American Association of Plastic Surgeons

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Dose-dependent Response in Birth Prevalence of Limb Reduction Defects Related to Quantity of Maternal Peripartum Smoking
Kiersten C Woodyard De Brito, MPH1, Sean White, BS2, Trent James, BA2, Maleeh Effendi, MD3, Douglas R Dembinski, MD4, Scott J Rapp, MD1, Ryan Gobble, MD3, Ann R Schwentker, MD1, Brian W Starr, MD1
1Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA, 2University of Cincinnati College of Medicine, Cincinnati, OH, USA, 3University of Cincinnati, Division of Plastic and Reconstructive Surgery, Cincinnati, OH, USA, 4Brigham and Women’s Hospital, Boston, MA, USA

PURPOSE: Limb Reduction Defects (LRDs) are congenital anomalies shown to be modestly associated with maternal peripartum tobacco use. Limb bud development starts in early gestation and continues until the second trimester. Here we investigate dose-dependence of limb reduction defects related to quantity of maternal peripartum smoking in relevant gestational periods.
METHODS: Population-based data was extracted using the U.S. Natality database, which included maternal demographics, peripartum cigarette use, and presence of congenital defects. Odds Ratios with confidence intervals were calculated to compare birth records with Limb Reduction Defects to birth records without. Mantel-Haenszel (MH) Chi-squared test for linear trend assessed dose-dependence through comparison of likelihood of LRD at three doses of maternal smoking, 1-5, 6-10 and 11-20 cigarettes daily. RESULTS: 2868 infants with LRDs were born from 2016 to 2021, with approximately 22.5 million births recorded without LRDs. Any tobacco use in pregnancy or the periconceptional period demonstrated increased risk for LRDs with an OR 2.16 (p-value <0.0000001, CI 1.94, 2.42). Increasing doses of smoking in the periconceptional period, 1st trimester, and 2nd trimester demonstrated increasing risk for LRDs, with MH values 168.3, 198.5, 166.1, respectively. Likelihood of LRDs associated with pre-pregnancy, 1st trimester, and 2nd trimester smoking increased with each dose of maternal cigarette use, confirming a linear trend and dose-response relationship (p-value <0.000001).
CONCLUSION: Population-based data was used to solidify a dose-dependent relationship between quantity of maternal smoking and birth prevalence of LRDs. Patients should be counseled that any reduction in maternal smoking can decrease risk of LRDs.


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