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Data on GDM, smoking status, maternal characteristics, pregnancy duration, newborn hospitalization, and mortality were obtained from the Finnish Medical Birth Register. Associations were examined using linear, logistic, and Poisson regression. Interaction between GDM and maternal smoking was assessed on multiplicative and additive scales.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      GDM and continued smoking were independently associated with shorter pregnancy duration and an increased risk of newborn hospitalization beyond 1 week. Continued smoking also increased the risks of preterm birth and perinatal mortality. On the additive scale, combined exposure to GDM and maternal continued smoking produced higher absolute risks than expected from either exposure alone. Additive interaction was observed for preterm birth (RERI\u2009=\u20090.44, 95% CI: 0.16\u20130.67), gestational duration (RERI\u2009=\u20092.05\u2009days, 95% CI: 1.07\u20133.04), and delayed hospital discharge (RERI\u2009=\u20090.36, 95% CI: 0.27\u20130.39). On the multiplicative scale, interaction was detected only for gestational duration (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both GDM and maternal smoking contribute independently to adverse perinatal outcomes, but their combined exposure elevates absolute risks more than either factor alone, particularly for reduced gestational length, preterm birth, and delayed newborn discharge. These findings highlight the importance of addressing both smoking and GDM in prenatal care, even among generally low\u2010risk primiparous women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70233","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T11:47:33Z","timestamp":1776772053000},"page":"1113-1123","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal smoking during pregnancy and gestational diabetes mellitus: Interactions and independent associations on pregnancy duration and perinatal outcomes"],"prefix":"10.1111","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2138-4878","authenticated-orcid":false,"given":"Lotta S.","family":"Holopainen","sequence":"first","affiliation":[{"name":"Department of General Practice, Institute of Clinical Medicine University of Turku and Turku University Hospital  Turku Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1912-4877","authenticated-orcid":false,"given":"Hanna H.","family":"T\u00e4htinen","sequence":"additional","affiliation":[{"name":"Department of General Practice, Institute of Clinical Medicine University of Turku and Turku University Hospital  Turku Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8254-7525","authenticated-orcid":false,"given":"Mika","family":"Gissler","sequence":"additional","affiliation":[{"name":"THL Finnish Institute for Health and Welfare Department of Data and Analytics  Helsinki Finland"},{"name":"Research Centre for Child Psychiatry University of Turku  Turku Finland"},{"name":"Karolinska Institute Department of Molecular Medicine and Surgery  Stockholm Sweden"},{"name":"Region Stockholm Academic Primary Health Care Centre  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5614-6442","authenticated-orcid":false,"given":"P\u00e4ivi E.","family":"Korhonen","sequence":"additional","affiliation":[{"name":"Department of General Practice, Institute of Clinical Medicine University of Turku and Turku University Hospital  Turku Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8369-4359","authenticated-orcid":false,"given":"Mikael O.","family":"Ekblad","sequence":"additional","affiliation":[{"name":"Department of General Practice, Institute of Clinical Medicine University of Turku and Turku University Hospital  Turku Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-3797(98)00089-0"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/db08-1112"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00109-025-02629-7"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.2741\/e708"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12144572"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2024-222259"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-49916-2"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60074-4"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-14881-4"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002501"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.14920"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1527358"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767058.2023.2259048"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/140349489502300113"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1403494812456637"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1515\/em-2013-0005"},{"key":"e_1_2_14_18_1","volume-title":"Current Care Guidelines. 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