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.


Secondhand smoke, Smoking Caused Disease, Surveillance and monitoring

DOI of Published Version



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

Journal/Book/Conference Title

Tobacco control

PubMed ID