Polakowski Laura L, Akinbami Lara J, Mendola Pauline
From the Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia; National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland; U.S. Public Health Service, Rockville, Maryland.
Obstet Gynecol. 2009 Aug;114(2 Pt 1):318-325. doi: 10.1097/AOG.0b013e3181ae9e9c.
To examine the association between prenatal smoking cessation and delivery of a preterm or small-for-gestational-age (SGA) newborn in a large U.S. subpopulation using the revised (2003) birth certificate, which now assesses maternal smoking status by trimester.
We analyzed a cohort of U.S.-resident, singleton births in the 11 states that used the revised birth certificate in 2005 (n=915,441). Self-reported maternal smoking status was categorized as "never smoked," "quit in the first trimester," "quit in the second trimester," and "smoked throughout" pregnancy (referent). Multinomial logistic regression was used to estimate adjusted odds ratios (aORs) for three outcomes (preterm non-SGA, term SGA, or preterm SGA newborns) by maternal smoking status. Analyses stratified by maternal age were also conducted.
Compared with women who smoked throughout pregnancy, first-trimester quitters reduced their odds of delivering a preterm non-SGA newborn by 31% (aOR 0.69, 95% confidence interval [CI] 0.65-0.74), a term SGA newborn by 55% (aOR 0.45, 95% CI 0.42-0.48), and a preterm SGA newborn by 53% (aOR 0.47, 95% CI 0.40-0.55), similar to nonsmokers. Second-trimester quitters also reduced their odds of delivering preterm non-SGA and term SGA newborns but to a lesser magnitude. When comparing first-trimester quitters with smokers in each age group, older mothers had generally lower odds of these outcomes than younger mothers.
Pregnant smokers who quit in the first trimester lowered their risk of delivering preterm and SGA newborns to a level similar to that of pregnant nonsmokers, and this benefit appeared to increase with maternal age. These findings reinforce current clinical guidance to encourage smoking cessation among pregnant smokers and serve as an additional incentive to quit.
II.
利用修订后的（2003年）出生证明，在美国一个大型亚人群中研究产前戒烟与早产或小于胎龄（SGA）新生儿分娩之间的关联，该出生证明现在按孕期评估母亲吸烟状况。
我们分析了2005年使用修订后出生证明的11个州的美国常住单胎分娩队列（n = 915,441）。自我报告的母亲吸烟状况分为“从不吸烟”、“孕早期戒烟”、“孕中期戒烟”和“整个孕期吸烟”（参照组）。采用多项逻辑回归按母亲吸烟状况估计三种结局（早产非SGA、足月SGA或早产SGA新生儿）的调整优势比（aOR）。还进行了按母亲年龄分层的分析。
与整个孕期吸烟的女性相比，孕早期戒烟者分娩早产非SGA新生儿的几率降低了31%（aOR 0.69，95%置信区间[CI] 0.65 - 0.74），分娩足月SGA新生儿的几率降低了55%（aOR 0.45，95% CI 0.42 - 0.48），分娩早产SGA新生儿的几率降低了53%（aOR 0.47，95% CI 0.40 - 0.55），与不吸烟者相似。孕中期戒烟者也降低了分娩早产非SGA和足月SGA新生儿的几率，但降低幅度较小。在比较各年龄组的孕早期戒烟者与吸烟者时，年龄较大的母亲出现这些结局的几率通常低于年龄较小的母亲。
孕早期戒烟的孕妇将分娩早产和SGA新生儿的风险降低到与不吸烟孕妇相似的水平，而且这种益处似乎随着母亲年龄的增加而增加。这些发现强化了当前鼓励孕妇戒烟的临床指导，并成为戒烟的额外动力。
II级。
