{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T17:46:45Z","timestamp":1791740805023,"version":"4.3.4"},"reference-count":42,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:00:00Z","timestamp":1791676800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82373581"],"award-info":[{"award-number":["82373581"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Recent meta-analyses have reported inconsistent pooled relative risks of miscarriage associated with secondhand smoke exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a meta-analysis to examine the relationship between fetal loss and maternal secondhand smoke exposure during pregnancy in nonsmoking women. The outcome measures included spontaneous abortion and stillbirth. We searched PubMed, Web of science, Ovid and Cochrane databases up to May 1, 2026. Statistical analysis was performed using R version 4.3.1. Pooled odds ratios (ORs) with 95% confidence intervals were estimated using random-effect models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our analysis included 21 studies that assessed the effects of secondhand smoke exposure in nonsmoking pregnant women. Secondhand smoke exposure significantly increased the risk of fetal loss (OR: 1.21 [95% CI: 1.11\u20131.31]; I2\u00a0=\u00a055%; \u03c42\u00a0=\u00a00.007; P_het\u00a0&amp;lt;\u00a00.01). When stratifying fetal loss into spontaneous abortion and stillbirth, secondhand smoke exposure was associated with increased risks of spontaneous abortion (OR: 1.18 [95% CI: 1.02\u20131.37]; I2\u00a0=\u00a066%; \u03c42\u00a0=\u00a00.010; P_het\u00a0&amp;lt;\u00a00.01; 10 studies) and stillbirth (OR: 1.27 [95% CI: 1.10\u20131.46]; I2\u00a0=\u00a018%; \u03c42\u00a0=\u00a00.006; P_het\u00a0=\u00a00.28; 10 studies).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study provided compelling evidence that secondhand smoke exposure during pregnancy increased the risk of fetal loss, emphasizing the need for avoidance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/pubmed\/fdag071","type":"journal-article","created":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T17:26:22Z","timestamp":1791739582000},"source":"Crossref","is-referenced-by-count":0,"title":["Secondhand smoke exposure and fetal loss in nonsmoking pregnant women: a meta-analysis"],"prefix":"10.1093","author":[{"given":"Mengqi","family":"Chen","sequence":"first","affiliation":[{"name":"State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University , 101 Longmian Avenue, Nanjing , 211166, Jiangsu,","place":["China"]},{"name":"Department of Maternal, Child and Adolescent Health, Center for Global Health, School of Public Health, Nanjing Medical University , 101 Longmian Avenue, Nanjing, 211166, Jiangsu ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinghan","family":"Wang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University , 101 Longmian Avenue, Nanjing , 211166, Jiangsu,","place":["China"]},{"name":"Department of Maternal, Child and Adolescent Health, Center for Global Health, School of Public Health, Nanjing Medical University , 101 Longmian Avenue, Nanjing, 211166, Jiangsu ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Xu","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University , 101 Longmian Avenue, Nanjing , 211166, Jiangsu,","place":["China"]},{"name":"Department of Maternal, Child and Adolescent Health, Center for Global Health, School of Public Health, Nanjing Medical University , 101 Longmian Avenue, Nanjing, 211166, Jiangsu ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Lv","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University , 101 Longmian Avenue, Nanjing , 211166, Jiangsu,","place":["China"]},{"name":"Department of Maternal, Child and Adolescent Health, Center for Global Health, School of Public Health, Nanjing Medical University , 101 Longmian Avenue, Nanjing, 211166, Jiangsu ,","place":["China"]},{"name":"State Key Laboratory of Reproductive Medicine and Offspring Health (Suzhou Centre), The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University , 26 Daoqian Street, Suzhou, 215002, Jiangsu ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangqian","family":"Jiang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University , 101 Longmian Avenue, Nanjing , 211166, Jiangsu,","place":["China"]},{"name":"Department of Maternal, Child and Adolescent Health, Center for Global Health, School of Public Health, Nanjing Medical University , 101 Longmian Avenue, Nanjing, 211166, Jiangsu ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8961-8971","authenticated-orcid":false,"given":"Yuan","family":"Lin","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University , 101 Longmian Avenue, Nanjing , 211166, Jiangsu,","place":["China"]},{"name":"Department of Maternal, Child and Adolescent Health, Center for Global Health, School of Public Health, Nanjing Medical University , 101 Longmian Avenue, Nanjing, 211166, Jiangsu ,","place":["China"]},{"name":"State Key Laboratory of Reproductive Medicine and Offspring Health (Suzhou Centre), The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University , 26 Daoqian Street, Suzhou, 215002, Jiangsu ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,11]]},"reference":[{"key":"2026101113261751600_ref1","volume-title":"Framework Convention on Tobacco Control","year":"2003"},{"key":"2026101113261751600_ref2","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1136\/tc.2005.011288","article-title":"Philip Morris toxicological experiments with fresh sidestream smoke: More toxic than mainstream smoke","volume":"14","author":"Schick","year":"2005","journal-title":"Tob Control"},{"key":"2026101113261751600_ref3","doi-asserted-by":"publisher","first-page":"F351","DOI":"10.1136\/adc.2007.133553","article-title":"Environmental tobacco smoke and fetal health: Systematic review and meta-analysis","volume":"93","author":"Leonardi-Bee","year":"2008","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"2026101113261751600_ref4","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1007\/s10995-010-0599-2","article-title":"The association between second hand smoke and low birth weight and preterm delivery","volume":"15","author":"Khader","year":"2011","journal-title":"Matern Child Health J"},{"key":"2026101113261751600_ref5","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1111\/birt.12401","article-title":"Congenital malformations are associated with secondhand smoke among nonsmoking women: A meta-analysis","volume":"46","author":"Zheng","year":"2019","journal-title":"Birth."},{"key":"2026101113261751600_ref6","doi-asserted-by":"publisher","first-page":"e2422","DOI":"10.1002\/bdr2.2422","article-title":"Parental smoking and the risk of birth defects in offspring in China: A systematic review and meta-analysis","volume":"116","author":"Han","year":"2024","journal-title":"Birth Defects Res"},{"key":"2026101113261751600_ref7","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1111\/aogs.13011","article-title":"Maternal smoking during pregnancy and risk of stillbirth: Results from a nationwide Danish register-based cohort study","volume":"95","author":"Bj\u00f8rnholt","year":"2016","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2026101113261751600_ref8","doi-asserted-by":"publisher","first-page":"1658","DOI":"10.1016\/S0140-6736(21)00682-6","article-title":"Miscarriage matters: The epidemiological, physical, psychological, and economic costs of early pregnancy loss","volume":"397","author":"Quenby","year":"2021","journal-title":"Lancet."},{"key":"2026101113261751600_ref9","doi-asserted-by":"publisher","first-page":"1955","DOI":"10.1016\/S0140-6736(24)01925-1","article-title":"Global, regional, and national stillbirths at 20 weeks' gestation or longer in 204 countries and territories, 1990-2021: Findings from the global burden of disease study 2021","volume":"404","year":"2024","journal-title":"Lancet."},{"key":"2026101113261751600_ref10","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1542\/peds.2010-3041","article-title":"Secondhand smoke and adverse Fetal outcomes in nonsmoking pregnant women: A meta-analysis","volume":"127","author":"Leonardi-Bee","year":"2011","journal-title":"Pediatrics."},{"key":"2026101113261751600_ref11","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1093\/aje\/kwt334","article-title":"Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy","volume":"179","author":"Pineles","year":"2014","journal-title":"Am J Epidemiol"},{"key":"2026101113261751600_ref12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18332\/tid\/207156","article-title":"Tobacco exposure and risk of spontaneous abortion, a dose-dependent association: A systematic review and meta-analysis","volume":"23","author":"Yuan","year":"2025","journal-title":"Tob Induc Dis"},{"key":"2026101113261751600_ref13","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"Bmj."