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Exposure to tobacco smoke and stillbirth: a national prospective cohort study in rural China
  1. Yimin Qu1,2,
  2. Shi Chen3,
  3. Hui Pan3,
  4. Huijuan Zhu3,
  5. Chengsheng Yan4,
  6. Shikun Zhang5,
  7. Yu Jiang1
  1. 1 School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
  2. 2 The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, New Territories, Hong Kong
  3. 3 Department of Endocrinology, Key Lab of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng-qu, China
  4. 4 Hebei Center for Women and Children’s Health, Shijiazhuang, China
  5. 5 Research Association for Women and Children’s Health, Beijing, China
  1. Correspondence to Professor Yu Jiang, School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China; jiangyu{at}


Introduction Parental exposure to tobacco smoke has been associated with an increased risk of stillbirth, while only a few studies took the overall parental tobacco exposure status into consideration. We aim to explore the relationship of parental smoking and passive smoking before and during pregnancy with stillbirth in a large Chinese rural cohort.

Design 248 501 couples were enrolled in a national prospective cohort study conducted in rural China. Parental exposure to tobacco smoke before and during pregnancy, along with other risk factors, was ascertained by questionnaires. Pregnancy outcomes were recorded by physicians.

Results The ORs (Odds Ratios) of maternal active smoking, maternal passive smoking, paternal active smoking and paternal passive smoking were 2.07 (95% CI 1.25 to 3.41), 1.22 (95% CI 1.01 to 1.47), 1.36 (95% CI 1.13 to 1.63) and 1.10 (95% CI 0.87 to 1.39), respectively. The rates of stillbirth increased from 0.31% for the maternal non-smoking group to 0.43% for the smoking cessation during pregnancy group, to 0.64% for the decreased smoking group and 1.28% for the continuing smoking group. A similar pattern was found in the change in paternal smoking status and stillbirth. Stratified by maternal passive smoking, the OR of paternal smoking was 1.35 (95% CI 1.13 to 1.61) in the maternal non-smoking group and 1.67 (95% CI 1.09 to 2.56) in the maternal passive smoking group.

Conclusions Parental exposure to tobacco smoke increased the risk of stillbirth, especially for those continuing smoking during pregnancy. Paternal smoking is an independent risk factor for stillbirth despite maternal passive smoking status.

  • pregnancy
  • smoking
  • passive smoking
  • cohort studies

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  • YQ and SC are joint first authors.

  • Contributors HP obtained funding. HP, SC, CY, SZ and HZ designed the study and collected the data. YQ, YJ, SC and HP analysed the data and drafted the manuscript. All authors have read and approved the final manuscript.

  • Funding This study was supported by grants from the National Natural Science Foundation of China (grant number 81673184).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Institutional Review Board of the Chinese Association of Maternal and Child Health Studies (IRB201001). Informed consent was obtained from all participants or their legal representatives.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.