1. Pregnancy Smoking, ETS Exposure, and Birth Outcomes: Relative Risk and Timing of Exposure Department of Family Medicine & Tennessee Intervention for Pregnant Smokers, East Tennessee State University, Johnson City, TN Support for this project was provided by Tennessee Governor Bredesen’s Office of Children’s Care Coordination  In this sample, pregnancy ETS exposure was as detrimental as pregnancy smoking with respect to birth outcomes  In addition, the effects of both smoking and ETS exposure were minimized if eliminated by 20 weeks  Findings underscore the need to address both active smoking and ETS during pregnancy, and the benefits of smoking cessation and elimination of ETS even into the second trimester Beth A. Bailey, PhD The goal of the study was to examine links between pregnancy smoking, ETS, and birth outcomes Of particular interest was the relative risk of each exposure and the possible role of timing of exposure METHODS CONCLUSIONS RESULTS  688 pregnant women from Southern Appalachia were recruited at entry into prenatal care  At the time of conception, all participants were either active smokers, or were exposed to significant levels of ETS (i.e. lived with at least one pack per day or more smoker who smoked around them)  Interviews were conducted and medical charts were reviewed RESULTS  665 women could be classified into the following five categories:  Smoked 10+ cigarettes/day thru pregnancy (N=118)  Smoked <10 cigarettes/day thru pregnancy (N=282)  Non-smoker with ETS exposure to 20+ cigarettes/day thru pregnancy (N=55)  Non-smoker, early exposure to 20+ cigarettes/day, ETS exposure eliminated by 20 wks (N=150)  Early smoker, quit smoking and eliminated all ETS by 20 wks (N=60) OBJECTIVES  Research has revealed associations between pregnancy smoking and adverse pregnancy, birth, and long term child health and developmental outcomes  Less well studied and understood is the potential role of environmental tobacco smoke (ETS) BACKGROUND Smokers 10+ Cig/Day Smokers <10 Cig/Day Smokers Quit by 20 Wks Non-Smokers ETS Thruout Non-Smokers ETS Elim by 20 Wks Significant (LSD p<.05) Group Diffs* Birth Weight (lbs) 6.516.747.216.847.03 SvS;SvNS Low Birth Weight (%) 9.912.37.518.66.7 SvS,NS; NSvS,S,S,NS Gestational Age (wks) 38.138.238.737.438.2 SvNS Preterm Birth (%) 13.714.613.322.011.7 NSvS,S,S,NS Birth Length (in) 19.219.319.719.319.6 SvS,NS; SvNS Head Circumference (in) 13.013.113.413.2 SvS,S 1 Min Apgar Score 7.7 7.66.87.5 NSvS,S,S,NS NICU Admission (%) 8.77.13.821.49.6 NSvS,S,S,NS; SvS,S,NS Fetal/Neontl Demise (%) 5.75.00.06.14.1 SvS,S,NS,NS Pregnancy Smoke Exposure and Birth Outcomes  The five groups of women did not differ significantly on any demographic or medical variables  Women who smoked throughout pregnancy had significantly worse birth outcomes than those who quit smoking by 20 weeks  Smoking at least a half pack per day was associated with the highest risk of poor birth outcomes  Women with significant ETS exposure throughout pregnancy had birth outcomes comparable to, and in come cases worse than, those of active smokers, and significantly worse than those who smoked early in pregnancy but quit by 20 weeks  Risk was moderately reduced for those who eliminated active ETS exposure by 20 weeks * S=Smokers 10+/day; S=Smokers <10/day; S=Smokers Quit by 20 wks; NS=Non-Smoker significant ETS Throughout Pregnancy; NS=Non-Smoker ETS Eliminated by 20 wks