Brooke O G, Anderson H R, Bland J M, Peacock J L, Stewart C M
Department of Child Health, St George's Hospital Medical School, London.
BMJ. 1989 Mar 25;298(6676):795-801. doi: 10.1136/bmj.298.6676.795.
To investigate the effects of smoking, alcohol, and caffeine consumption and socio-economic factors and psychosocial stress on birth weight.
Prospective population study.
District general hospital in inner London.
A consecutive series of 1860 white women booking for delivery were approached. 136 Refused and 211 failed to complete the study for other reasons (moved, abortion, subsequent refusal), leaving a sample of 1513. Women who spoke no English, booked after 24 weeks, had insulin dependent diabetes, or had a multiple pregnancy were excluded.
Data were obtained by research interviewers at booking (general health questionnaire, modified Paykel's interview, and Eysenck personality questionnaire) and at 17, 28, and 36 weeks' gestation and from the structured antenatal and obstetric record. Variables assessed included smoking, alcohol consumption, caffeine consumption, and over 40 indicators of socio-economic state and psychosocial stress, including social class, tenure of accommodations, education, employment, income, anxiety and depression, stressful life events, social stress, social support, personality, and attitudes to pregnancy. Birth weight was corrected for gestation and adjusted for maternal height, parity, and baby's sex.
Smoking was the most important single factor (5% reduction in corrected birth weight). Passive smoking was not significant (0.5% reduction). After smoking was controlled for, alcohol had an effect only in smokers and the effects of caffeine became non-significant. Only four of the socioeconomic and stress factors significantly reduced birth weight and these effects became non-significant after smoking was controlled for.
Social and psychological factors have little or no direct effect on birth weight corrected for gestational age (fetal growth), and the main environmental cause of its variation in this population was smoking.
研究吸烟、饮酒、咖啡因摄入、社会经济因素及心理社会压力对出生体重的影响。
前瞻性人群研究。
伦敦市中心区综合医院。
连续选取1860名预约分娩的白人女性。136人拒绝参与，211人因其他原因（搬家、流产、随后拒绝）未能完成研究，最终样本为1513人。不会说英语、孕24周后预约、患有胰岛素依赖型糖尿病或多胎妊娠的女性被排除。
研究访员在预约时（通过一般健康问卷、改良的佩克尔访谈和艾森克人格问卷）、妊娠17周、28周和36周时收集数据，并从结构化的产前和产科记录中获取信息。评估的变量包括吸烟、饮酒、咖啡因摄入，以及40多项社会经济状况和心理社会压力指标，包括社会阶层、住房 tenure、教育程度、就业情况、收入、焦虑和抑郁、应激性生活事件、社会压力、社会支持、人格以及对妊娠的态度。出生体重根据孕周进行校正，并对母亲身高、产次和婴儿性别进行调整。
吸烟是最重要的单一因素（校正后出生体重降低5%）。被动吸烟影响不显著（降低0.5%）。在控制吸烟因素后，酒精仅对吸烟者有影响，咖啡因的影响不再显著。社会经济和压力因素中只有四项显著降低出生体重，在控制吸烟因素后这些影响不再显著。
社会和心理因素对校正孕周后的出生体重（胎儿生长）几乎没有直接影响，该人群中出生体重变化的主要环境因素是吸烟。
