Castles A, Adams E K, Melvin C L, Kelsch C, Boulton M L
Pacific Business Group on Health, San Francisco, CA, USA.
Am J Prev Med. 1999 Apr;16(3):208-15. doi: 10.1016/s0749-3797(98)00089-0.
The purpose of this study was to estimate, using meta-analysis, pooled odds ratios for the effects of smoking on five pregnancy complications: placenta previa, abruptio placenta, ectopic pregnancy, preterm premature rupture of the membrane (PPROM), and pre-eclampsia.
Published articles were identified through computer search and literature review. Five criteria were applied to those studies initially identified to determine those eligible for the meta-analysis. A random effects model was applied to derive pooled odds ratios for the eligible studies for each pregnancy complication. Meta-analyses were repeated on subsets of the studies to confirm the overall results.
Smoking was found to be strongly associated with an elevated risk or placenta previa, abruptio placenta, ectopic pregnancy, and PPROM, and a decreased risk of pre-eclampsia. All pooled odds ratios were statistically significant. The pooled ratios ranged from 1.58 for placenta previa to 1.77 for ectopic pregnancy. The pooled odds ratio for pre-eclampsia was 0.51 and all subset analyses confirmed this seemingly protective effect.
Smoking during pregnancy is a significant and preventable factor affecting ectopic pregnancy, placental abruption, placenta previa, and PPROM. The findings of smoking's apparently protective effect on pre-eclampsia should be balanced with these harmful effects. In addition, the biological linkage between smoking and pre-eclampsia is not yet well understood. Pregnant women should be advised to stop smoking in order to reduce the overall risk of pregnancy complications as well as any risk of adverse impact on the unborn child.
本研究的目的是通过荟萃分析估计吸烟对五种妊娠并发症的影响的合并比值比，这五种并发症为前置胎盘、胎盘早剥、异位妊娠、胎膜早破（PPROM）和子痫前期。
通过计算机检索和文献综述确定已发表的文章。对最初确定的研究应用五条标准来确定那些符合荟萃分析条件的研究。应用随机效应模型得出每种妊娠并发症符合条件的研究的合并比值比。对研究的子集重复进行荟萃分析以确认总体结果。
发现吸烟与前置胎盘、胎盘早剥、异位妊娠和PPROM风险升高以及子痫前期风险降低密切相关。所有合并比值比均具有统计学意义。合并比值比范围从前置胎盘的1.58到异位妊娠的1.77。子痫前期的合并比值比为0.51，所有子集分析均证实了这种看似具有保护作用的效应。
孕期吸烟是影响异位妊娠、胎盘早剥、前置胎盘和PPROM的一个重要且可预防的因素。吸烟对子痫前期的明显保护作用的研究结果应与这些有害影响相权衡。此外，吸烟与子痫前期之间的生物学联系尚未完全明了。应建议孕妇戒烟，以降低妊娠并发症的总体风险以及对未出生胎儿产生任何不良影响的风险。
