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pubmed:otherAbstract |
PIP: This prospective population study attempted to investigate the effects of smoking, alcohol, and caffeine consumption and socioeconomic factors and psychosocial stress on birthweight. A consecutive series of 1860 white women booking for delivery at a district general hospital in inner London were asked to participate. 136 refused and 211 failed to complete the study for other reasons (relocation, abortion, subsequent refusal), leaving a sample of 1513. Women who spoke no English, booked after 24 weeks, had insulin-dependent diabetes, or had a multiple pregnancy were excluded. Data were obtained by research interviewers at booking (general health questionnaire, modified Paykel's interview, and Eysenck personality questionnaire), at 17, 28, and 36 weeks' gestation, and from the structured antenatal and obstetric record. Variables assessed included smoking, alcohol consumption, caffeine consumption, and over 40 indicators of socioeconomic status and psychosocial stress, including social class, tenure of accomodation, educational status, employment status, income, anxiety and depression, stressful life events, social stress, social support, personality, and attitudes to pregnancy. Birthweight was adjusted for gestation and for maternal height, parity, and baby's sex. Smoking was the single most important factor (5% reduction in corrected birthweight). Passive smoking was not significant (0.5% reduction). After smoking was controlled for, alcohol had an effect only in smokers and the effects of caffeine became significant. Only 4 of the socioeconomic and stress factors significantly reduced birthweight and these became nonsignificant after smoking was controlled for. Social and psychological factors have little or no direct effect on birthweight corrected for gestational age (fetal growth), and the main environmental cause of its variation in this population was smoking.
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