ORIGINAL ARTICLE

¹ Department of Neonatology, University Hospital, Besançon, France
² Epidemiological Research Unit on Perinatal and Women’s Health, INSERM U149, Villejuif, France
³ Department of Neonatology, University Hospital, Lille, France
⁴ Department of Obstetrics and Gynaecology, University Hospital, Rouen, France
⁵ Department of Neonatology, Institut de Puériculture, Paris, France
⁶ Department of Neonatology, University Hospital, Nantes, France
⁷ Department of Neonatology, University Hospital Strasbourg, France
⁸ Department of Pediatrics, University Hospital Montpellier, France
⁹ Department of Neonatology, University Hospital, Nancy, France
¹⁰ INSERM U558, Toulouse, France

Correspondence to:
Correspondence to:
Dr Burguet
Réanimation Infantile Polyvalente et Prématurés, Hôpital Saint-Jacques, Centre Hospitalier Universitaire, 25030 Besançon cedex, France; a.burguet{at}chu-poitiers.fr

Objectives: To assess the relation between cigarette smoking during pregnancy and neonatal respiratory distress syndrome (RDS) in very preterm birth, and to analyse the differential effect of antenatal steroids on RDS among smokers and non-smokers.

Design: A population based cohort study (the French Epipage study).

Setting: Regionally defined births in France.

Methods: A total of 858 very preterm liveborn singletons (27–32 completed weeks of gestation) of the French Epipage study were included in this analysis. The odds ratio for RDS in relation to smoking in pregnancy was estimated using a logistic regression to control for gestational age. The odds ratio for RDS in relation to antenatal steroids was estimated taking into account an interaction between antenatal steroids and cigarette smoking, using multiple logistic regression to control for gestational age, birthweight ratio, main causes of preterm birth, mode of delivery, and sex.

Results: The odds ratio for RDS in relation to smoking in pregnancy adjusted for gestational age (aOR) was 0.59 (95% confidence interval (CI) 0.44 to 0.79). The aOR for RDS in relation to antenatal steroids was 0.31 (95% CI 0.19 to 0.49) in babies born to non-smokers and 0.63 (95% CI 0.38 to 1.05) in those born to smokers; the difference was significant (p = 0.04).

Conclusions: Cigarette smoking during pregnancy is associated with a decrease in the risk of RDS in very preterm babies. Although antenatal steroids reduce the risk of RDS in babies born to both smokers and non-smokers, the reduction is smaller in those born to smokers.

Abbreviations: PPROM, preterm premature rupture of membranes; RDS, respiratory distress syndrome

Keywords: antenatal steroids; respiratory distress syndrome; smoking in pregnancy

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