Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands.
PLoS One. 2012;7(5):e37002. doi: 10.1371/journal.pone.0037002. Epub 2012 May 10.
Socioeconomic status (SES) is adversely associated with perinatal outcomes. This association is likely to be mediated by tobacco exposure. However, previous studies were limited to single perinatal outcomes and devoted no attention to environmental tobacco exposure. Therefore, this study aimed firstly to explain the role of maternal smoking in the association between maternal education and preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA), and secondly to explain whether environmental tobacco smoke mediates these associations further.
This study was nested in a population-based cohort study in the Netherlands, the Amsterdam Born Children and their Development (ABCD) study. Analyses were done in a sample of 3821 pregnant women of Dutch origin, using logistic regression analysis.
Least educated women, who were more often smoking and exposed to environmental tobacco smoke, had a significantly higher risk of PTB (OR 1.95 [95% CI: 1.19-3.20]), LBW (OR 2.41 [95% CI: 1.36-4.27]) and SGA (OR 1.90 [95% CI 1.32-2.74]) than highly educated women. The mediating effect of smoking in the least educated women was 43% for PTB, 55% for LBW and 66% for SGA. Environmental tobacco smoke did not explain these associations further. After adjustment for maternal smoking, the association between lower maternal education and pregnancy outcomes was no longer significant.
Smoking explains to a considerable extent the association between lower maternal education and adverse perinatal outcomes. Therefore, tobacco-interventions in lower educated women should be primarily focussed on maternal smoking to reduce PTB, LBW, and SGA. Additional attention to environmental tobacco exposure does not seem to reduce educational inequalities in perinatal outcomes.
社会经济地位（SES）与围产期结局不良相关。这种关联可能是通过烟草暴露来介导的。然而，以前的研究仅限于单一的围产期结局，并且没有关注环境烟草暴露。因此，本研究首先旨在解释母亲吸烟在母亲教育与早产（PTB）、低出生体重（LBW）和小于胎龄儿（SGA）之间的关联中的作用，其次是解释环境烟草烟雾是否进一步介导这些关联。
本研究嵌套在荷兰一项基于人群的队列研究——阿姆斯特丹出生儿童及其发育研究（ABCD 研究）中。在一个由 3821 名荷兰裔孕妇组成的样本中，使用逻辑回归分析进行了分析。
受教育程度最低的女性，她们更经常吸烟和暴露于环境烟草烟雾中，PTB（OR1.95[95%CI：1.19-3.20]）、LBW（OR2.41[95%CI：1.36-4.27]）和 SGA（OR1.90[95%CI1.32-2.74]）的风险显著高于受教育程度较高的女性。在受教育程度最低的女性中，吸烟的中介作用在 PTB 中占 43%，在 LBW 中占 55%，在 SGA 中占 66%。环境烟草烟雾不能进一步解释这些关联。在调整母亲吸烟后，较低的母亲教育程度与妊娠结局之间的关联不再显著。
吸烟在很大程度上解释了较低的母亲教育程度与不良围产期结局之间的关联。因此，在受教育程度较低的女性中，烟草干预应主要集中在母亲吸烟上，以减少 PTB、LBW 和 SGA。对环境烟草暴露的额外关注似乎并不能减少围产期结局的教育不平等。
