1] Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA [2] Division of Nutritional Epidemiology, The National Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Int J Obes (Lond). 2013 Oct;37(10):1356-63. doi: 10.1038/ijo.2013.101. Epub 2013 May 29.
Emerging evidence suggests that prenatal exposures may affect long-term health outcomes. In utero exposure to smoking is associated with an increased risk of overweight and obesity in children and adolescents. However, few studies have examined how prenatal exposure to parental smoking influences the risk of obesity during adulthood and whether these associations are independent of childhood and adolescent adiposity. The aim of the current study was to investigate whether prenatal exposure to parental smoking influences body size during adulthood and whether any association may be mediated by childhood and adolescent body size.
We investigated the association between parental smoking during pregnancy and the risk of being overweight and obese during adulthood and at age 18 and adiposity during childhood among 35 370 participants in the Nurses' Health Study II. Data on smoking during pregnancy and socioeconomic variables were provided by the mothers, and anthropometric data and adult risk factors were reported by participants.
After adjustment for socioeconomic and behavioral variables, maternal smoking during pregnancy was associated with adiposity at ages 5-10, 18 and during adulthood. For age 18 overweight, the odd ratios, ORs (95% confidence intervals, CIs) for 1-14, 15-24 and 25+cigarettes per day were 1.13 (1.18-1.50), 1.40 (1.20-1.64) and 1.15 (0.79-1.69), and for obesity were 1.41 (1.14-1.75), 1.69 (1.31-2.18) and 2.36 (1.44-3.86). The corresponding ORs (95% CIs) for obesity during adulthood were 1.26 (1.16-1.37), 1.46 (1.30-1.63) and 1.43 (1.10-1.86). Risk of adiposity was not increased among daughters whose mothers stopped smoking during the first trimester (OR (95% CI) for overweight (1.03 (95% CI 0.90-1.17)) and for obesity (1.12 (95% CI 0.97-1.30)). Women whose fathers smoked during pregnancy were also at an increased risk of being overweight and obese during adulthood with covariate-adjusted ORs (95% CIs) for obesity of 1.19 (1.11-1.29) for 1-14 cigarettes per day, 1.27 (1.18-1.37) for 15-24 cigarettes per day and 1.40 (1.27-1.54) for 25+ cigarettes per day compared with fathers who did not smoke (Ptrend<0.0001). Paternal smoking during pregnancy was also associated with an increased risk of obesity at age 18 among those whose fathers smoked 15 or more cigarettes per day but was not associated with childhood body size.
Maternal smoking during pregnancy was associated in a dose-response manner with overweight and obesity in the daughter across adolescence and adult life. Smoking cessation during the first trimester appears to mitigate this excess risk.Paternal smoking was also associated with the risk of being overweight and obese of the adult daughter and this association persisted after adjustment for maternal smoking.
新出现的证据表明，产前暴露可能会影响长期健康结果。子宫内暴露于吸烟与儿童和青少年超重和肥胖的风险增加有关。然而，很少有研究探讨产前暴露于父母吸烟如何影响成年期肥胖的风险，以及这些关联是否独立于儿童和青少年时期的肥胖。本研究的目的是调查产前暴露于父母吸烟是否会影响成年期的身体大小，以及任何关联是否可能通过儿童和青少年时期的身体大小来介导。
我们调查了孕妇吸烟与成年期超重和肥胖风险以及儿童时期肥胖的关联在护士健康研究 II 中，35370 名参与者的数据中，母亲提供了关于怀孕期间吸烟和社会经济变量的数据，参与者报告了人体测量数据和成年危险因素。
调整了社会经济和行为变量后，母亲在怀孕期间吸烟与 5-10 岁、18 岁和成年时的肥胖有关。对于 18 岁时超重，每天 1-14、15-24 和 25+支香烟的比值比（95%置信区间，CI）分别为 1.13（1.18-1.50）、1.40（1.20-1.64）和 1.15（0.79-1.69），肥胖的比值比（95%CI）分别为 1.41（1.14-1.75）、1.69（1.31-2.18）和 2.36（1.44-3.86）。对于成年期肥胖，相应的比值比（95%CI）为 1.26（1.16-1.37）、1.46（1.30-1.63）和 1.43（1.10-1.86）。如果母亲在怀孕的第一个三个月戒烟，女儿肥胖的风险不会增加（超重的比值比（95%CI）为 1.03（95%CI 0.90-1.17）和肥胖的比值比（95%CI）为 1.12（95%CI 0.97-1.30））。怀孕期间父亲吸烟的女性在成年后超重和肥胖的风险也会增加，与调整后的协变量相比，肥胖的比值比（95%CI）分别为每天 1-14 支香烟 1.19（1.11-1.29）、每天 15-24 支香烟 1.27（1.18-1.37）和每天 25+支香烟 1.40（1.27-1.54）与不吸烟的父亲相比（P<0.0001）。怀孕期间父亲吸烟也与 15 岁或以上吸烟的父亲的成年女儿肥胖风险增加有关，但与儿童时期的体型大小无关。
母亲在怀孕期间吸烟与女儿在青春期和成年期超重和肥胖呈剂量反应关系。怀孕早期戒烟似乎可以减轻这种额外的风险。父亲吸烟也与成年女儿超重和肥胖的风险有关，并且这种关联在调整了母亲吸烟后仍然存在。
