Fetal growth restriction and maternal smoking in the Macedonian Roma population: a causality dilemma

Purpose Macedonia is one of the top five countries globally in reported smoking rates. Over 10 % of the population consists of the underprivileged Roma minority. We aimed to determine whether Roma ethnicity is an independent risk factor for adverse pregnancy outcome or merely mediating maternal smoking. Methods Maternal data were retrieved from the perinatal computerized database for all deliveries during 2007-2011 at the only Clinical Hospital in Bitola, Macedonia. Multi-variable regression models were constructed to control for confounders. Results Of nearly 7,000 deliveries, 8.65 % were of maternal Roma ethnicity and 40 % of the Romani women admitted to regularly smoke during pregnancy. Both Roma ethnicity and maternal smoking were significantly associated with the absence of maternal education, history of abortions and intra uterine growth restriction (IUGR) in the univariate analysis. Both maternal Roma ethnicity (OR 2.46, 95 % CI 1.79-3.38) and smoking status (OR 1.37, 95 % CI 1.02-1.85) were found to be independent predictors of IUGR using the multivariate analysis. Lower birthweight and smaller head circumference were both independently associated with Roma ethnicity and smoking. Conclusions Underprivileged ethnic background is a significant risk factor for IUGR, independent of maternal smoking status. To the best of our knowledge, this is the first publication focusing on pregnancy outcome in Romani Macedonian parturients.