Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
Matern Child Health J. 2013 May;17(4):746-55. doi: 10.1007/s10995-012-1059-y.
To examine the association between exposure to tobacco compounds in breast milk and risk of childhood overweight, we used historical data for a subset of 21,063 mother-child pairs in the US Collaborative Perinatal Project. Based on self-reports, mothers were classified as non-smokers, light (1-9 cigarettes/day), moderate (10-19), or heavy (20+) smokers. Feeding type (exclusive breastfeeding or bottle-feeding) was observed during nursery stay after birth. We stratified children by maternal smoking and feeding type, and then fit interaction terms to isolate exposure to tobacco compounds via breast milk from exposure in uterus and in ambient air after birth. Using measured weight and height, overweight at age 7 was defined as a body mass index ≥85th percentile by sex and age. Among exclusively bottle-fed children, adjusted odds ratios (ORs) of overweight at age 7 were 1.24 (95% confidence interval [CI], 1.12-1.38; vs. non-smoking) for light maternal smoking, 1.43 (95% CI, 1.25-1.63) for moderate maternal smoking, and 1.46 (95% CI, 1.28-1.66) for heavy maternal smoking. Among exclusively breastfed children, the corresponding ORs were 1.33 (95% CI, 0.96-1.84) for light, 1.86 (95% CI, 1.27-2.73) for moderate, and 2.22 (95% CI, 1.53-3.20) for heavy maternal smoking. There was a modest positive interaction between breastfeeding and heavy maternal smoking on overweight risk at age 7. Tobacco compounds via breast milk of smoking mothers (significantly for heavy smokers) appear to be associated with a modest elevation in childhood overweight risk at 7 years of age. More aggressive intervention is needed to help pregnant and breastfeeding women to quit smoking.
为了研究母乳中烟草化合物暴露与儿童超重风险之间的关联，我们使用了美国合作围产期项目中 21063 对母婴对子的历史数据。根据自我报告，母亲被分为不吸烟者、轻度（每天 1-9 支香烟）、中度（每天 10-19 支）或重度（每天 20 支以上）吸烟者。出生后在托儿所期间观察母乳喂养类型（纯母乳喂养或奶瓶喂养）。我们根据母亲吸烟和喂养类型对儿童进行分层，然后拟合交互项，以将母乳中的烟草化合物暴露与子宫内和出生后环境空气中的暴露隔离开来。使用测量的体重和身高，7 岁时超重定义为体重指数按性别和年龄≥第 85 百分位数。在纯奶瓶喂养的儿童中，7 岁时超重的调整比值比（OR）分别为轻度母亲吸烟（vs. 不吸烟）1.24（95%置信区间[CI]，1.12-1.38），中度母亲吸烟 1.43（95%CI，1.25-1.63），重度母亲吸烟 1.46（95%CI，1.28-1.66）。在纯母乳喂养的儿童中，相应的 OR 分别为轻度 1.33（95%CI，0.96-1.84），中度 1.86（95%CI，1.27-2.73），重度 2.22（95%CI，1.53-3.20）。母乳喂养与重度母亲吸烟对 7 岁时超重风险存在适度正交互作用。吸烟母亲的母乳中的烟草化合物（重度吸烟者显著）似乎与 7 岁时儿童超重风险的适度升高有关。需要采取更积极的干预措施，帮助孕妇和哺乳期妇女戒烟。
