{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:05:31Z","timestamp":1756857931183,"version":"3.44.0"},"reference-count":31,"publisher":"BMJ","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000325","name":"Wellbeing of Women","doi-asserted-by":"publisher","award":["RGS2301"],"award-info":[{"award-number":["RGS2301"]}],"id":[{"id":"10.13039\/501100000325","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["CH\/F\/20\/90003"],"award-info":[{"award-number":["CH\/F\/20\/90003"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000589","name":"Chief Scientist Office","doi-asserted-by":"publisher","award":["SPHSU17"],"award-info":[{"award-number":["SPHSU17"]}],"id":[{"id":"10.13039\/501100000589","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MC_UU_00022\/2"],"award-info":[{"award-number":["MC_UU_00022\/2"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"UK Medical Research Council","doi-asserted-by":"crossref","award":["MC_UU_00032\/05"],"award-info":[{"award-number":["MC_UU_00032\/05"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Tob Control"],"accepted":{"date-parts":[[2025,7,30]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To assess the impact of comprehensive tobacco control policies on maternal smoking during pregnancy and perinatal outcomes over a 20-year period.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Population-based cohort study using linked Scottish National Health Service. We assessed the impact of tobacco control measures on maternal smoking and perinatal outcomes over four distinct time periods. Step and slope changes in risk were evaluated using multivariable Poisson regression models with robust errors to determine immediate and sustained effects.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>All Scottish National Health Service hospitals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>919\u2009324 singleton births between 24<jats:sup>+0<\/jats:sup> and 44<jats:sup>+6<\/jats:sup> weeks gestation, spanning 1 January 2000 to 31 December 2019.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Intervention<\/jats:title>\n                  <jats:p>Tobacco control policies were introduced progressively over four periods. Period A (2000\u20132002) served as the reference. Period B (2002\u20132006) introduced advertising restrictions, including bans on tobacco sponsorship and product displays. Period C (2006\u20132016) incorporated smoke-free legislation, prohibiting smoking in enclosed public spaces. Period D (2016\u20132019) introduced further legislative measures, bans on smoking in vehicles carrying children and enhanced taxation policies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>Maternal smoking, small for gestational age (SGA), stillbirth, preterm births and pre-eclampsia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Comprehensive measures were associated with a reduction in maternal smoking (step change relative risk (RR)<jats:sub>A to D<\/jats:sub> 0.73 (95% CI 0.70 to 0.75), which was sustained over time (slope RR<jats:sub>A to D<\/jats:sub> 0.97 (95% CI 0.95 to 0.99)). There were also reductions in pre-eclampsia (slope RR<jats:sub>A to D<\/jats:sub> 0.88 (95% CI 0.80 to 0.96), SGA (slope RR<jats:sub>A to D<\/jats:sub> 0.94 (95% CI 0.90 to 0.97). While preterm births increased (primarily iatrogenic), and stillbirth rates declined, these trends were not directly attributable to tobacco control measures.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Comprehensive tobacco control measures were associated with reduction in maternal smoking during pregnancy, pre-eclampsia and SGA, underscoring their potential to improve perinatal outcomes and supporting the global implementation of WHO-recommended tobacco-control strategies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tc-2025-059391","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T11:15:13Z","timestamp":1756811713000},"page":"tc-2025-059391","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of comprehensive tobacco control policies on maternal and child outcomes: a population-based linkage study"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2981-8688","authenticated-orcid":false,"given":"Aizhan","family":"Kyzayeva","sequence":"first","affiliation":[{"name":"School of Medicine, University of Glasgow, Glasgow, UK"},{"name":"MRC\/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Shaw","sequence":"additional","affiliation":[{"name":"NHS Greater Glasgow and Clyde, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jill","family":"Pell","sequence":"additional","affiliation":[{"name":"University of Glasgow School of Health and Wellbeing, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3741-7099","authenticated-orcid":false,"given":"Alastair H","family":"Leyland","sequence":"additional","affiliation":[{"name":"MRC\/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6793-2262","authenticated-orcid":false,"given":"Deborah A","family":"Lawlor","sequence":"additional","affiliation":[{"name":"MRC Integrative Epidemiology Unit at The University of Bristol, University of Bristol, Bristol, UK"},{"name":"University of Bristol Population Health Sciences, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6156-6858","authenticated-orcid":false,"given":"Rachel Joyce","family":"Kearns","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Glasgow, Glasgow, UK"},{"name":"Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott M","family":"Nelson","sequence":"additional","affiliation":[{"name":"University of Bristol Population Health Sciences, Bristol, UK"},{"name":"University of Glasgow, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,2]]},"reference":[{"key":"2025090204150697000_tc-2025-059391v1.1","unstructured":"Royal College of Physicians . 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Information services division. births in Scottish hospitals: technical report. 2018."},{"key":"2025090204150697000_tc-2025-059391v1.13","unstructured":"WHO recommendations on interventions to improve preterm birth outcomes, Available: www.who.int\/reproductivehealth [Accessed 2 Jun 2025]."},{"key":"2025090204150697000_tc-2025-059391v1.14","unstructured":"NSS Information and Intelligence . Assessment of SMR02 (maternity inpatient and day case) data; Scotland 2017-2018. Edinburgh, 2018."},{"key":"2025090204150697000_tc-2025-059391v1.15","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001175","article-title":"Impact of Scotland\u2019s smoke-free legislation on pregnancy complications: retrospective cohort study","volume":"9","author":"Mackay","year":"2012","journal-title":"PLoS Med"},{"key":"2025090204150697000_tc-2025-059391v1.16","unstructured":"Scotland Home ISD . ISD Scotland Edinburgh. Data dictionary A-Z, Available: https:\/\/publichealthscotland.scot\/resources-and-tools\/health-intelligence-and-data-management\/national-data-catalogue\/data-dictionary\/search-the-data-dictionary\/(accessed [Accessed 19 Sep 2024]."},{"key":"2025090204150697000_tc-2025-059391v1.17","unstructured":"Scottish Government . Scottish Index of Multiple Deprivation, Available: https:\/\/www.gov.scot\/collections\/scottish-index-of-multiple-deprivation-2020\/ [Accessed 19 Sep 2023]."},{"key":"2025090204150697000_tc-2025-059391v1.18","unstructured":"World Health Organization . Preterm births, Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/preterm-birth [Accessed 19 Sep 2023]."},{"key":"2025090204150697000_tc-2025-059391v1.19","unstructured":"Action on Smoking and Health . Key dates in tobacco regulation: 1962 \u2014 2020. London; 2022."},{"key":"2025090204150697000_tc-2025-059391v1.20","unstructured":"Whitehead R . Strengths and Limitations of Tobacco Taxation and Pricing Strategies. Edinburgh: NHS Health Scotland, 2018."},{"key":"2025090204150697000_tc-2025-059391v1.21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-9531.2007.00180.x"},{"key":"2025090204150697000_tc-2025-059391v1.22","doi-asserted-by":"crossref","unstructured":"Buuren SV , Groothuis-Oudshoorn K . MICE: Multivariate Imputation by Chained Equations in R. 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