{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T06:35:38Z","timestamp":1790922938931,"version":"4.1.0"},"reference-count":32,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2022,9,19]],"date-time":"2022-09-19T00:00:00Z","timestamp":1663545600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Japan Society for the Promotion of Science KAKENHI","award":["JP 21H04856"],"award-info":[{"award-number":["JP 21H04856"]}]},{"name":"Japan Society for the Promotion of Science KAKENHI","award":["JPMJSC21U6"],"award-info":[{"award-number":["JPMJSC21U6"]}]},{"name":"Japan Society for the Promotion of Science KAKENHI","award":["R3-2-2"],"award-info":[{"award-number":["R3-2-2"]}]},{"name":"Japan Society for the Promotion of Science KAKENHI","award":["5th period 2nd term 001"],"award-info":[{"award-number":["5th period 2nd term 001"]}]},{"name":"Japan Society for the Promotion of Science KAKENHI","award":["20FA1005"],"award-info":[{"award-number":["20FA1005"]}]},{"DOI":"10.13039\/501100002241","name":"Japan Science and Technology Agency","doi-asserted-by":"publisher","award":["JP 21H04856"],"award-info":[{"award-number":["JP 21H04856"]}],"id":[{"id":"10.13039\/501100002241","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002241","name":"Japan Science and Technology Agency","doi-asserted-by":"publisher","award":["JPMJSC21U6"],"award-info":[{"award-number":["JPMJSC21U6"]}],"id":[{"id":"10.13039\/501100002241","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002241","name":"Japan Science and Technology Agency","doi-asserted-by":"publisher","award":["R3-2-2"],"award-info":[{"award-number":["R3-2-2"]}],"id":[{"id":"10.13039\/501100002241","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002241","name":"Japan Science and Technology Agency","doi-asserted-by":"publisher","award":["5th period 2nd term 001"],"award-info":[{"award-number":["5th period 2nd term 001"]}],"id":[{"id":"10.13039\/501100002241","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002241","name":"Japan Science and Technology Agency","doi-asserted-by":"publisher","award":["20FA1005"],"award-info":[{"award-number":["20FA1005"]}],"id":[{"id":"10.13039\/501100002241","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Intramural fund of the National Institute for Environmental Studies","award":["JP 21H04856"],"award-info":[{"award-number":["JP 21H04856"]}]},{"name":"Intramural fund of the National Institute for Environmental Studies","award":["JPMJSC21U6"],"award-info":[{"award-number":["JPMJSC21U6"]}]},{"name":"Intramural fund of the National Institute for Environmental Studies","award":["R3-2-2"],"award-info":[{"award-number":["R3-2-2"]}]},{"name":"Intramural fund of the National Institute for Environmental Studies","award":["5th period 2nd term 001"],"award-info":[{"award-number":["5th period 2nd term 001"]}]},{"name":"Intramural fund of the National Institute for Environmental Studies","award":["20FA1005"],"award-info":[{"award-number":["20FA1005"]}]},{"name":"Innovative Research Program on Suicide Countermeasures","award":["JP 21H04856"],"award-info":[{"award-number":["JP 21H04856"]}]},{"name":"Innovative Research Program on Suicide Countermeasures","award":["JPMJSC21U6"],"award-info":[{"award-number":["JPMJSC21U6"]}]},{"name":"Innovative Research Program on Suicide Countermeasures","award":["R3-2-2"],"award-info":[{"award-number":["R3-2-2"]}]},{"name":"Innovative Research Program on Suicide Countermeasures","award":["5th period 2nd term 001"],"award-info":[{"award-number":["5th period 2nd term 001"]}]},{"name":"Innovative Research Program on Suicide Countermeasures","award":["20FA1005"],"award-info":[{"award-number":["20FA1005"]}]},{"name":"Ready for COVID-19 Relief Fund","award":["JP 21H04856"],"award-info":[{"award-number":["JP 21H04856"]}]},{"name":"Ready for COVID-19 Relief Fund","award":["JPMJSC21U6"],"award-info":[{"award-number":["JPMJSC21U6"]}]},{"name":"Ready for COVID-19 Relief Fund","award":["R3-2-2"],"award-info":[{"award-number":["R3-2-2"]}]},{"name":"Ready for COVID-19 Relief Fund","award":["5th period 2nd term 001"],"award-info":[{"award-number":["5th period 2nd term 001"]}]},{"name":"Ready for COVID-19 Relief Fund","award":["20FA1005"],"award-info":[{"award-number":["20FA1005"]}]},{"name":"Ministry of Health, Labour, and Welfare","award":["JP 21H04856"],"award-info":[{"award-number":["JP 21H04856"]}]},{"name":"Ministry of Health, Labour, and Welfare","award":["JPMJSC21U6"],"award-info":[{"award-number":["JPMJSC21U6"]}]},{"name":"Ministry of Health, Labour, and Welfare","award":["R3-2-2"],"award-info":[{"award-number":["R3-2-2"]}]},{"name":"Ministry of Health, Labour, and Welfare","award":["5th