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It should be noted that our study did not find clear dose-response associations between maternal smoking before or during the pregnancy and birth congenital anomalies, similar to a previous study on maternal smoking and congenital heart defects by Alverson et al

[19] Tobacco smoke is a complex, dynamic and reactive mixture containing around 5,000 chemicals

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Nicotine and other chemicals in e-liquids can affect testosterone levels and other hormones involved in sperm production, potentially leading to decreased fertility

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