INTRODUCTION Maternal pregnancy smoking has adverse perinatal outcomes and the relationship between maternal smoking and neonatal death has not been fully elucidated. We aimed to examine the risk of neonatal death in relation to maternal smoking and to quantify potential mediators of these associations. METHODS We did a population-based cohort study using Period Linked Birth-Infant Death data from 2016 to 2019 in the US National Vital Statistics System. The exposure was maternal smoking status. The main outcome was neonatal death. Association between maternal smoking and neonatal death was estimated through logistic regression. Mediation analysis was performed to assess the extent to which the association between maternal smoking and neonatal death was mediated by neonatal complications. RESULTS The final sample consisted of 14,717,020 mothers with live singleton births. The overall neonatal mortality rate was 2.2 per 1,000 live births. Maternal pregnancy smoking was associated with an increased risk of neonatal death {adjusted odds ratio (aOR, 1.33 [95% CI, 1.28-1.38]; p < 0.001)}, while smoking cessation during the whole pregnancy showed a comparable risk of neonatal death with nonsmokers (aOR, 1.06 [95% CI, 0.99-1.14]; p = 0.116). Mediation analysis indicated that the association between pregnancy smoking and neonatal death might be mainly mediated by preterm birth and low Apgar score at 5 min. CONCLUSIONS Maternal pregnancy smoking, regardless of pregnancy trimester and intensity, was associated with increased risk of neonatal death. Efforts are needed for policymakers to promote smoking cessation before pregnancy, and professional perinatal care should be provided for those who smoked during pregnancy.

中文翻译：

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母亲吸烟与新生儿死亡的关联：一项基于人群的队列研究。

引言 孕产妇怀孕期间吸烟会对围产期结局产生不良影响，并且孕产妇吸烟与新生儿死亡之间的关系尚未完全阐明。我们的目的是检查与母亲吸烟相关的新生儿死亡风险，并量化这些关联的潜在中介因素。方法 我们使用美国国家生命统计系统 2016 年至 2019 年期间相关出生-婴儿死亡数据进行了一项基于人群的队列研究。暴露的是母亲吸烟状况。主要结局是新生儿死亡。通过逻辑回归估计孕产妇吸烟与新生儿死亡之间的关联。进行中介分析以评估新生儿并发症介导孕产妇吸烟与新生儿死亡之间的关联程度。结果 最终样本由 14,717,020 名单胎活产母亲组成。总体新生儿死亡率为每 1,000 名活产儿 2.2 人。孕期吸烟与新生儿死亡风险增加相关{调整后的比值比 (aOR, 1.33 [95% CI, 1.28-1.38]; p < 0.001)}，而在整个怀孕期间戒烟则显示出相当的新生儿死亡风险与非吸烟者（aOR，1.06 [95% CI，0.99-1.14]；p = 0.116）。中介分析表明，妊娠期吸烟与新生儿死亡之间的关联可能主要是由早产和5分钟低Apgar评分介导的。结论 母亲怀孕期间吸烟，无论妊娠三个月和吸烟强度如何，都与新生儿死亡风险增加相关。政策制定者需要努力促进孕前戒烟，并为孕期吸烟者提供专业的围产期护理。