period 2nd term 001"],"award-info":[{"award-number":["5th period 2nd term 001"]}]},{"name":"Ministry of Health, Labour, and Welfare","award":["20FA1005"],"award-info":[{"award-number":["20FA1005"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Combustible cigarette smoking impacts fetal growth during pregnancy. However, the risk associated with heated tobacco products (HTPs) remains unclear. This nationwide cross-sectional study investigated whether HTP use during pregnancy is associated with small for gestational age (SGA) outcomes among 5647 post-delivery women with singleton pregnancies, which were divided into four groups: lifetime never-smokers, former smokers before pregnancy, and current smokers for each of the tobacco products during pregnancy (sole HTP and sole combustion smokers). Information on the prevalence of SGA, defined as birth weight and height below the 10th percentile, was retrieved from the Maternal and Child Health Handbooks of post-delivery women. Using logistic regression, the association between sole HTP smokers during pregnancy and SGA, adjusted for covariates, with lifetime never-smokers as reference, was investigated. The prevalence was: current sole HTP smokers during pregnancy, 1.8% (102\/5647); and SGA, 2.9% (164\/5647). Sole HTP smokers during pregnancy had a higher prevalence of SGA (5.9% [6\/102] vs. 2.7% [111\/4144]) with an adjusted odds ratio (OR) of 2.50 (95% confidence interval [CI], 1.03\u20136.05) than lifetime never-smokers. Among sole combustion smokers, the adjusted OR for SGA was 1.95 (95% CI, 0.81\u20134.67). In Japan, HTP smoking during pregnancy may be associated with an increased risk for SGA.<\/jats:p>","DOI":"10.3390\/ijerph191811826","type":"journal-article","created":{"date-parts":[[2022,9,19]],"date-time":"2022-09-19T21:47:27Z","timestamp":1663624047000},"page":"11826","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Association between Heated Tobacco Product Use during Pregnancy and Fetal Growth in Japan: A Nationwide Web-Based Survey"],"prefix":"10.3390","volume":"19","author":[{"given":"Yoshihiko","family":"Hosokawa","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7616-355X","authenticated-orcid":false,"given":"Masayoshi","family":"Zaitsu","sequence":"additional","affiliation":[{"name":"Center for Research of the Aging Workforce, University of Occupational and Environmental Health, Kitakyushu 807-8556, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumiyo","family":"Okawa","sequence":"additional","affiliation":[{"name":"Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naho","family":"Morisaki","sequence":"additional","affiliation":[{"name":"Department of Social Medicine, National Center for Child Health and Development, Tokyo 157-8535, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ai","family":"Hori","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, University of Tsukuba, Tsukuba 305-8577, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukiko","family":"Nishihama","sequence":"additional","affiliation":[{"name":"Japan Environment and Children\u2019s Study Programme Office, National Institute for Environmental Studies, Tsukuba 305-8506, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7772-0389","authenticated-orcid":false,"given":"Shoji F.","family":"Nakayama","sequence":"additional","affiliation":[{"name":"Japan Environment and Children\u2019s Study Programme Office, National Institute for Environmental Studies, Tsukuba 305-8506, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1074-3954","authenticated-orcid":false,"given":"Takeo","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Department of Global Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromi","family":"Hamada","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toyomi","family":"Satoh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1050-3125","authenticated-orcid":false,"given":"Takahiro","family":"Tabuchi","sequence":"additional","affiliation":[{"name":"Cancer Control Center, Osaka International Cancer Institute, Osaka 541-8567, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e25","DOI":"10.1136\/tobaccocontrol-2017-053947","article-title":"Heat-not-burn tobacco product use in Japan: Its prevalence, predictors and perceived symptoms from exposure to secondhand heat-not-burn tobacco aerosol","volume":"27","author":"Tabuchi","year":"2018","journal-title":"Tob. Control"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e64","DOI":"10.1136\/tobaccocontrol-2020-056257","article-title":"Prevalence of heated tobacco product use in Japan: The 2020 JASTIS