Kharrazi Martin, DeLorenze Gerald N, Kaufman Farla L, Eskenazi Brenda, Bernert John T, Graham Steve, Pearl Michelle, Pirkle James
Genetic Disease Branch, California Department of Health Services, Richmond, California 94804, USA.
Epidemiology. 2004 Nov;15(6):660-70. doi: 10.1097/01.ede.0000142137.39619.60.
Recent reviews conclude that environmental tobacco smoke (ETS) leads to diminished birth weight. However, the threshold and magnitude of that effect is uncertain. We aimed to determine the magnitude and shape of the relations between ETS and various adverse pregnancy outcomes using a highly sensitive biochemical assay.
Maternal serum specimens were collected from more than 3000 women enrolled in California's prenatal screening program in 1992 and analyzed for cotinine. Information on pregnancy outcomes was obtained from live birth/fetal death records and hospital questionnaires. We conducted analyses on 2777 woman-live birth pairs and 19 woman-fetal death pairs in which the mother was presumed to be a nonsmoker (midtrimester cotinine levels < or =10 ng/mL).
In multiple logistic regression analyses, the odds ratios of fetal death, preterm delivery, and term-low birth weight were 3.4, 1.8, and 1.8, respectively, in the highest cotinine quintile (0.236-10 ng/mL), compared with the lowest quintile (<0.026 ng/mL). In adjusted linear models, there was a linear dose-dependent effect of log cotinine on mean birth weight (-109 g) and mean infant length (-0.84 cm) over the range of cotinine values. Linear relations were not found with respect to infant head circumference or the ratio of brain weight to body weight. Infant's body mass index declined with exposures above approximately 0.5 ng/mL cotinine. We estimated that ETS levels at or above 0.05 ng/mL (experienced by 62% of the study population) accounted for 12% of all adverse outcomes.
ETS exposure in pregnant women adversely affects pregnancy by increasing fetal mortality and preterm delivery at higher exposure levels and slowing fetal growth across all levels of ETS exposure.
近期综述得出结论，环境烟草烟雾（ETS）会导致出生体重降低。然而，这种影响的阈值和程度尚不确定。我们旨在使用一种高度敏感的生化检测方法来确定ETS与各种不良妊娠结局之间关系的程度和形式。
1992年从加利福尼亚州产前筛查项目中登记的3000多名妇女中收集母血标本，并分析其中的可替宁。妊娠结局信息来自活产/胎儿死亡记录和医院问卷。我们对2777对母婴活产对和19对母婴胎儿死亡对进行了分析，这些母亲被假定为非吸烟者（孕中期可替宁水平≤10 ng/mL）。
在多因素逻辑回归分析中，与最低五分位数（<0.026 ng/mL）相比，最高可替宁五分位数（0.236 - 10 ng/mL）中胎儿死亡、早产和足月低出生体重的比值比分别为3.4、1.8和1.8。在调整后的线性模型中，在可替宁值范围内，log可替宁对平均出生体重（-109 g）和平均婴儿身长（-0.84 cm）有线性剂量依赖效应。未发现婴儿头围或脑重与体重之比存在线性关系。当可替宁暴露量高于约0.5 ng/mL时，婴儿的体重指数下降。我们估计，可替宁水平在0.05 ng/mL及以上（研究人群中的62%有此经历）占所有不良结局的12%。
孕妇暴露于ETS会对妊娠产生不利影响，在较高暴露水平下会增加胎儿死亡率和早产率，并且在所有ETS暴露水平下都会减缓胎儿生长。
