Stathis S L, O'Callaghan D M, Williams G M, Najman J M, Andersen M J, Bor W
Child Developmental and Rehabilitation Services, Mater Children's Hospital, South Brisbane, Australia.
Pediatrics. 1999 Aug;104(2):e16. doi: 10.1542/peds.104.2.e16.
Although an increasing body of literature has demonstrated a link between in utero exposure to cigarette smoke and childhood morbidity, the extent to which such exposure is associated with middle ear disease (MED) is less certain. We hypothesized that in utero exposure to cigarette smoke was associated with an increased risk of MED and aimed to calculate the proportion of disease at 5 years' postdelivery attributable to cigarette exposure during pregnancy. Methods. At their first antenatal session, 8556 women were enrolled in a prospective study of pregnancy. Mothers were followed during pregnancy, at birth, at 6 months' and at 5 years' postdelivery and completed a detailed questionnaire aimed at assessing the frequency of acute (<1 month) and subacute (1-3 months) symptoms of MED and ear surgery. The relationship between MED and smoking status during pregnancy was then examined and subsequently adjusted simultaneously for smoking status at other times and for other potentially confounding variables. Results. In the adjusted analyses, acute ear infections were associated with consumption of 1 to 9 cigarettes (OR: 1.6; 95% CI: 1.1-2.5), 10 to 19 cigarettes (OR: 2.6; 95% CI: 1. 6-4.2) and 20+ cigarettes (OR: 3.3; 95% CI: 1.9-5.9) per day at the first clinic visit. For subacute ear infections, an association was present with consumption of 10 to 19 cigarettes (OR: 2.6; 95% CI: 1. 4-5.0) and 20+ cigarettes (OR: 2.8; 95% CI: 1.3-6.0) at the first clinic visit. In utero exposure to 20+ cigarettes per day at the first clinic visit was also associated with an increased risk of ear surgery by 5 years' postdelivery (OR: 2.9; 95% CI: 1.3-6.6). These associations were independent of smoking at 6 months and at 5 years, age and gender of the child, breastfeeding history, maternal age, maternal education, maternal employment at 5 years, marital status at 5 years, socioeconomic status, use of day care, and the number of siblings or children in the household. A population attributable risk percent at 5 years of 39.4% for acute ear infections, 37.9% for subacute ear infections, and 30.0% for previous ear surgery was found for in utero exposure to cigarette smoke at the first clinic visit. Conclusions. Smoking at the first clinic visit was associated with an increased risk of MED and ear surgery at 5 years of age. The frequency of maternal smoking in the general population gives rise to a high population attributable risk percent for MED. Therefore, it is a significant contributor to childhood morbidity and provides another reason why women should be encouraged to avoid smoking during pregnancy.
尽管越来越多的文献表明子宫内接触香烟烟雾与儿童发病率之间存在联系，但这种接触与中耳疾病（MED）的关联程度尚不确定。我们假设子宫内接触香烟烟雾会增加患MED的风险，并旨在计算分娩后5年因孕期接触香烟而导致的疾病比例。方法。在首次产前检查时，8556名妇女被纳入一项关于妊娠的前瞻性研究。在孕期、分娩时、出生后6个月和5年对母亲进行随访，并完成一份详细问卷，旨在评估MED急性（<1个月）和亚急性（1 - 3个月）症状的发生频率以及耳部手术情况。然后检查MED与孕期吸烟状况之间的关系，并随后同时对其他时间的吸烟状况以及其他潜在混杂变量进行调整。结果。在调整分析中，首次就诊时每天吸食1至9支香烟（比值比：1.6；95%置信区间：1.1 - 2.5）、10至19支香烟（比值比：2.6；95%置信区间：1.6 - 4.2）和20支及以上香烟（比值比：3.3；95%置信区间：1.9 - 5.9）与急性耳部感染相关。对于亚急性耳部感染，首次就诊时吸食10至19支香烟（比值比：2.6；95%置信区间：1.4 - 5.0）和20支及以上香烟（比值比：2.8；95%置信区间：1.3 - 6.0）存在关联。首次就诊时子宫内每天接触20支及以上香烟还与分娩后5年耳部手术风险增加相关（比值比：2.9；95%置信区间：1.3 - 6.6）。这些关联独立于6个月和5岁时的吸烟情况、孩子的年龄和性别、母乳喂养史、母亲年龄、母亲教育程度、母亲5岁时的就业情况、5岁时的婚姻状况、社会经济地位、日托使用情况以及家庭中的兄弟姐妹或孩子数量。首次就诊时子宫内接触香烟烟雾导致5岁时急性耳部感染的人群归因风险百分比为39.4%，亚急性耳部感染为37.9%，既往耳部手术为30.0%。结论。首次就诊时吸烟与5岁时患MED及耳部手术风险增加相关。一般人群中母亲吸烟的频率导致MED有较高的人群归因风险百分比。因此，它是儿童发病率的一个重要因素，也为鼓励女性在孕期避免吸烟提供了另一个理由。
