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The relationship between smoking and maternal age and their combined effects on birth weight, intrauterine growth retardation, and preterm delivery were studied. Smoking lowers birth weight both by decreasing fetal growth and by lowering gestational age at delivery. However, the effect of smoking on both fetal growth and gestational age is significantly greater as maternal age advances. In a multiple logistic regression model adjusting for race, parity, marital status, maternal weight, weight gain, and alcohol use, smoking was associated with a fivefold increased risk of growth retardation in women older than 35 but less than a twofold increased risk in women younger than 17. Smoking reduced birth weight by 134 gm in young women but 301 gm in women older than 35. Smoking in older women also was associated with more instances of preterm delivery and a lower mean gestational age when compared to women 25 or younger.
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