},{"key":"2026101113261751600_ref14","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur J Epidemiol"},{"key":"2026101113261751600_ref15","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1186\/1471-2458-13-154","article-title":"Are healthcare workers' intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review","volume":"13","author":"Herzog","year":"2013","journal-title":"BMC Public Health"},{"key":"2026101113261751600_ref16","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1007\/978-3-030-71921-0_3","volume-title":"Principles and Practice of Systematic Reviews and Meta-Analysis","author":"Assessing","year":"2021"},{"key":"2026101113261751600_ref17","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1136\/tobaccocontrol-2013-051458","article-title":"Associations of lifetime active and passive smoking with spontaneous abortion, stillbirth and tubal ectopic pregnancy: A cross-sectional analysis of historical data from the Women's Health Initiative","volume":"24","author":"Hyland","year":"2015","journal-title":"Tob Control"},{"key":"2026101113261751600_ref18","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1007\/s10654-016-0190-2","article-title":"Smoking, physical exercise, BMI and late foetal death: A study within the Danish National Birth Cohort","volume":"31","author":"Morales-Suarez-Varela","year":"2016","journal-title":"Eur J Epidemiol"},{"key":"2026101113261751600_ref19","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1136\/tc.2008.027961","article-title":"Associations between adult and childhood secondhand smoke exposures and fecundity and fetal loss among women who visited a cancer hospital","volume":"18","author":"Peppone","year":"2009","journal-title":"Tob Control"},{"key":"2026101113261751600_ref20","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1093\/inthealth\/ihz021","article-title":"Exposure to second-hand smoking as a predictor of fetal loss: Egypt demographic and health survey 2014","volume":"11","author":"Yaya","year":"2019","journal-title":"Int Health"},{"key":"2026101113261751600_ref21","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1097\/AOG.0000000000000052","article-title":"Association between stillbirth and illicit drug use and smoking during pregnancy","volume":"123","author":"Varner","year":"2014","journal-title":"Obstet Gynecol J"},{"key":"2026101113261751600_ref22","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1097\/OGX.0b013e31823311a7","article-title":"Effects of environmental tobacco smoke on perinatal outcomes: A retrospective cohort study","volume":"66","author":"Crane","year":"2011","journal-title":"Obstet Gynecol Surv"},{"key":"2026101113261751600_ref23","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1097\/01.ede.0000142137.39619.60","article-title":"Environmental tobacco smoke and pregnancy outcome","volume":"15","author":"Kharrazi","year":"2004","journal-title":"Epidemiology."},{"key":"2026101113261751600_ref24","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1097\/01.ede.0000229984.53726.33","article-title":"Environmental tobacco smoke and risk of spontaneous abortion","volume":"17","author":"George","year":"2006","journal-title":"Epidemiology."},{"key":"2026101113261751600_ref25","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1093\/oxfordjournals.aje.a009798","article-title":"Exposure to environmental and mainstream tobacco smoke and risk of spontaneous abortion","volume":"149","author":"Windham","year":"1999","journal-title":"Am J Epidemiol"},{"key":"2026101113261751600_ref26","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1177\/003335490912400220","article-title":"Exposure to maternal and paternal tobacco consumption and risk of spontaneous abortion","volume":"124","author":"Blanco-Mu\u00f1oz","year":"2009","journal-title":"Public Health Rep"},{"key":"2026101113261751600_ref27","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1136\/jech-2019-213290","article-title":"Exposure to tobacco smoke and stillbirth: A national prospective cohort study in rural China","volume":"74","author":"Qu","year":"2020","journal-title":"J Epidemiol Community Health"},{"key":"2026101113261751600_ref28","doi-asserted-by":"publisher","first-page":"572","DOI":"10.3109\/00016341003801656","article-title":"Higher risk of stillbirth among lower and middle income women who do not use tobacco, but live with smokers","volume":"89","author":"Subramoney","year":"2010","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2026101113261751600_ref29","doi-asserted-by":"publisher","first-page":"f108","DOI":"10.1136\/bmj.f108","article-title":"Maternal and fetal risk factors for stillbirth: Population based study","volume":"346","author":"Gardosi","year":"2013","journal-title":"BMJ\u00a0[Br Med J]"},{"key":"2026101113261751600_ref30","doi-asserted-by":"publisher","first-page":"3674","DOI":"10.3390\/nu14183674","article-title":"Maternal passive smoking, vitamin D deficiency and risk of spontaneous abortion","volume":"14","author":"Lin","year":"2022","journal-title":"Nutrients."