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The authors speculate that their analysis might have under estimated the true difference in relative risk between the sexes, since in many regions women have only started to smoke in large numbers in recent years

27 Similarly, a study from Sweden found that heavy smoking during pregnancy increased the risk of having an extremely preterm baby (born before 28 weeks gestation) by 91%

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They utilized natural language processing (NLP) techniques and clinical decision rules, but limitations include potential misclassification due to conflicting data sources and reliance on clinician-documented information