The relationship of smoking with gestational diabetes. A population-based study and a matched comparison of more than 340,000 smokers

Published:November 17, 2022DOI:


      Research Question

      Is smoking associated with an increased risk for gestational diabetes (GDM)?


      A retrospective population-based study using data from the United States Healthcare Cost and Utilization Project—Nationwide Inpatient Sample. A dataset of all deliveries that took place between 2004 and 2014 (inclusively) was created. The population was divided into two groups according to smoking status and matched 1:1 for age, obesity, race, insurance type, thyroid disease, drug use and chronic hypertension. Delivery outcomes were compared between the two matched groups and the control group of non-smokers as a whole. A multivariate logistic analysis was performed adjusting for any statistically significant confounding baseline effects not matched for.


      Our study identified 9,096,788 births between 2004-2014, of which 443,590 (4.8%) were maternal smokers. When compared to the entire group of non-smokers as controls, there was an increased risk of GDM, adjusted odd ratio (aOR):1.10 (95% CI 1.07-1.14 p< 0.0001). This relationship was of a mild nature and there were many confounding variables which differed between the groups. As such a matched control group was developed to compare the risk of GDM in the smokers and non-smokers. An increased risk for GDM among smokers remained with an aOR of 1.07 (95% CI 1.05-1.10 p< 0.001).


      Our data suggests that smoking is a small but significant risk factor for GDM with an aOR of 1.07.

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