},{"key":"2026101113261751600_ref31","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1093\/oxfordjournals.aje.a116250","article-title":"Parental cigarette smoking and the risk of spontaneous abortion","volume":"135","author":"Windham","year":"1992","journal-title":"Am J Epidemiol"},{"key":"2026101113261751600_ref32","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1093\/aje\/kwh128","article-title":"Paternal smoking and pregnancy loss: A prospective study using a biomarker of pregnancy","volume":"159","author":"Venners","year":"2004","journal-title":"Am J Epidemiol"},{"key":"2026101113261751600_ref33","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1136\/jech-2017-210311","article-title":"Paternal smoking and spontaneous abortion: A population-based retrospective cohort study among non-smoking women aged 20-49 years in rural China","volume":"72","author":"Wang","year":"2018","journal-title":"J Epidemiol Community Health"},{"key":"2026101113261751600_ref34","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1038\/s41598-018-35931-1","article-title":"Risk factors of stillbirth in rural China: A national cohort study","volume":"9","author":"Qu","year":"2019","journal-title":"Sci Rep"},{"key":"2026101113261751600_ref35","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1093\/aje\/kwm128","article-title":"Risk of spontaneous abortion in women with childhood exposure to parental cigarette smoke","volume":"166","author":"Meeker","year":"2007","journal-title":"Am J Epidemiol"},{"key":"2026101113261751600_ref36","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1093\/oxfordjournals.aje.a115886","article-title":"Tobacco smoke exposure and pregnancy outcome among working women. A prospective study at prenatal care centers in Orebro County, Sweden","volume":"133","author":"Ahlborg","year":"1991","journal-title":"Am J Epidemiol"},{"key":"2026101113261751600_ref37","doi-asserted-by":"publisher","first-page":"103228","DOI":"10.1016\/j.pmedr.2025.103228","article-title":"Fetal loss in women exposed to cigarette smoke in-utero","volume":"58","author":"Honorato-Rzeszewicz","year":"2025","journal-title":"Prev Med Rep"},{"key":"2026101113261751600_ref38","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s13072-022-00437-8","article-title":"Effects of paternal exposure to cigarette smoke on sperm DNA methylation and long-term metabolic syndrome in offspring","volume":"15","author":"Liu","year":"2022","journal-title":"Epigenetics Chromatin"},{"key":"2026101113261751600_ref39","doi-asserted-by":"publisher","first-page":"1255304","DOI":"10.3389\/fendo.2023.1255304","article-title":"Effects of cigarette smoking on semen quality, reproductive hormone levels, metabolic profile, zinc and sperm DNA fragmentation in men: Results from a population-based study","volume":"14","author":"Osadchuk","year":"2023","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2026101113261751600_ref40","doi-asserted-by":"publisher","first-page":"3212","DOI":"10.3390\/ijerph17093212","article-title":"Influence of second-hand smoke and prenatal tobacco smoke exposure on biomarkers, genetics and physiological processes in children-an overview in research insights of the last few years","volume":"17","author":"Braun","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2026101113261751600_ref41","first-page":"371","article-title":"Effect of nicotine on human fetal blood flow","volume":"72","author":"Lindblad","year":"1988","journal-title":"Obstet Gynecol"},{"key":"2026101113261751600_ref42","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1136\/tobaccocontrol-2016-053239","article-title":"Childhood secondhand smoke exposure and pregnancy loss in never smokers: The Guangzhou biobank cohort study","volume":"26","author":"Yang","year":"2017","journal-title":"Tob Control"}],"container-title":["Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jpubhealth\/advance-article-pdf\/doi\/10.1093\/pubmed\/fdag071\/71840011\/fdag071.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jpubhealth\/advance-article-pdf\/doi\/10.1093\/pubmed\/fdag071\/71840011\/fdag071.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T17:26:24Z","timestamp":1791739584000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jpubhealth\/advance-article\/doi\/10.1093\/pubmed\/fdag071\/8907443"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,11]]},"references-count":42,"URL":"https:\/\/doi.org\/10.1093\/pubmed\/fdag071","relation":{},"ISSN":["1741-3842","1741-3850"],"issn-type":[{"value":"1741-3842","type":"print"},{"value":"1741-3850","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,11]]},"article-number":"fdag071"}}