Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN 60153, USA.
J Perinatol. 2010 May;30(5):319-23. doi: 10.1038/jp.2009.175. Epub 2009 Nov 12.
To determine the effects of tobacco use on perinatal outcomes among patients with gestational diabetes (GDM).
This was a retrospective cohort study of singleton pregnancies with GDM and live births from 2003 to 2006. The primary outcome, large for gestational age (LGA) infants, was compared between smoking and nonsmoking groups. Secondary outcomes included cesarean deliveries, shoulder dystocia, birth trauma, peripartum complications, macrosomia, 5-min Apgar score < or =3, birth defects, and neonatal intensive care unit (NICU) admissions. chi(2) and Student t-tests compared the two groups; a P-value <0.05 was statistically significant and odds ratios (OR) were reported with 95% confidence intervals (CI). A multivariate logistic regression analysis controlled for variables known to affect outcomes in GDM.
We identified 915 patients with GDM, of which 130 (14.2%) smoked during pregnancy. Women who smoked during pregnancy were less likely to have LGA infants (22.4 vs 31.2%; OR, 0.61; 95% CI, 0.39 to 0.95). In a logistic regression analysis, the inverse relationship between smoking and LGA persisted (OR, 0.59; 95% CI, 0.36 to 0.97) after controlling for maternal age, multiparity, ethnicity, weight status before pregnancy, weight gain during pregnancy, and male gender. Preterm labor, preeclampsia, Cesareans, shoulder dystocia, and birth trauma were similar in both groups. PPROM was more likely to occur in nonsmokers (0 vs 4%, P=0.03), but postpartum hemorrhage was more common among smokers (OR, 2.3; 95% CI, 1.02 to 5.31). Macrosomia, low 5-min Apgar score, birth defects, and NICU admissions were similar between the groups.
Patients with GDM who smoke during pregnancy were 40% less likely to have LGA infants. However, smoking was not protective of other common morbidities associated with GDM.
确定吸烟对患有妊娠期糖尿病（GDM）的围产期结局的影响。
这是一项对 2003 年至 2006 年期间患有 GDM 并分娩活产儿的单胎妊娠的回顾性队列研究。主要结局指标是巨大儿（LGA）婴儿，比较吸烟组和不吸烟组之间的差异。次要结局指标包括剖宫产、肩难产、分娩创伤、围产期并发症、巨大儿、5 分钟 Apgar 评分≤3 分、出生缺陷和新生儿重症监护病房（NICU）入院。采用卡方检验和 t 检验比较两组间的差异；P 值<0.05 为统计学显著差异，报告比值比（OR）及其 95%置信区间（CI）。采用多变量逻辑回归分析控制已知影响 GDM 结局的变量。
共纳入 915 例 GDM 患者，其中 130 例（14.2%）在孕期吸烟。孕期吸烟的孕妇发生 LGA 婴儿的可能性较低（22.4% vs 31.2%；OR，0.61；95%CI，0.39 至 0.95）。在逻辑回归分析中，控制了母亲年龄、多胎妊娠、种族、孕前体重状况、孕期体重增加和男性性别等变量后，吸烟与 LGA 之间的负相关关系仍然存在（OR，0.59；95%CI，0.36 至 0.97）。两组的早产、子痫前期、剖宫产、肩难产和分娩创伤相似。在不吸烟者中更有可能发生胎膜早破（0% vs 4%，P=0.03），但吸烟者产后出血更常见（OR，2.3；95%CI，1.02 至 5.31）。两组之间巨大儿、5 分钟 Apgar 评分低、出生缺陷和 NICU 入院率相似。
患有 GDM 的孕妇在孕期吸烟可使 LGA 婴儿的发生风险降低 40%。然而，吸烟并不能预防与 GDM 相关的其他常见并发症。
