Lee Laura J, Lupo Philip J
Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA.
Pediatr Cardiol. 2013 Feb;34(2):398-407. doi: 10.1007/s00246-012-0470-x. Epub 2012 Aug 12.
Although a previous metaanalysis indicated that maternal smoking during pregnancy increased the risk of congenital heart defects (CHD) in offspring, the effect of smoking on individual CHD subtypes was not determined. Because CHDs are anatomically, clinically, epidemiologically, and developmentally heterogeneous, the authors conducted a systematic review and metaanalysis of the association between maternal smoking during pregnancy and the risk of CHDs, including CHD subtypes among offspring. Two types of summary relative risk (RR) estimates (any smoking vs no smoking and increasing categories of smoking, i.e., light, medium, and heavy) were calculated for CHDs as a group and for a number of CHD subtypes using both fixed- and random-effects models. Random effects estimates were reported if there was evidence of heterogeneity among the studies. Consistent with the previous metaanalysis, the authors observed a positive association between maternal smoking during pregnancy and the risk of CHDs as a group (RR, 1.11; 95 % confidence interval [CI], 1.02-1.21; number of cases [n] = 18,282). Additionally, women who smoked during pregnancy were more likely to have a child with 12 (71 %) of 17 CHD subtypes analyzed compared with women who did not smoke. The highest risk was for septal defects as a group (RR, 1.44; 95 % CI, 1.16-1.79; n = 2977). The evidence of dose response was observed for septal defects as a group, atrial septal defects, and atrioventricular septal defects. This systematic review and metaanalysis suggests that maternal smoking is modestly associated with an increased risk of CHDs and some CHD subtypes.
尽管先前的一项荟萃分析表明，孕期母亲吸烟会增加后代患先天性心脏病（CHD）的风险，但吸烟对个体CHD亚型的影响尚未确定。由于CHD在解剖学、临床、流行病学和发育方面具有异质性，作者对孕期母亲吸烟与CHD风险之间的关联进行了系统评价和荟萃分析，包括后代中的CHD亚型。使用固定效应模型和随机效应模型，针对CHD总体以及多种CHD亚型计算了两种汇总相对风险（RR）估计值（任何吸烟与不吸烟以及吸烟量增加类别，即轻度、中度和重度）。如果研究之间存在异质性证据，则报告随机效应估计值。与先前的荟萃分析一致，作者观察到孕期母亲吸烟与CHD总体风险之间存在正相关（RR，1.11；95%置信区间[CI]，1.02 - 1.21；病例数[n]=18282）。此外，与不吸烟的女性相比，孕期吸烟的女性所生孩子患所分析的17种CHD亚型中的12种（71%）的可能性更高。风险最高的是作为一个组的间隔缺损（RR，1.44；95%CI，1.16 - 1.79；n = 2977）。在作为一个组的间隔缺损、房间隔缺损和房室间隔缺损中观察到剂量反应证据。这项系统评价和荟萃分析表明，孕期母亲吸烟与CHD及某些CHD亚型风险增加存在适度关联。
