Skip to main content
SMFM 2024 Pregnancy Meeting Main banner
Final Program


Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Additional registration fee required
Additional registration fee required
Faculty have requested this content not be shared on social media
Faculty have requested this content not be shared on social media
CME Credit Offered
CME Credit Offered
Poster Icons
Foundation Awardee
Foundation Awardee
No Social Media
No Social Media
Back
Q&A

Epidemiology

Poster Session 4

(1069) Risk of perinatal mortality associated with expectant management in patients who used nicotine products

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: Prior studies have demonstrated an association between maternal nicotine use and adverse neonatal outcomes. Balancing the risk of stillbirth and infant death with increasing gestational age (GA) is nuanced and an important aspect of decision making around delivery timing. There is limited guidance regarding timing of delivery and whether earlier delivery reduces overall perinatal mortality rate in patients who used nicotine products. Therefore, we sought to compare the risk of perinatal death associated with each additional week of expectant management to that of immediate delivery.

Study Design: This was a retrospective cohort study of singleton non-anomalous term births in California between 2016 and 2019. We included patients who used nicotine products during any trimester of pregnancy. Pregnancies complicated by pre-existing diabetes and chronic hypertension were excluded. To determine the optimal GA for delivery, we compared the risk of delivery, which represented the risk of infant death at each week, with the fetal/infant mortality risk of expectant management for an additional week. The risk of expectant management was the sum of the risk of stillbirth during a subsequent week plus the risk of infant death in the subsequent week.

Results: In this study, 24,895 births were included who had tobacco use during pregnancy. At 37 weeks' gestation, the risk of immediate delivery was greater than one week of expectant management (64.2 vs. 48.0 deaths per 10,000 births) (Table 1). At 38 weeks' gestation the risks were not different (42.1 vs. 41.0 deaths per 10,000 births). At 39 weeks, the risk of immediate delivery was lower than expectant management (30.8 vs. 54.7) and remained lower at 40 and 41 weeks' gestation.

Conclusion: In this study of those who used nicotine during pregnancy, we found that the risk of perinatal mortality was increased with expectant management at 39 weeks and beyond. These findings can be used to guide clinical counseling and care in the context of ongoing prenatal care.