study","volume":"31","author":"Odani","year":"2022","journal-title":"Tob. Control"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1136\/tobaccocontrol-2020-056168","article-title":"Heated tobacco product use and combustible cigarette smoking relapse\/initiation among former\/never smokers in Japan: The JASTIS 2019 study with 1-year follow-up","volume":"31","author":"Matsuyama","year":"2022","journal-title":"Tob. Control"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"103726","DOI":"10.1016\/j.ijnurstu.2020.103726","article-title":"Will the tobacco industry ultimately triumph in the midst of COVID-19 pandemic? A call for nurses\u2019 action in tobacco control","volume":"115","author":"Lee","year":"2021","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"378","DOI":"10.2188\/jea.JE20200533","article-title":"Changes in smoking behavior since the declaration of the COVID-19 state of emergency in Japan: A cross-sectional study from the Osaka health app","volume":"31","author":"Koyama","year":"2021","journal-title":"J. Epidemiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1001\/jamainternmed.2017.1419","article-title":"Heat-not-burn tobacco cigarettes: Smoke by any other name","volume":"177","author":"Auer","year":"2017","journal-title":"JAMA Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Znyk, M., Jurewicz, J., and Kaleta, D. (2021). Exposure to heated tobacco products and adverse health effects, a systematic review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18126651"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.toxrep.2021.01.014","article-title":"Systematic review of biomarker findings from clinical studies of electronic cigarettes and heated tobacco products","volume":"8","author":"Akiyama","year":"2021","journal-title":"Toxicol. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Bravo-Guti\u00e9rrez, O.A., Falf\u00e1n-Valencia, R., Ram\u00edrez-Venegas, A., Sansores, R.H., Ponciano-Rodr\u00edguez, G., and P\u00e9rez-Rubio, G. (2021). Lung damage caused by heated tobacco products and electronic nicotine delivery systems: A systematic review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18084079"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"595","DOI":"10.13075\/ijomeh.1896.01433","article-title":"New ideas, old problems? Heated tobacco products\u2014A systematic review","volume":"32","author":"Jankowski","year":"2019","journal-title":"Int. J. Occup. Med. Environ. Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1080\/15376516.2019.1669245","article-title":"IQOS\u2013 a heat-not-burn (HnB) tobacco product\u2014Chemical composition and possible impact on oxidative stress and inflammatory response. A systematic review","volume":"30","author":"Kopa","year":"2020","journal-title":"Toxicol. Mech. Methods"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1016\/S2213-2600(19)30189-4","article-title":"Early-life exposure to electronic cigarettes: Cause for concern","volume":"7","author":"Larcombe","year":"2019","journal-title":"Lancet Respir. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"s70","DOI":"10.1136\/tobaccocontrol-2018-054322","article-title":"Examining perceptions about IQOS heated tobacco product: Consumer studies in Japan and Switzerland","volume":"27","author":"Hair","year":"2018","journal-title":"Tob. Control"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e052976","DOI":"10.1136\/bmjopen-2021-052976","article-title":"Heated tobacco product use and hypertensive disorders of pregnancy and low birth weight: Analysis of a cross-sectional, web-based survey in Japan","volume":"11","author":"Zaitsu","year":"2021","journal-title":"BMJ Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e179","DOI":"10.1136\/tobaccocontrol-2014-051569","article-title":"Comparison of secondhand smoke exposure measures during pregnancy in the development of a clinical prediction model for small-for-gestational-age among non-smoking Chinese pregnant women","volume":"24","author":"Xie","year":"2015","journal-title":"Tob. Control"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"106276","DOI":"10.1016\/j.envint.2020.106276","article-title":"Exposure to heavy metals modifies optimal gestational weight gain: A large nationally representative cohort of the Japan Environment and Children\u2019s Study","volume":"146","author":"Jung","year":"2021","journal-title":"Environ. Int."},{"key":"ref_17","unstructured":"Morisaki, N., Piedvache, A., Morokuma, S., Nakahara, K., Ogawa, M., Kato, K., Sanefuji, M., Shibata, E., Tsuji, M., and Shimono, M. (2021). Gestational weight gain growth charts adapted to Japanese pregnancies using a Bayesian approach in a longitudinal study: The Japan Environment and Children\u2019s Study. J. Epidemiol., JE20210049."