Smoking during pregnancy and congenital limb deficiency

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Abstract
Objective : To examine genetic and environmental factors in the origin of isolated congenital limb deficiencies. Design : Case-control study with questionnaire at a family interview of cases of isolated congenital limb deficiencies (six types), negative controls (matched for age, sex, and place of residence), and positive controls (cases of sentinel anomalies). Setting : The database of the Hungarian Congenital Abnormality Registry, 1975-84, complemented by three other sources of ascertainment (1575 904 births). Subjects : 537 case-control pairs; 392 positive controls. Main outcome measures : Smoking during pregnancy, congenital limb deficiencies. Results : The adjusted rate of smoking during pregnancy was significantly higher in the mothers of cases of terminal transverse defect (relative odds 1.48; 95% confidence interval 0.98 to 2.23; P=0.017). This finding supports the hypothesis of vascular disruption as a cause of congenital limb deficiency. Conclusions : Maternal smoking during pregnancy raises the relative odds for terminal transverse20limb deficiencies.