61 (95% CI 1.16 to 2.24) for ectopic pregnancy.

CONCLUSIONS: Women who were ever-smokers during their reproductive years had significantly greater estimates of risk for spontaneous abortion, stillbirth and tubal ectopic pregnancy. Never-smoking women with the highest levels of lifetime exposure to SHS had significantly increased estimates of risk for spontaneous abortion, stillbirth and tubal ectopic pregnancy.

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Citation: Tob Control. 2015 Jul;24(4):328-35. doi: 10.1136/tobaccocontrol-2013-051458. Epub 2014 Feb 26. Link to article on publisher's site

Related Resources

Link to Article in PubMed


Secondhand smoke, Smoking Caused Disease, Surveillance and monitoring

Journal/Book/Conference Title

Tobacco control

PubMed ID