Neonatal Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Q2:07 Astrid Lindgrens Barnsjukhus, 171 76 Karolinska University Hospital, Stockholm, Sweden.
Pediatrics. 2011 Sep;128(3):503-9. doi: 10.1542/peds.2010-3811. Epub 2011 Aug 28.
Maternal smoking is associated with disturbed cardiorespiratory control in the infant. Despite lacking knowledge of whether the harmful effects of smoking are caused by combustion products in tobacco smoke or by nicotine, it has been argued that nicotine-replacement therapy during pregnancy is safer than smoking.
The goal of this study was to investigate if the disturbances in cardiorespiratory control associated with maternal smoking are also seen in infants prenatally exposed to snuff. We hypothesized that prenatal nicotine exposure (via moist snuff) causes disturbances in autonomic control and thereby increases the risk of apnea in the newborn.
In a nationwide Swedish cohort study, we studied associations between maternal tobacco use during pregnancy and neonatal apnea. Of 609 551 live-born singleton infants, 7599 were born to snuff-using mothers, 41 391 and 16 928 were born to light (1-9 cigarettes per day) and heavy (≥ 10 cigarettes per day) smokers, respectively. Logistic regression was used to calculate odds ratios, using 95% confidence intervals.
Compared with infants of nontobacco users, infants with prenatal exposure to snuff were at an increased risk of apnea even after adjustment for differences in gestational age (odds ratio: 1.96 [95% confidence interval: [1.30-2.96]) Smoking was associated with increased risk of apnea before, but not after, adjusting for gestational age.
Snuff use during pregnancy is associated with a higher risk of neonatal apnea than smoking. Maternal use of snuff or nicotine-replacement therapy cannot be regarded as an alternative to smoking during pregnancy.
母亲吸烟与婴儿心肺呼吸控制紊乱有关。尽管人们不清楚吸烟的有害影响是由烟草烟雾中的燃烧产物还是尼古丁引起的，但有人认为，怀孕期间使用尼古丁替代疗法比吸烟更安全。
本研究旨在调查母亲吸烟史与婴儿吸烟史是否会导致心肺呼吸控制紊乱。我们假设，通过鼻烟（湿鼻烟）暴露于尼古丁会干扰自主神经控制，并增加新生儿呼吸暂停的风险。
在一项全国性的瑞典队列研究中，我们研究了母亲怀孕期间吸烟与新生儿呼吸暂停之间的关联。在 609551 名活产单胎婴儿中，有 7599 名婴儿的母亲使用鼻烟，41391 名和 16928 名婴儿的母亲分别为轻度（每天 1-9 支香烟）和重度（每天≥10 支香烟）吸烟者。使用 logistic 回归计算比值比，置信区间为 95%。
与非吸烟母亲的婴儿相比，即使在调整了胎龄差异后，有产前鼻烟暴露的婴儿发生呼吸暂停的风险仍然增加（比值比：1.96 [95%置信区间：1.30-2.96]）。吸烟与胎龄调整前而非调整后的呼吸暂停风险增加相关。
与吸烟相比，孕妇使用鼻烟与新生儿呼吸暂停的风险增加有关。怀孕期间使用鼻烟或尼古丁替代疗法不能被视为吸烟的替代方法。
