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Updated: Jun 16, 2026

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Prenatal smoking among adolescents and risk of fetal demise before and during labor
Muktar H Aliyu1, Hamisu M Salihu, Amina P Alio
1Department of Preventive Medicine & Institute for Global Health, Vanderbilt University, Nashville, Tennessee, USA.
Study Objective:
To investigate the relationship between smoking during pregnancy and the occurrence of stillbirth phenotypes among adolescent mothers.
Design:
Retrospective cohort
Setting:
Singleton births in Missouri from 1978 through 1997.
Participants:
Two groups of "younger" (<15 years) and "older" (15-19 years) adolescent mothers were compared to "mature" mothers (age 20-24 years).
Main Outcome Measures:
Cox Proportional Hazards Regression models generated adjusted risk estimates of the association between intrauterine nicotine exposure and the risk of total, antepartum, and intrapartum stillbirth in each age group.
Results:
Approximately 32% (N=205,887) of the total 633,849 singleton births analyzed were among adolescent mothers. The overall prevalence of smoking was 31.2%, with the lowest prevalence (14.1%) among the youngest mothers while older adolescents had the highest (31.7%). The risk for intrapartum stillbirth among smoking adolescents <15 years of age was twice the risk for older adolescent and mature mothers. The risk of intrapartum stillbirth among smokers decreased as maternal age increased: [adjusted hazard ratio (AHR), 95% confidence interval (CI) for young mothers: 4.0, 95%CI=0.6-28.7; for older adolescents AHR=1.5, 95%CI=1.1-2.1 and for mature mothers AHR=1.8, 95% CI=1.4-2.2], respectively.
Conclusions:
In utero tobacco exposure has maternal age-related differential and lethal effects on the fetus. Young maternal age tends to potentiate these effects. There is a public health need to develop appropriate smoking cessation messages targeted specifically to this high risk group.
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