Environmental tobacco smoke and low birth weight: a hazard in the workplace?

Low birth weight (LBW) increases infant morbidity and mortality worldwide. One well-established risk factor is maternal smoking. Environmental tobacco smoke (ETS) exposure has recently been focused on as another potential risk factor. In this article, we review epidemiologic literature on the effects of ETS on LBW and intrauterine growth retardation (IUGR), the cause of LBW related to maternal smoking. As we consider the feasibility of modifying women's exposure, we focus our discussion on workplace exposure to ETS. The workplace is particularly important to consider because women of child-bearing age are present in the workplace in greater numbers now than ever before. In addition, certain subgroups of working women may be particularly at risk from the effects of ETS on pregnancy because they work in environments with higher exposure or they are more susceptible to its effects. We conclude that there is consistent evidence to relate maternal ETS exposure to an increased risk of adverse pregnancy outcomes and that this association may be generalized to the work environment. In studies with positive findings, infants exposed to ETS antenatally were 1.5-4 times more likely to be born with LBW, but few studies examined LBW. Most studies looked at measures of IUGR. ETS was associated with reductions in birth weight (adjusted for gestational age) ranging from 25 to 90 g. Infants born to women exposed to ETS were generally 2-4 times more likely to be born small-for-gestational age. ETS exposure in the workplace can and should be minimized to protect pregnant women from its adverse effects.