Birth outcomes among mothers reporting smoking before pregnancy and use of fertility treatments, Maryland, 2001-2009

Background: Our goal was to understand associations between birth outcomes among mothers who reported using Fertility Treatments (FT) and smoking prepregnancy. Methods: Data were obtained from a stratified random sample of 14,194 mothers who delivered live infants 2001-2009 and completed the Maryland Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Logistic regression analyses were performed using SAS. FT includes fertility drugs, insemination techniques, assisted reproductive technology or other medical treatments. Smoking prepregnancy was based on any smoking during the 3 months prepregnancy. Analysis of birth outcomes was restricted to mothers with singleton or twin births (all 3+ multiples were low birth weight [LBW,<2500g] and preterm [<37weeks]). Results: Five percent of mothers reported using FT: most were White non-Hispanic (70%), 30+ years old (74%), and college graduates (68%). Of mothers reporting FT use, 5% smoked prepregnancy. Prevalence of LBW births among smoking FT users was 24% compared to 14% among nonsmoking FT users (P=0.03). Smokers using FT who delivered twins were six times more likely to have a LBW birth than nonsmokers (OR=6.1, P=0.003). After adjustment for maternal age, race/ethnicity, plurality, and smoking during pregnancy, smokers were three times more likely to have a LBW infant than nonsmokers (OR=2.92, P=0.003), and were four times more likely to deliver a very LBW (VLBW,<1500g) infant (OR=4.27, P=0.002). Prematurity rates did not differ between smoking and nonsmoking FT users. Conclusion: Prepregnancy smoking cessation interventions targeted at these highly educated, motivated mothers undergoing fertility treatments may have a large impact on reducing LBW and VLBW infants.