Maternal Exposures to Cigarette Smoking and Alcohol and Congenital Diaphragmatic Hernia Public
Finn, Julia (Fall 2020)
Abstract
BACKGROUND: Congenital diaphragmatic hernia (CDH) is a major birth of the diaphragm in which abdominal organs herniate into the thoracic cavity. CDH contributes substantially to infant mortality and disability. CDH has both genetic and environmental risk factors. Previous studies suggest maternal smoking and alcohol exposures during pregnancy may be associated with CDH, but more comprehensive studies are needed. Using data from the National Birth Defects Prevention Study, we examined associations between maternal early pregnancy (one month prior through three months following conception) smoking and alcohol exposures and CDH.
METHODS: CDH cases and unaffected live born singleton controls, delivered from 1997 through 2011, were included. Interview reports of smoking (quantity, frequency, variability) and alcohol consumption (quantity, frequency, variability, type) were obtained from 883 case mothers and 11,829 control mothers. Two analyses were conducted: the main analysis examined deliveries from 2006-2011 and the second, a pooled analysis of all deliveries from 1997 through 2011. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated for each smoking and alcohol exposure variable and all CDH and CDH subtypes using multivariable logistic regression analysis.
RESULTS: In the main analysis, positive associations were observed for any smoking, active and/or passive smoking, smoking a minimum of 15 cigarettes per day, and smoking for any duration during early pregnancy and all CDH. Findings were similar for CDH subtypes. Positive associations were also observed for drinking 30 or more drinks/month and 4 or more binge episodes and all CDH. Findings were generally similar for CDH subtypes, with additional positive association observed for 1 binge episode and drinking for 2 months during early pregnancy and CDH Bochdalek. The results of the pooled analyses were generally similar to those for 2006-2011.
CONCLUSIONS: Several positive associations were observed between maternal smoking and all CDH and CDH subtypes. Whereas few positive associations were observed for maternal early pregnancy alcohol consumption and all CDH or CDH subtypes. Future studies should aim to improve exposure assessment and should examine potential mechanisms accounting for unexpected effects of maternal periconceptional cigarette smoking and alcohol observed in this study.
Table of Contents
TABLE OF CONTENTS
ABSTRACT
ACKNOWLEDGMENTS
THESIS STATEMENT
TABLE OF CONTENTS
LIST OF TABLES
CHAPTER I: Public Health Significance
Congenital diaphragmatic hernia
Survival in CDH
Clinical care and costs
Goal and significance
CHAPTER II: Background and Literature Review
Diaphragm development
Mechanisms of CDH development
Diagnosis and management of CDH
Genetic risk factors
Non-genetic risk factors
Maternal smoking and alcohol exposure
CHAPTER III: Methods
National Birth Defects Prevention Study (NBDPS)
Subject Selection
Case Classification
Exposure Assessment
Smoking exposure
Alcohol exposure
Statistical Analysis
CHAPTER IV: Results
Findings from the analytic period January 1, 2006 - December 31, 2011
Findings from the analytic period October 1, 1997 - December 31, 2011
CHAPTER V: Discussion
Maternal Smoking
Maternal Alcohol
Strengths and Limitations
REFERENCES
APPENDIX
About this Master's Thesis
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