eprintid: 10132147 rev_number: 19 eprint_status: archive userid: 608 dir: disk0/10/13/21/47 datestamp: 2021-08-02 11:58:13 lastmod: 2021-12-03 23:18:28 status_changed: 2021-08-02 11:58:13 type: article metadata_visibility: show creators_name: Avşar, TS creators_name: McLeod, H creators_name: Jackson, L title: Health outcomes of smoking during pregnancy and the postpartum period: an umbrella review ispublished: pub divisions: UCL divisions: B02 divisions: D12 divisions: G21 keywords: Health outcomes, Partner smoking, Smoking during pregnancy, Systematic review, Umbrella review, Cleft Lip, Cleft Palate, Female, Humans, Infant Health, Infant, Newborn, Maternal Health, Mothers, Postpartum Period, Pregnancy, Pregnant Women, Premature Birth, Prenatal Exposure Delayed Effects, Smoking, Smoking Prevention, Systematic Reviews as Topic note: This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ abstract: BACKGROUND: Smoking during pregnancy (SDP) and the postpartum period has serious health outcomes for the mother and infant. Although some systematic reviews have shown the impact of maternal SDP on particular conditions, a systematic review examining the overall health outcomes has not been published. Hence, this paper aimed to conduct an umbrella review on this issue. METHODS: A systematic review of systematic reviews (umbrella review) was conducted according to a protocol submitted to PROSPERO ( CRD42018086350 ). CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, CRD Database and HMIC databases were searched to include all studies published in English by 31 December 2017, except those focusing exclusively on low-income countries. Two researchers conducted the study selection and quality assessment independently. RESULTS: The review included 64 studies analysing the relationship between maternal SDP and 46 health conditions. The highest increase in risks was found for sudden infant death syndrome, asthma, stillbirth, low birth weight and obesity amongst infants. The impact of SDP was associated with the number of cigarettes consumed. According to the causal link analysis, five mother-related and ten infant-related conditions had a causal link with SDP. In addition, some studies reported protective impacts of SDP on pre-eclampsia, hyperemesis gravidarum and skin defects on infants. The review identified important gaps in the literature regarding the dose-response association, exposure window, postnatal smoking. CONCLUSIONS: The review shows that maternal SDP is not only associated with short-term health conditions (e.g. preterm birth, oral clefts) but also some which can have life-long detrimental impacts (e.g. obesity, intellectual impairment). IMPLICATIONS: This umbrella review provides a comprehensive analysis of the overall health impacts of SDP. The study findings indicate that while estimating health and cost outcomes of SDP, long-term health impacts should be considered as well as short-term effects since studies not including the long-term outcomes would underestimate the magnitude of the issue. Also, interventions for pregnant women who smoke should consider the impact of reducing smoking due to health benefits on mothers and infants, and not solely cessation. date: 2021-03-26 date_type: published official_url: https://doi.org/10.1186/s12884-021-03729-1 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1879039 doi: 10.1186/s12884-021-03729-1 pii: 10.1186/s12884-021-03729-1 lyricists_name: Saygin Avsar, Tuba lyricists_id: TSAYG41 actors_name: Saygin Avsar, Tuba actors_id: TSAYG41 actors_role: owner full_text_status: public publication: BMC Pregnancy Childbirth volume: 21 article_number: 254 event_location: England citation: Avşar, TS; McLeod, H; Jackson, L; (2021) Health outcomes of smoking during pregnancy and the postpartum period: an umbrella review. BMC Pregnancy Childbirth , 21 , Article 254. 10.1186/s12884-021-03729-1 <https://doi.org/10.1186/s12884-021-03729-1>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10132147/1/Umbrella%20Review_published_SCI_Q1.pdf