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13: Effect of prenatal tobacco use on perinatal outcomes and childhood neurodevelopment among infants born prematurely

  • Lindsay S. Robbins
    Affiliations
    Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL

    Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
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  • Christina T. Blanchard
    Affiliations
    Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL

    Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
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  • Rachel G. Sinkey
    Affiliations
    Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL

    Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
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  • Stacy L. Harris
    Affiliations
    Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL

    Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
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  • Alan T. Tita
    Affiliations
    Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL

    Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
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  • Lorie M. Harper
    Affiliations
    Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, AL

    Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
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      Objective

      Although it is well-known that nicotine is a neuroteratogen and prenatal tobacco exposure alters neurodevelopment, the effect on infants born prematurely is not yet well-described. We sought to examine the impact of prenatal tobacco exposure on childhood neurodevelopment until two years of age among infants born preterm.

      Study Design

      Secondary analysis of a multicenter RCT which assessed the benefits of magnesium for prevention of cerebral palsy in preterm infants. Women were included in the secondary analysis if they delivered a singleton, non- anomalous infant <37 weeks. Our exposure was any reported prenatal tobacco use. The primary outcome was the trial composite outcome of stillbirth or infant death by 1 year of age or moderate or severe cerebral palsy, assessed at or beyond two years of age. Secondary outcomes included cerebral palsy at two years, Bayley Scales of Infant Development II (BSIDII, motor and mental) scores at 24 months, need for auditory aids, and need for corrective lenses. Chi square, Fisher Exact, and two-sample t-tests were used as appropriate. Multivariable logistic regression models were performed to control for confounding factors.

      Results

      Of 1,921 women included, 548 (29%) used tobacco. Tobacco users were more likely to be younger, unmarried, white, have a prior preterm birth, and to have received no prenatal care. Illicit drug and alcohol use were also more prevalent among tobacco users. GA at delivery, betamethasone exposure and magnesium exposure were similar between groups. There were no differences in the composite primary outcome or in rates of CP by tobacco use (Table). BY BSIDII, moderate developmental delay (<70) was more common among tobacco users in univariate but not adjusted analysis (20.5% vs 15.9%, p = 0.035). There was no significant difference in need for auditory aids. In adjusted analysis, tobacco use was associated with increased need for corrective lenses (5.0% vs. 2.9%, aOR 2.28, 95% CI 1.28-4.07).