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Nicotine & Tobacco Research Advance Access published online on January 27, 2009
Nicotine & Tobacco Research, doi:10.1093/ntr/ntn014
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© The Author 2009. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Prenatal alcohol consumption and fetal growth restriction: Potentiation effect by concomitant smoking

Muktar H. Aliyu, Ronee E. Wilson, Roger Zoorob, Kristal Brown, Amina P. Alio, Heather Clayton and Hamisu M. Salihu

Muktar H. Aliyu, M.D., Dr.P.H., Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN
Roger Zoorob, M.D., M.P.H., Department of Family and Community Medicine, Meharry Medical College, Nashville, TN
Kristal Brown, B.S., Division of Public Health Practice, Meharry Medical College, Nashville, TN
Ronee E. Wilson, M.P.H., Department of Epidemiology and Biostatistics, University of South Florida, Tampa, FL
Amina P. Alio, Ph.D., Department of Community and Family Health, University of South Florida, Tampa, FL
Heather Clayton, M.P.H., Department of Community and Family Health, University of South Florida, Tampa, FL
Hamisu M. Salihu, M.D., Ph.D., Department of Epidemiology and Biostatistics, University of South Florida, Tampa, FL, Department of Obstetrics and Gynecology and Rhea Lawton Chiles Center for Healthy Mothers and Babies, University of South Florida, Tampa, FL

Corresponding Author: Hamisu Salihu, Lawton and Rhea Chiles Center for Healthy Mothers and Babies, University of South Florida, 3111 East Fletcher Avenue, Tampa, FL 33613, USA. Telephone: 813-974-1073. Fax: 813-974-8889. E-mail: hamisu.salihu{at}gmail.com


  Abstract

Introduction: This study investigates whether maternal cigarette smoking modifies the association between alcohol use in pregnancy and the risk of small-for-gestational-age (SGA) delivery.

Method: We employed linked vital statistics data of singleton births in the state of Missouri covering the period 1989 through 1997 (N = 655,758). Multivariate logistic regression was used to generate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for SGA associated with maternal alcohol intake. A subanalysis was conducted to assess the impact of the interaction of alcohol consumption and tobacco use on SGA.

Results: About 2% of mothers (n = 14,444) reported consuming alcohol during pregnancy, and approximately 4% of SGA births occurred among these mothers. Women who consumed alcohol during pregnancy had a 20% greater risk for delivering an SGA infant than mothers who abstained (AOR = 1.2; CI = 1.1–1.3). The relative risk for SGA birth rose as the reported number of drinks consumed per week increased (trend p < .0001). The relative risk of delivering an SGA infant was consistently higher among women who reported both drinking alcohol and using tobacco products in pregnancy as compared to women who were drinkers but nonsmokers. The greatest risk was among women who smoked and consumed five or more drinks per week (AOR = 4.8, CI = 4.2–5.5).

Discussion: Our findings suggest significant interaction between prenatal alcohol consumption and smoking on the risk of delivering an SGA infant and highlight the relevance of developing "dual message" health education programs that would stress the deleterious effect of joint exposure to alcohol and nicotine in pregnancy.

Received: February 11, 2008; Accepted: July 15, 2008
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