• Jasper V Been, Daniel F Mackay, Christopher Millett, Jill P Pell, Onno C P van Schayck, and Aziz Sheikh.
• 1] Division of Neonatology, Erasmus University Medical Centre - Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, Netherlands [2] Department of Paediatrics, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, Netherlands.
• Sci Rep. 2015 Aug 13; 5: 13020.

AbstractSmoke-free legislation is associated with improved early-life outcomes; however its impact on perinatal survival is unclear. We linked individual-level data with death certificates for all registered singletons births in England (1995-2011). We used interrupted time series logistic regression analysis to study changes in key adverse perinatal events following the July 2007 national, comprehensive smoke-free legislation. We studied 52,163 stillbirths and 10,238,950 live-births. Smoke-free legislation was associated with an immediate 7.8% (95%CI 3.5-11.8; p < 0.001) reduction in stillbirth, a 3.9% (95%CI 2.6-5.1; p < 0.001) reduction in low birth weight, and a 7.6% (95%CI 3.4-11.7; p = 0.001) reduction in neonatal mortality. No significant impact on SIDS was observed. Using a counterfactual scenario, we estimated that in the first four years following smoke-free legislation, 991 stillbirths, 5,470 cases of low birth weight, and 430 neonatal deaths were prevented. In conclusion, smoke-free legislation in England was associated with clinically important reductions in severe adverse perinatal outcomes.

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