The relationship between exposure during pregnancy to cigarette smoking and cocaine use and placenta previa*,**,*,**

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Abstract

OBJECTIVE: This study examined the relationship between two maternal exposures, cigarette smoking and cocaine use, and placenta previa. STUDY DESIGN: A hospital-based case-control study was conducted. Three hundred four cases of placenta previa were compared with 2732 controls with respect to demographic characteristics, substance use, and perinatal characteristics. Logistic regression was used to examine the individual effects of cigarette smoking and cocaine use on placenta previa, independent of other known risk factors. RESULTS: A dose-response relationship between smoking cigarettes and placenta previa was observed independent of other known risk factors (ptrend < 0.01). Pregnant women who smoked ≥20 cigarettes per day were over two times more likely to experience a placenta previa relative to nonsmokers (odds ratio 2.3, 95% confidence interval 1.5 to 3.5). Pregnant women who used cocaine were 1.4 times (95% confidence interval 0.8 to 2.4) as likely to experience a placenta previa as nonusers. CONCLUSIONS: The previously observed association between smoking and placenta previa is supported by the dose-response relationship observed in this study. The potential association of cocaine with placenta previa needs more exploration. (AM J OBSTET GYNECOL 1994;170:884-9.)

Section snippets

MATERIAL AND METHODS

A hospital-based case-control study was used to explore the relationship between substance use during pregnancy, primarily tobacco cigarettes and cocaine, and the occurrence of placenta previa. Data for this study were from two large perinatal registries, the University of Illinois Hospital Perinatal Database and the Cook County Hospital Perinatal Database. Medical records from all obstetric events during 1988 and 1989 at the University of Illinois Hospital and during 1988, 1989, and 1990 at

RESULTS

The incidence of placenta previa in the combined University of Illinois and Cook County Perinatal Databases for 1988 and 1989 and for 1990 at Cook County Hospital was 0.59% (5.9/1000) singleton deliveries. Table I presents the demographic, prior pregnancy history, and substance use characteristics of the placenta previa cases and controls. There were no racial or ethnic differences between cases and controls. The likelihood of being a case increased with maternal age (ptrend < 0.001) and with

COMMENT

On the basis of data from two large perinatal registries a relationship was found between placenta previa and smoking increasing numbers of cigarettes during pregnancy, independent of other known risk factors. After multivariable adjustment, the elevated odds ratio between cocaine and placenta previa previously reported15 decreased in magnitude.

That data for this study were generated from perinatal registries and were not collected for the purpose of this analysis provides assurance that our

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    • Cited by (0)

    *

    From the University of Illinois School of Public Healtha and Cook County Hospital.b

    **

    Supported by the 1991 University of Illinois School of Public Health Biomedical Services Research Grant Competition.

    *

    Reprint requests: Arden Handler, DrPH, Assistant Professor, Community Health Sciences, University of Illinois School of Public Health, 2035 W. Taylor, Chicago, IL 60612.

    **

    0002-9378/94 $3.00 + 0 6/1/51817

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