{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:51:05Z","timestamp":1782953465095,"version":"3.54.5"},"reference-count":25,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2002,9,3]],"date-time":"2002-09-03T00:00:00Z","timestamp":1031011200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Prenatal Diagnosis"],"published-print":{"date-parts":[[2002,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To determine the influence of maternal smoking on the birth prevalence of Down syndrome and on second trimester screening performance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>First, a meta\u2010analysis of cohort and case\u2010control studies was performed to estimate the effect of maternal smoking on the live birth prevalence of Down syndrome. Then, data from 8779 women screened using the quadruple test (alphafetoprotein (AFP), unconjugated estriol (uE<jats:sub>3<\/jats:sub>), human chorionic gonadotrophin (free \u03b2\u2010hCG), and inhibin\u2010A levels with maternal age) were used to determine the effect of smoking on the serum markers. A Monte Carlo simulation was used to assess the impact of adjusting for smoking status on screening performance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The relative risk of Down syndrome in smokers (versus non\u2010smokers) was 0.95 (95% confidence interval (CI) 0.87 to 1.03). Serum marker levels were determined as multiples of the median for non\u2010smokers of the same gestational age and adjusted for maternal weight (MoM). The MoM values for AFP were 5% higher (95% CI 2\u20137%), uE<jats:sub>3<\/jats:sub> 4% lower (95% CI 2\u20135%), free \u03b2\u2010hCG 20% lower (95% CI 17\u201323%) and inhibin\u2010A 62% higher (95% CI 57\u201367%) in smokers compared with non\u2010smokers. Adjusting marker levels for smoking resulted in less than a 1 percentage point increase in the detection rate for a 5% false positive rate with the double, triple or quadruple tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There is no evidence of an association between the birth prevalence of Down syndrome and maternal smoking. The case for adjusting screening marker levels for smoking is not compelling. But if smoking data are collected routinely adjustment could be made and this would yield similar detection and false positive rates in smokers and non\u2010smokers. Copyright \u00a9 2002 John Wiley &amp; Sons, Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pd.440","type":"journal-article","created":{"date-parts":[[2002,10,14]],"date-time":"2002-10-14T16:40:50Z","timestamp":1034613650000},"page":"893-897","source":"Crossref","is-referenced-by-count":40,"title":["Influence of maternal smoking on the birth prevalence of Down syndrome and on second trimester screening performance"],"prefix":"10.1002","volume":"22","author":[{"given":"Alicja R.","family":"Rudnicka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"Wald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne","family":"Huttly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan K.","family":"Hackshaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2002,9,3]]},"reference":[{"key":"e_1_2_1_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a009831"},{"key":"e_1_2_1_3_1","first-page":"545","article-title":"Maternal smoking and Down syndrome","volume":"43","author":"Christianson RE","year":"1988","journal-title":"Am J Hum Genet"},{"key":"e_1_2_1_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.313"},{"key":"e_1_2_1_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.1970100903"},{"key":"e_1_2_1_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0223(199904)19:4<372::AID-PD537>3.0.CO;2-O"},{"key":"e_1_2_1_7_1","doi-asserted-by":"publisher","DOI":"10.1159\/000010091"},{"key":"e_1_2_1_8_1","first-page":"1216","article-title":"Cigarette smoking and Down syndrome","volume":"37","author":"Hook EB","year":"1985","journal-title":"Am J Hum Genet"},{"key":"e_1_2_1_9_1","first-page":"482","article-title":"Maternal cigarette smoking, Down syndrome in live births, and infant race","volume":"42","author":"Hook EB","year":"1988","journal-title":"Am J Hum Genet"},{"key":"e_1_2_1_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1098-2272(1997)14:1<77::AID-GEPI6>3.0.CO;2-2"},{"key":"e_1_2_1_11_1","first-page":"131","volume-title":"Frontiers in knowledge in mental retardation, Vol II, Biochemical Aspects","author":"Kline J","year":"1981"},{"key":"e_1_2_1_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/gepi.1370100105"},{"key":"e_1_2_1_13_1","unstructured":"Office for National Statistics.1998.Birth Statistics 1996\u20131998. Series FM1 no. 25 26 27. Stationery Office: London."},{"key":"e_1_2_1_14_1","first-page":"675","article-title":"Cigarette smoking and levels of maternal serum alpha\u2010fetoprotein, unconjugated estriol, and hCG: impact on Down syndrome screening","volume":"81","author":"Palomaki GE","year":"1993","journal-title":"Obstet Gynecol"},{"key":"e_1_2_1_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s005990050040"},{"key":"e_1_2_1_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/tera.1420340109"},{"key":"e_1_2_1_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0223(199803)18:3<225::AID-PD239>3.0.CO;2-B"},{"key":"e_1_2_1_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.1320370715"},{"key":"e_1_2_1_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/152.12.1185"},{"key":"e_1_2_1_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3016.1990.tb00630.x"},{"key":"e_1_2_1_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.297.6653.883"},{"key":"e_1_2_1_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.1970140810"},{"key":"e_1_2_1_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/096914139700400402"},{"key":"e_1_2_1_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/jms.7.2.74"},{"key":"e_1_2_1_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780101105"},{"key":"e_1_2_1_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/00125817-199903000-00004"}],"container-title":["Prenatal Diagnosis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fpd.440","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pd.440","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,18]],"date-time":"2023-11-18T15:08:53Z","timestamp":1700320133000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/pd.440"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2002,9,3]]},"references-count":25,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2002,10]]}},"alternative-id":["10.1002\/pd.440"],"URL":"https:\/\/doi.org\/10.1002\/pd.440","archive":["Portico"],"relation":{},"ISSN":["0197-3851","1097-0223"],"issn-type":[{"value":"0197-3851","type":"print"},{"value":"1097-0223","type":"electronic"}],"subject":[],"published":{"date-parts":[[2002,9,3]]}}}