Williams M A, Mittendorf R, Stubblefield P G, Lieberman E, Schoenbaum S C, Monson R R
Department of Epidemiology, Harvard School of Public Health, Boston, MA.
Am J Epidemiol. 1992 Apr 15;135(8):895-903. doi: 10.1093/oxfordjournals.aje.a116385.
Premature (prior to 37 completed weeks of gestation) rupture of the membranes (preterm PROM) is one of the most common underlying causes of preterm delivery. However, there have been few epidemiologic studies of this obstetric complication. The authors studied the relation of maternal cigarette smoking and coffee consumption to both preterm PROM and spontaneous preterm labor not complicated by premature rupture of the membranes (preterm NONPROM) in a large cross-sectional data base. The 307 preterm PROM and 488 preterm NONPROM cases who delivered during 1977-1980 at the Boston Hospital for Women were compared with 2,252 randomly selected women who delivered at term at that institution. Multiple logistic regression techniques were used to derive maximum likelihood estimates of adjusted odds ratios (OR) and 95% confidence intervals (CI). After confounders had been adjusted for, the relative risk of preterm PROM for women who reported ever having smoked during pregnancy, as compared with nonsmokers, was 1.6 (95% CI 1.1-2.4). However, no gradient between the number of cigarettes smoked per day and the risk of preterm PROM was observed. Similar results were observed for preterm NONPROM. Women who consumed three or more cups of coffee daily during the first trimester had a 2.2-fold greater risk of preterm PROM than did women who drank two or fewer cups (95% CI 1.5-3.3). Among coffee drinkers, there was some evidence of a linear trend in the risk of preterm PROM as coffee consumption increased. Consumption of three or more cups of coffee per day was less strongly associated with the occurrence of preterm NONPROM (adjusted OR = 1.4, 95% CI 1.0-1.9).
胎膜早破（妊娠满37周前）是早产最常见的潜在原因之一。然而，关于这种产科并发症的流行病学研究很少。作者在一个大型横断面数据库中研究了孕妇吸烟和喝咖啡与胎膜早破早产及未合并胎膜早破的自发性早产（非胎膜早破早产）之间的关系。将1977 - 1980年在波士顿妇女医院分娩的307例胎膜早破早产病例和488例非胎膜早破早产病例与该机构随机选取的2252例足月分娩的妇女进行比较。采用多元逻辑回归技术得出调整后的优势比（OR）和95%置信区间（CI）的最大似然估计值。在对混杂因素进行调整后，报告孕期曾吸烟的妇女发生胎膜早破早产的相对风险与不吸烟者相比为1.6（95%CI 1.1 - 2.4）。然而，未观察到每日吸烟量与胎膜早破早产风险之间存在梯度关系。非胎膜早破早产也观察到类似结果。孕早期每天饮用三杯或更多咖啡的妇女发生胎膜早破早产的风险是饮用两杯或更少咖啡妇女的2.2倍（95%CI 1.5 - 3.3）。在喝咖啡的人群中，有证据表明随着咖啡摄入量增加，胎膜早破早产风险呈线性趋势。每天饮用三杯或更多咖啡与非胎膜早破早产的发生关联较弱（调整后OR = 1.4，95%CI 1.0 - 1.9）。
