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The Association Between Tobacco Exposure During Pregnancy and Newborns’ Birth Weight in Dki Jakarta Community Members

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The Association Between Tobacco Exposure During Pregnancy and Newborns’ Birth Weight in Dki Jakarta Community Members medRxiv preprint doi: https://doi.org/10.1101/2020.10.29.20222059; this version posted November 3, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC 4.0 International license . THE ASSOCIATION BETWEEN TOBACCO EXPOSURE DURING PREGNANCY AND NEWBORNS’ BIRTH WEIGHT IN DKI JAKARTA COMMUNITY MEMBERS Jason Phowira,1* Felicitas Tania Elvina,1 Igor Ian Wiguna,1 Fathurohman Ramadhan Hanif Bari Wahyudi,1 Bernie Endyarni Medise2 1Faculty of Medicine, Universitas Indonesia 2Child Health Department, Faculty of Medicine, Universitas Indonesia *corresponding author: [email protected] Abstract Low birth weight (LBW), a major determinant of neonate morbidity and mortality, remains a global public health concern. Intrauterine exposure to tobacco has been discerned as an important risk factor for LBW. This study aims to investigate the association between parental smoking during pregnancy and LBW. An analytical cross-sectional study was conducted from December 2019 - July 2020 on a random sample of parents with child aged 0-5 years old from 5 health centers in DKI Jakarta, Indonesia. A total of 145 subjects met the criteria and were analysed. Data analysis was carried out using IBM SPSS Statistics software. In the study, 11% of infants were born with LBW. The prevalence of smoking in fathers and mothers were 55.2% and 3.4%, respectively. Paternal smoking status was significantly associated with LBW (p < 0.05). Although not statistically significant, there was a dose-response relationship between paternal number of cigarettes/day and duration of smoking with LBW. Maternal smoking status (p = 0.448) was not closely associated with LBW, which might be due limited number of actively smoking mothers. From multivariate logistic regression, paternal smoking status, premature delivery, birth order and inadequate food intake during pregnancy were significant predictors of LBW (p < 0.05). Keywords: Low birth weight, tobacco exposure, parental smoking habit, pregnancy, Indonesia Introduction people in Indonesia begin casually Smoking remains as the leading smoking at an early age between 15 to 20, preventable cause of health problems and reflecting the vulnerability to initiate an premature deaths globally. Despite early smoking habit among Indonesian acknowledging the harm and detrimental youths.3 Tobacco is a strong and powerful health effects, majority of highly multisite carcinogen with a global health dependent smokers find it arduous to quit impact, resulting in cancers of lungs, smoking. The underlying reason behind upper aero-digestive tracts, pancreas, this is primarily due to nicotine in cigarette liver, stomach, lower urinary tracts, generating strong desire to smoke, kidney, and leukimia.4 About half of therefore overwhelming the concerns tobacco users die due to a smoking- regarding its health impacts.1 related disease, and smoking reduces Without the implementation of greatly one’s overall life expectancy by an reduction strategies, tobacco use is average of 15 to 20 years.5 projected over the next few decades to be When associated with pregnancy, the most significant cause of adult deaths tobacco exposure can result in worldwide.2 Indonesia is one of the unfavorable pregnancy outcomes, countries with the most tobacco- including low birth weight (LBW), consuming population, and the prevalence spontaneous abortion, premature delivery, of tobacco users in Indonesia has been perinatal mortality, and ectopic showing an increasing trend. In general, pregnancy.6 It has been long proposed NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. 1 medRxiv preprint doi: https://doi.org/10.1101/2020.10.29.20222059; this version posted November 3, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC 4.0 International license . and widely-believed that many of the On this research, cross-sectional chemicals present in tobacco can cross study was used to analyze the association the placental barrier and lead to a direct between exposure to tobacco during harmful effect on the fetus.7 Organ volume pregnancy and birth weight of newborns. analysis on magnetic resonance imaging This research was performed for 8 months (MRI) also demonstrated that in utero starting from December 2019 until July exposure to nicotine results in subsequent 2020, and the data collection was decreased brain, lung, kidney, and conducted at Primary Health Centers in placental volume.8 The severity of fetal DKI Jakarta, particularly in Central growth restriction (FGR) resulted from Jakarta. The target population were nicotine exposure has been demonstrated parents with child aged 0-5 years old from