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Cigarette Smoking and the Risk of Gestational and Pregestational Diabetes in Two Consecutive Pregnancies

¹ Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
² International Agency for Research on Cancer (IARC), Lyon, France
³ Department of Endocrinology, Karolinska Hospital, Stockholm, Sweden

Address correspondence and reprint requests to Paul D. Terry, PhD, MPH, NIEHS, Epidemiology Branch, P.O. Box 12233 MD A3-05, (Overnight: 111 T.W. Alexander Dr., South Campus, Bldg. 101, MD A3-05, Room A302-A), Research Triangle Park, NC 27709-2233. E-mail: terry2{at}niehs.nih.gov

OBJECTIVE—Cigarette smoking during pregnancy may increase the risk of gestational diabetes mellitus (GDM) or pregestational diabetes mellitus (PDM). Smoking has been associated positively with hyperinsulinemia and insulin resistance in experimental studies, although the association with diabetes remains unclear. To further explore this issue, we examined the association with smoking in the largest prospective cohort study of GDM and PDM to date.

RESEARCH DESIGN AND METHODS—The study population comprised 212,190 women in the population-based Swedish Birth Registry who had their first and second deliveries between January 1987 and December 1995. Maternal characteristics were recorded in a standardized manner at the first prenatal visit, followed by a clinical examination and a standardized in-person interview to assess lifestyle habits. Women were categorized as nonsmokers, light smokers (one to nine cigarettes per day), or moderate-to-heavy smokers (at least 10 cigarettes per day).

RESULTS—Women with GDM in their first pregnancy experienced an eight- to ninefold increased risk of GDM or PDM in their second pregnancy. Cigarette smoking was not associated with increased risk of these conditions. Neither women who smoked during their first and second pregnancies nor those who commenced smoking between pregnancies had a higher risk of GDM or PDM than nonsmokers.

CONCLUSIONS—Our findings do not support an association between cigarette smoking and risk of GDM or PDM in young women of childbearing age.

Abbreviations: GDM, gestational diabetes mellitus • PDM, pregestational diabetes mellitus • OGTT, oral glucose tolerance test

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