},{"key":"ref_18","unstructured":"(2022, February 25). International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010. Available online: https:\/\/icd.who.int\/browse10\/2010\/en#\/P05.1."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1210\/jc.2006-2017","article-title":"Management of the child born small for gestational age through to adulthood: A consensus statement of the International Societies of Pediatric Endocrinology and the Growth Hormone Research Society","volume":"92","author":"Clayton","year":"2007","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1542\/peds.111.6.1253","article-title":"International Small for Gestational Age Advisory Board consensus development conference statement: Management of short children born small for gestational age, April 24\u2013October 1, 2001","volume":"111","author":"Lee","year":"2003","journal-title":"Pediatrics"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Kim, S., and Oancea, S.C. (2020). Electronic cigarettes may not be a \u201csafer alternative\u201d of conventional cigarettes during pregnancy: Evidence from the nationally representative PRAMS data. BMC Pregnancy Childbirth, 20.","DOI":"10.1186\/s12884-020-03247-6"},{"key":"ref_22","unstructured":"(2022, June 15). Rakuten Insight, about Us. Available online: https:\/\/insight.rakuten.co.jp\/en\/aboutus.html."},{"key":"ref_23","unstructured":"Japan Pediatric Society 2022 (2022, June 15). Report of the Neonatal Committee of the Japan Pediatric Society: New Standard Values of Body Mass at Birth by Pregnancy Period. Available online: http:\/\/www.jpeds.or.jp\/uploads\/files\/saisin_100924.pdf."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1093\/pubmed\/fdx175","article-title":"Maternal and Child Health Handbook use for maternal and child care: A cluster randomized controlled study in rural Java, Indonesia","volume":"41","author":"Osaki","year":"2019","journal-title":"J. Public Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1038\/hr.2016.126","article-title":"Epidemiology of hypertensive disorders in pregnancy: Prevalence, risk factors, predictors and prognosis","volume":"40","author":"Umesawa","year":"2017","journal-title":"Hypertens. Res."},{"key":"ref_26","unstructured":"Japan Society of Obstetrics and Gynecology (2022, June 15). Guidelines for Weight Gain during Pregnancy. Available online: https:\/\/www.jsog.or.jp\/news\/pdf\/20210616_shuuchi.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/j.bpobgyn.2009.06.003","article-title":"Risk factors for small for gestational age infants","volume":"23","author":"McCowan","year":"2009","journal-title":"Best. Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S125","DOI":"10.1080\/14622200410001669187","article-title":"The epidemiology of smoking during pregnancy: Smoking prevalence, maternal characteristics, and pregnancy outcomes","volume":"6","author":"Cnattingius","year":"2004","journal-title":"Nicotine Tob. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"268","DOI":"10.7326\/M16-2607","article-title":"Sensitivity analysis in observational research: Introducing the E-value","volume":"167","author":"VanderWeele","year":"2017","journal-title":"Ann. Intern. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.scitotenv.2011.10.019","article-title":"Self-reported tobacco smoke exposure and plasma cotinine levels during pregnancy\u2014A validation study in Northern Japan","volume":"412\u2013413","author":"Sasaki","year":"2011","journal-title":"Sci. Total Environ."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Nishihama, Y., Nakayama, S.F., Tabuchi, T., Isobe, T., Jung, C.-R., Iwai-Shimada, M., Kobayashi, Y., Michikawa, T., Sekiyama, M., and Taniguchi, Y. (2020). Determination of urinary cotinine cut-off concentrations for pregnant women in the Japan environment and children\u2019s study (JECS). Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17155537"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"i1981","DOI":"10.1136\/bmj.i1981","article-title":"Sparse data bias: A problem hiding in plain sight","volume":"352","author":"Greenland","year":"2016","journal-title":"BMJ"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/18\/11826\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:34:34Z","timestamp":1760142874000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/18\/11826"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,19]]},"references-count":32,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["ijerph191811826"],"URL":"https:\/\/doi.org\/10.3390\/ijerph191811826","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,19]]}}}