Abstract
Forty papers on the association between environmental tobacco smoke (ETS)exposure of the mother and low birthweight of offspring were examined from the point of view of experimental design, criteria for ETS exposure, sample size, methods of statistical analysis, individual confounders considered, specific endpoints, and outcome. An approximately equal number of studies employed either the prospective or retrospective design, with very few using the case-control design. The vast majority of studies used a surrogate for ETS exposure (mainly paternal smoking), without verification of such exposure with a biochemical marker. The sample sizes of the studies ranged from under 100 subjects to almost 25,000 subjects. Most studies employed regression analysis. A considerable variation from study to study was noted in the treatment of potential confounding variables and most studies considered relatively few of these. Most of the individual confounding variables were considered in a relatively small proportion (one third or less) of the studies. The majority(almost two thirds) of the studies failed to demonstrate a statistically significant association between ETS exposure of the pregnant woman and low birthweight. This general lack of consistency of association could reflect absence of an adverse effect of ETS or méthodologie difficulties such as misclassification error, type II error, recall bias, or inadequate adjustment for potential confounders.