Hum. Reprod. Update-2011-Hackshaw-589-604.pdf

........................................................................................................................... Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls AllanHackshaw 1,*, Charles Rodeck 2, and Sadie Boniface 3 1CRUK UCL Trials Centre, University College London, 5th Floor, 90 Tottenham Court Road, London W1T 4TJ, UK 2Department of Obstetrics and Gynaecology, University College London/University College London Hospitals, London, UK 3Department of Epidemiology and Public Health, University College London, London, UK Correspondence address. E-mail: ah@ctc.ucl.ac.uk Submitted on January 27, 2011; resubmitted on April 5, 2011; accepted on April 13, 2011 table of contents ? Introduction ? Methods ? Results Cardiovascular/heart defects Musculoskeletal defects and craniosynostosis Facial defects (face, eyes or ears) Defects of the gastrointestinal system Defects of the genitourinary system Defects of the CNS Defects of the respiratory system and skin All congenital abnormalities considered together Study quality, heterogeneity and publication bias ? Discussion background: There is uncertainty over whether maternal smoking is associated with birth defects. We conducted the first ever comprehensive systematic review to establish which specific malformations are associated with smoking. methods: Observational studies published 1959–2010 were identified (Medline), and included if they reported the odds ratio (OR) for having a non-chromosomal birth defect among women who smoked during pregnancy compared with non-smokers. ORs adjusted for poten- tial confounders were extracted (e.g. maternal age and alcohol), otherwise unadjusted estimates were used. One hundred and seventy-two articles were used in the meta-analyses: a total of 173 687 malformed cases and 11 674 332 unaffected controls. results: Significant positive associations with maternal smoking were found for: cardiovascular