Water-pipe tobacco and cigarette smoking, on preeclampsia: adverse or protective effect: MATCH cohort study
Abstract
OBJECTIVES
While cigarette smoking has been paradoxically associated with a reduced risk of preeclampsia, the effect of waterpipe (WP) smoking, an increasingly prevalent form of tobacco use remains poorly understood. This study aimed to investigate and compare the independent associations of cigarette and WP smoking with the risk of developing preeclampsia.
STUDY DESIGN AND MAIN OUTCOME MEASURES
This prospective cohort study, conducted within the MATCH study at Arash Women's Hospital, Tehran, Iran (2020-2023), enrolled 1,856 first-trimester pregnant women (18-45 years) without chronic/metabolic conditions, following them until delivery. The main outcome was preeclampsia, defined per ACOG (2020) criteria as new-onset hypertension (≥140/90 mmHg on two occasions ≥ 4 h apart) with proteinuria (≥300 mg/24 h, protein‑to‑creatinine ratio ≥ 0.3 mg/mg, or dipstick ≥ 2 + ) after 20 weeks' gestation. Smoking status and covariates were assessed via questionnaires and clinical measurements. Adjusted risk ratios (aRRs) were estimated using modified Poisson regression, controlling for confounders identified via directed acyclic graphs (DAGs).
RESULTS
During follow-up, 92 women (4.95%) developed preeclampsia. Current cigarette smoking was associated with a significantly lower risk compared to never-smoking (aRR 0.48; 95% CI 0.25-0.90). In contrast, current WP smoking showed no significant association (aRR 0.74; 95% CI 0.39-1.41). Former and passive WP smoking also demonstrated no…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 92 participants or records.
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