Sokol Robert J, Janisse James J, Louis Judette M, Bailey Beth Nordstrom, Ager Joel, Jacobson Sandra W, Jacobson Joseph L
C.S. Mott Center for Human Growth and Development, Detroit, Michigan 48201, USA.
Alcohol Clin Exp Res. 2007 Jun;31(6):1031-7. doi: 10.1111/j.1530-0277.2007.00384.x. Epub 2007 Mar 31.
Rates of preterm delivery, a major proximate cause of perinatal morbidity and mortality, have been increasing. Prenatal alcohol exposure has been implicated in preterm delivery, although results have been inconsistent due to inadequate control for confounding factors, insufficient power, unreliable and inaccurate assessment of both exposure and gestational age, and lack of stratification of prematurity into severity levels. The purpose of this study was to examine the relation between maternal alcohol, cocaine and cigarette use during pregnancy, and extreme and mild preterm birth.
Three thousand one hundred thirty consecutive gravidas were followed prospectively for antenatal substance use and had ultrasound confirmed pregnancy dating.
Alcohol and cocaine, but not cigarette use, were associated with increased risk of extreme preterm delivery after control for potential confounders. For every unit increase in alcohol exposure, risk of extreme preterm delivery increased significantly [odds ratio (OR) 34.8]. Furthermore, in women aged 30+, alcohol exposure was associated with mild prematurity. Abstention from alcohol while continuing to use cocaine and tobacco was related to a decrease in extreme prematurity of 41%.
The risk of extreme preterm delivery associated with alcohol use is substantial and similar in magnitude to other well-recognized risks. Increased accuracy in identifying exposure and the use of ultrasound to confirm gestational age dating likely contributed to the findings of the current study. These findings suggest that eliminating pregnancy alcohol use might substantially reduce the risk of preterm delivery.
早产是围产期发病和死亡的主要直接原因，其发生率一直在上升。产前酒精暴露与早产有关，尽管由于对混杂因素控制不足、样本量不足、暴露和孕周评估不可靠且不准确，以及未将早产分层为严重程度级别，结果一直不一致。本研究的目的是探讨孕期母亲饮酒、使用可卡因和吸烟与极早早产和轻度早产之间的关系。
对3130例连续孕妇进行前瞻性随访，了解其产前物质使用情况，并通过超声确定妊娠日期。
在控制潜在混杂因素后，酒精和可卡因（而非吸烟）与极早早产风险增加有关。酒精暴露每增加一个单位，极早早产风险显著增加[比值比（OR）34.8]。此外，在30岁及以上的女性中，酒精暴露与轻度早产有关。戒酒同时继续使用可卡因和烟草与极早早产率降低41%有关。
与酒精使用相关的极早早产风险很大，且与其他公认风险的程度相似。识别暴露的准确性提高以及使用超声确定孕周日期可能促成了本研究的结果。这些发现表明，消除孕期饮酒可能会大幅降低早产风险。
