Man Li-Xing, Chang Benjamin
Division of Plastic Surgery, Health System, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Plast Reconstr Surg. 2006 Jan;117(1):301-8. doi: 10.1097/01.prs.0000194904.81981.71.
The U.S. Natality database from 2001 and 2002 was used to investigate the relationship between maternal cigarette smoking during pregnancy and the risk of having a child with polydactyly, syndactyly, or adactyly.
The records of 6,839,854 live births were examined to identify 5171 newborns with isolated polydactyly, syndactyly, or adactyly and 10,342 controls with no congenital anomalies.
Maternal cigarette use during pregnancy was associated with a significantly elevated risk of having a child with a congenital digital anomaly (unadjusted odds ratio, 1.33; 95 percent confidence interval, 1.21 to 1.47; p < 0.0001). Univariate analysis indicated that maternal marital status and medical risk factors (anemia, cardiac disease, lung disease, diabetes, hydramnios/oligohydramnios, pregnancy-associated hypertension, incompetent cervix, previous preterm or small-for-gestational-age infant, and rhesus factor sensitization) were potential confounding factors. After adjustment for these variables, the odds ratio remained significant (adjusted odds ratio, 1.31; 95 percent confidence interval, 1.18 to 1.45; p < 0.0001). Cigarette consumption per day was divided into four groups: no smoking, 1 to 10 cigarettes per day, 11 to 20 cigarettes per day, and 21 or more cigarettes per day. A statistically significant dose-response relationship was found when comparing each smoking category with the no-smoking reference group: 1.29 (95 percent confidence interval, 1.15 to 1.46), 1.38 (95 percent confidence interval, 1.12 to 1.71), and 1.78 (95 percent confidence interval, 0.97 to 3.26), respectively. Increased cigarette smoking during pregnancy resulted in an elevated risk of having a child with polydactyly, syndactyly, or adactyly.
This is the largest study to date to investigate specifically the association between maternal cigarette smoking and the risk of having a newborn with a congenital digital anomaly. The elevated odds ratio for tobacco use and the significant trend in the dose-response relationship suggests smoking during pregnancy may be an important preventable risk factor for these common congenital differences.
利用2001年和2002年美国出生数据库调查孕期母亲吸烟与生出多指、并指或无指孩子风险之间的关系。
检查6839854例活产记录，以确定5171例患有孤立性多指、并指或无指的新生儿以及10342例无先天性异常的对照。
孕期母亲吸烟与生出患有先天性手指异常孩子的风险显著升高相关（未调整的优势比为1.33；95%置信区间为1.21至1.47；p<0.0001）。单因素分析表明，母亲婚姻状况和医学风险因素（贫血、心脏病、肺病、糖尿病、羊水过多/过少、妊娠相关高血压、宫颈机能不全、既往早产或小于胎龄儿以及恒河猴因子致敏）为潜在混杂因素。对这些变量进行调整后，优势比仍具有显著性（调整后的优势比为1.31；95%置信区间为1.18至1.45；p<0.0001）。每日吸烟量分为四组：不吸烟、每日1至10支、每日11至20支以及每日21支或更多。将每个吸烟类别与不吸烟参考组进行比较时发现了具有统计学显著性的剂量反应关系：分别为1.29（95%置信区间为1.15至1.46）、1.38（95%置信区间为1.12至1.71）和1.78（95%置信区间为0.97至3.26）。孕期吸烟量增加会导致生出多指、并指或无指孩子的风险升高。
这是迄今为止专门调查孕期母亲吸烟与生出患有先天性手指异常新生儿风险之间关联的最大规模研究。吸烟的优势比升高以及剂量反应关系中的显著趋势表明，孕期吸烟可能是这些常见先天性差异的一个重要可预防风险因素。
