Inamdar Aadil S, Croucher Raymond E, Chokhandre Mrunalini K, Mashyakhy Mohammed H, Marinho Valeria C C
Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia;
Barts and The London, School of Medicine and Dentistry, Queen Mary University of London, London, UK;
Nicotine Tob Res. 2015 Sep;17(9):1058-66. doi: 10.1093/ntr/ntu255. Epub 2014 Dec 22.
Perinatal morbidity and mortality are important indicators of maternal health and the future health of the child. Smokeless tobacco (ST) use during pregnancy is associated with low birth weight (LBW), preterm births, stillbirths, and small for gestation age (SGA). This study systematically reviews and summarizes evidence on the association of maternal ST use with these adverse health outcomes in newborns.
Electronic databases (Medline, Embase, Lilacs) were searched in July 2013 using appropriate keywords complemented with reference list searching. Observational studies of maternal ST use and these outcomes were considered; LBW, preterm, stillbirth, SGA. A comprehensive assessment of quality and risk of bias in all included studies was performed. RevMan software was used for data analysis. Results are expressed as crude odds ratios with 95% confidence intervals. Chi-square and I(2) tests checked for heterogeneity and quantified inconsistency between results.
There were 9 studies (16 reports) included (7 cohort-studies, 1 case-control study, and 1 cross-sectional study). They were clinically and methodologically diverse. Significant associations with ST use were seen in 5/7 studies for LBW, in 3/6 studies for preterm, in all 4 studies for stillbirth and in 1/2 studies assessing SGA. Heterogeneity between results was moderate for LBW (I(2) = 44%) and stillbirth (I(2) = 52%), and high for preterm (I(2) = 87%) and SGA (I(2) = 65%). Meta-analysis was considered inappropriate due to risk of bias and confounding.
Although most studies show an association between ST use in pregnancy and adverse health effects in newborns, these results may be limited by confounding and bias. Quality observational studies are needed to strengthen this evidence base.
围产期发病率和死亡率是孕产妇健康及儿童未来健康的重要指标。孕期使用无烟烟草（ST）与低出生体重（LBW）、早产、死产及小于胎龄儿（SGA）有关。本研究系统回顾并总结了孕产妇使用ST与新生儿这些不良健康结局之间关联的证据。
2013年7月使用适当关键词检索电子数据库（Medline、Embase、Lilacs），并辅以参考文献列表检索。纳入了关于孕产妇使用ST与这些结局（LBW、早产、死产、SGA）的观察性研究。对所有纳入研究的质量和偏倚风险进行了全面评估。使用RevMan软件进行数据分析。结果以粗比值比及95%置信区间表示。采用卡方检验和I²检验检查异质性并量化结果间的不一致性。
共纳入9项研究（16篇报告）（7项队列研究、1项病例对照研究和1项横断面研究）。这些研究在临床和方法学上存在差异。在5/7项研究中观察到ST使用与LBW有显著关联，在3/6项研究中与早产有显著关联，在所有4项研究中与死产有显著关联，在1/2项评估SGA的研究中有显著关联。LBW（I² = 44%）和死产（I² = 52%）结果间的异质性为中度，早产（I² = 87%）和SGA（I² = 65%）的异质性为高度。由于存在偏倚和混杂风险，认为不适合进行荟萃分析。
尽管大多数研究表明孕期使用ST与新生儿不良健康影响之间存在关联，但这些结果可能受混杂和偏倚的限制。需要高质量的观察性研究来加强这一证据基础。
