Maternal Smoking and Risk of Hypertensive Disorders of Pregnancy: Effect Modification by Body Mass Index and Gestational Weight Gain.

BACKGROUND: Although smoking cigarettes has been shown to have a protective effect on preeclampsia, quitting smoking also results in weight gain. Weight gain leading to an obese body mass index is a risk factor for hypertensive disorders of pregnancy (HDP). METHODS: The objective of this study was to explore the relationship between smoking status, body mass index, and gestational weight gain on the risk of HDP. A cross-sectional analysis was performed utilizing US birth certificate data. We examined HDP risks in relation to maternal smoking, body mass index, and gestational weight gain. Associations were expressed as rate ratios with 95% CIs and adjusted for potential confounders. Clinically important outcomes of smoking throughout pregnancy were also evaluated. RESULTS: Of the 22 191 568 women studied, HDP rates among nonsmokers, those who quit smoking, and persistent smokers were 6.8%, 8.6%, and 7.0%, respectively. The rate ratio of HDP was higher for women who quit smoking, especially evident among those with excessive gestational weight gain. Corrections for exposure misclassification and unmeasured confounding strengthened the associations among women who quit smoking. There was an almost 6-fold increase in the rate of stillbirth for persistent smokers (2.3%) compared with those who quit smoking (0.4%) and nonsmokers (0.4%). CONCLUSIONS: Women who quit smoking during pregnancy were more likely to gain excessive weight and develop HDP. Although quitting smoking during pregnancy may be associated with an increase in the risk of HDP, it is also associated with a reduced risk of stillbirth. Pregnant women counseled to quit smoking should also receive counseling on nutrition and exercise to prevent excessive gestational weight gain.

Gender-inclusive research instructions in author submission guidelines: results of a cross-sectional study of obstetrics and gynecology journals.

BACKGROUND: People with marginalized gender identities, including people with transgender and gender-expansive identities, have been historically excluded from research. Professional societies recommend the use of inclusive language in research, but it is uncertain how many obstetrics and gynecology journals mandate the use of gender-inclusive research practices in their author guidelines. OBJECTIVE: This study aimed to evaluate the proportion of "inclusive" journals with specific instructions about gender-inclusive research practices in their author submission guidelines; to compare these journals with "noninclusive" journals based on publisher, country of origin, and several metrics of research influence; and to qualitatively evaluate the components of inclusive research in author submission guidelines. STUDY DESIGN: A cross-sectional study of all obstetrics and gynecology journals in the Journal Citation Reports, a scientometric resource, was conducted in April 2022. Of note, One journal was indexed twice (due to a name change), and only the journal with the 2020 Journal Impact Factor was included. Author submission guidelines were reviewed by 2 independent reviewers to identify inclusive vs noninclusive journals based on whether journals had gender-inclusive research instructions. Journal characteristics, including publisher, country of origin, impact metrics (eg, Journal Impact Factor), normalized metrics (eg, Journal Citation Indicator), and source metrics (eg, number of citable items), were evaluated for all journals. The median (interquartile range) and median difference between inclusive and noninclusive journals with bootstrapped 95% confidence interval were calculated for journals with 2020 Journal Impact Factors. In addition, inclusive research instructions were thematically compared to identify trends. RESULTS: Author submission guidelines were reviewed for all 121 active obstetrics and gynecology journals indexed in the Journal Citation Reports. Overall, 41 journals (33.9%) were inclusive, and 34 journals (41.0%) with 2020 Journal Impact Factors were inclusive. Most inclusive journals were English-language publications and originated in the United States and Europe. In an analysis of journals with 2020 Journal Impact Factors, inclusive journals had a higher median Journal Impact Factor (3.4 [interquartile range, 2.2-4.3] vs 2.5 [interquartile range, 1.9-3.0]; median difference, 0.9; 95% confidence interval, 0.2-1.7) and median 5-year Journal Impact Factor (3.6 [interquartile range, 2.8-4.3] vs 2.6 [interquartile range, 2.1-3.2; median difference, 0.9; 95% confidence interval, 0.3-1.6) than noninclusive journals. Inclusive journals had higher normalized metrics, including a median 2020 Journal Citation Indicator (1.1 [interquartile range, 0.7-1.3] vs 0.8 [interquartile range, 0.6-1.0]; median difference, 0.3; 95% confidence interval, 0.1-0.5) and median normalized Eigenfactor (1.4 [interquartile range, 0.7-2.2] vs 0.7 [interquartile range, 0.4-1.5]; median difference, 0.8; 95% confidence interval, 0.2-1.5) than noninclusive journals. Moreover, inclusive journals had higher source metrics, including more citable items, total items, and Open Access Gold subscriptions, than noninclusive journals. The qualitative analysis of gender-inclusive research instructions revealed that most inclusive journals recommend that researchers use gender-neutral language and provide specific examples of inclusive language. CONCLUSION: Fewer than half of obstetrics and gynecology journals with 2020 Journal Impact Factors have gender-inclusive research practices in their author submission guidelines. This study underscores the urgent need for most obstetrics and gynecology journals to update their author submission guidelines to include specific instructions about gender-inclusive research practices.