to be dose-dependent. Each pack smoked DKI Jakarta community members. The during pregnancy results in an average of sample were the target population who 2.8 g decrement in neonatal body weight.9 fulfilled the inclusion and exclusion Intrauterine growth restriction (IUGR) criteria. The inclusion criteria includes and low birth weight are notable risk subjects who are being domiciled in DKI factors of neonatal mortality. In United Jakarta, subjects with child aged 0-5 years States, 65% of infant deaths occur among possessing Kesehatan Ibu dan Anak (KIA) low birth weight infants, and in Indonesia, book or medical record from Primary it was found that infants born with low birth Health Center, and subjects who agree to weight had a 9.89-fold higher risk of sign the informed consent. The exclusion neonatal death compared with infants criteria includes subjects with no data of born with normal birth weight.10,11 birth weight written in KIA book or medical Neonatal mortality rate (NMR) remains record, subjects with adopted child and high in Indonesia, with the rate of 21.4 subjects who do not fill the questionnaire infant deaths per 1,000 live births.12 completely. Recent years have seen the Table 2x2 whose data was taken from emergence of several studies addressing previous study regarding the association the association between exposure to between exposure to tobacco and low tobacco and newborns’ birth weight in birth weight is used to obtain the sample other countries. However, to our size. The minimum sample required for knowledge, limited research has been this study was 98 subjects. In this dedicated on this topic in Indonesia. Thus, research, the samples were selected this research is conducted to analyze the based on simple random sampling association between paternal tobacco method. The data was obtained from the exposure during pregnancy and its effects questionnaires filled by eligible subjects. on the infants’ birth weight at population The questionnaire was modified from level in Indonesia, particularly in DKI previous studies discussing about the Jakarta. Hopes are the findings of this association between tobacco exposure research could help provide better and several other factors related to understandings about the harmful effects prevalence of LBW. The data was used to of tobacco exposure during pregnancy, analyze the association between tobacco leading to increased awareness and exposure during pregnancy and the birth reduction in the number of morbidity and weight of the child in DKI Jakarta mortality associated with smoking. community members. In this research, the process of data collection was done by Methods distributing printed questionnaires to obtain primary data regarding the 2 medRxiv preprint doi: https://doi.org/10.1101/2020.10.29.20222059; this version posted November 3, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC 4.0 International license . exposure to tobacco during smoking and under five years old were eligible for this birth weight of the child. study. A total of 145 women fulfilled the Firstly, formal requests and ethical inclusion and exclusion criteria and were clearance were sent out to Primary Health analysed. Centers located in DKI Jakarta to ask for The characteristics of the parents in their permission. Then, randomized and this study are shown in Table 4.1. The eligible subjects were given explanation mean age of the mothers and fathers in regarding the procedure and aim of the this study was 31.06 ± 6.246 and 34.28 research. Subjects would have to read the ± 6.782 years, respectively. The parental informed consent form and asked to sign educational background ranged from not it if they agree with the conditions. attending any formal school to Master’s Subjects were made aware of their rights degree graduate. Majority of mothers in withdrawing from the research without (57.9%) and fathers (65.5%) had senior any consequence and of their rights in high school education on the basis of relation to confidentiality. Then, the educational status. Most mothers were subjects filled the demographic data of the unemployed (85.5%). In contrast to high respondent followed by the questionnaire unemployment rate in maternal group, form. The researcher did not interfere with majority of fathers were employed (88.3%) the subjects’ answers and helped the with 44.8% of them receiving a monthly subjects in answering if there is any income greater than provincial minimum difficulty. wage of Rp3.940.973. Data from this research was classified According to the measurement of into two categories, low birth weight and house crowding index, majority of subjects normal birth weight. Low birth weight is in this study lived in severely crowded defined as birth weight of less than 2500 housing (54.5%). Concerning maternal grams, while ≥ 2500 grams is considered age at delivery, most mothers gave birth to normal.
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