Interrupted time series study found mixed effects of the impact of the Bavarian smoke-free legislation on pregnancy outcomes

Abstract In 2007 the German government passed smoke-free legislation, leaving the details of implementation to the individual federal states. In January 2008 Bavaria implemented one of the strictest laws in Germany. We investigated its impact on pregnancy outcomes and applied an interrupted time ser...

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Autores principales:	Stephanie Polus, Jacob Burns, Sabine Hoffmann, Tim Mathes, Ulrich Mansmann, Jasper V. Been, Nicholas Lack, Daniela Koller, Werner Maier, Eva A. Rehfuess
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/b0e87bd3ab4347fa9b1ca61060ef1b9a
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spelling	oai:doaj.org-article:b0e87bd3ab4347fa9b1ca61060ef1b9a2021-12-02T14:21:59ZInterrupted time series study found mixed effects of the impact of the Bavarian smoke-free legislation on pregnancy outcomes10.1038/s41598-021-83774-02045-2322https://doaj.org/article/b0e87bd3ab4347fa9b1ca61060ef1b9a2021-02-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-83774-0https://doaj.org/toc/2045-2322Abstract In 2007 the German government passed smoke-free legislation, leaving the details of implementation to the individual federal states. In January 2008 Bavaria implemented one of the strictest laws in Germany. We investigated its impact on pregnancy outcomes and applied an interrupted time series (ITS) study design to assess any changes in preterm birth, small for gestational age (primary outcomes), and low birth weight, stillbirth and very preterm birth. We included 1,236,992 singleton births, comprising 83,691 preterm births and 112,143 small for gestational age newborns. For most outcomes we observed unclear effects. For very preterm births, we found an immediate drop of 10.4% (95%CI − 15.8, − 4.6%; p = 0.0006) and a gradual decrease of 0.5% (95%CI − 0.7, − 0.2%, p = 0.0010) after implementation of the legislation. The majority of subgroup and sensitivity analyses confirm these results. Although we found no statistically significant effect of the Bavarian smoke-free legislation on most pregnancy outcomes, a substantial decrease in very preterm births was observed. We cannot rule out that despite our rigorous methods and robustness checks, design-inherent limitations of the ITS study as well as country-specific factors, such as the ambivalent German policy context have influenced our estimation of the effects of the legislation.Stephanie PolusJacob BurnsSabine HoffmannTim MathesUlrich MansmannJasper V. BeenNicholas LackDaniela KollerWerner MaierEva A. RehfuessNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Stephanie Polus Jacob Burns Sabine Hoffmann Tim Mathes Ulrich Mansmann Jasper V. Been Nicholas Lack Daniela Koller Werner Maier Eva A. Rehfuess Interrupted time series study found mixed effects of the impact of the Bavarian smoke-free legislation on pregnancy outcomes
description	Abstract In 2007 the German government passed smoke-free legislation, leaving the details of implementation to the individual federal states. In January 2008 Bavaria implemented one of the strictest laws in Germany. We investigated its impact on pregnancy outcomes and applied an interrupted time series (ITS) study design to assess any changes in preterm birth, small for gestational age (primary outcomes), and low birth weight, stillbirth and very preterm birth. We included 1,236,992 singleton births, comprising 83,691 preterm births and 112,143 small for gestational age newborns. For most outcomes we observed unclear effects. For very preterm births, we found an immediate drop of 10.4% (95%CI − 15.8, − 4.6%; p = 0.0006) and a gradual decrease of 0.5% (95%CI − 0.7, − 0.2%, p = 0.0010) after implementation of the legislation. The majority of subgroup and sensitivity analyses confirm these results. Although we found no statistically significant effect of the Bavarian smoke-free legislation on most pregnancy outcomes, a substantial decrease in very preterm births was observed. We cannot rule out that despite our rigorous methods and robustness checks, design-inherent limitations of the ITS study as well as country-specific factors, such as the ambivalent German policy context have influenced our estimation of the effects of the legislation.
format	article
author	Stephanie Polus Jacob Burns Sabine Hoffmann Tim Mathes Ulrich Mansmann Jasper V. Been Nicholas Lack Daniela Koller Werner Maier Eva A. Rehfuess
author_facet	Stephanie Polus Jacob Burns Sabine Hoffmann Tim Mathes Ulrich Mansmann Jasper V. Been Nicholas Lack Daniela Koller Werner Maier Eva A. Rehfuess
author_sort	Stephanie Polus
title	Interrupted time series study found mixed effects of the impact of the Bavarian smoke-free legislation on pregnancy outcomes
title_short	Interrupted time series study found mixed effects of the impact of the Bavarian smoke-free legislation on pregnancy outcomes
title_full	Interrupted time series study found mixed effects of the impact of the Bavarian smoke-free legislation on pregnancy outcomes
title_fullStr	Interrupted time series study found mixed effects of the impact of the Bavarian smoke-free legislation on pregnancy outcomes
title_full_unstemmed	Interrupted time series study found mixed effects of the impact of the Bavarian smoke-free legislation on pregnancy outcomes
title_sort	interrupted time series study found mixed effects of the impact of the bavarian smoke-free legislation on pregnancy outcomes
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/b0e87bd3ab4347fa9b1ca61060ef1b9a
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Interrupted time series study found mixed effects of the impact of the Bavarian smoke-free legislation on pregnancy outcomes

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