From the Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland, and the Department of Psychiatry, Lapland Hospital District, Rovaniemi, Finland; the Department of Child Psychiatry, Faculty of Medicine, University of Turku, and Turku University Hospital, Turku, Finland; the National Institute for Health and Welfare, Oulu, Finland; the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, and New York State Psychiatric Institute, New York; and the Departments of Biostatistics and Epidemiology, Columbia University Mailman School of Public Health, New York.
Am J Psychiatry. 2016 Aug 1;173(8):799-806. doi: 10.1176/appi.ajp.2016.15060800. Epub 2016 May 24.
Cigarette smoking during pregnancy is a major public health problem leading to adverse health outcomes and neurodevelopmental abnormalities among offspring. Its prevalence in the United States and Europe is 12%-25%. This study examined the relationship between prenatal nicotine exposure (cotinine level) in archived maternal sera and schizophrenia in offspring from a national birth cohort.
The authors conducted a population-based nested case-control study of all live births in Finland from 1983 to 1998. Cases of schizophrenia in offspring (N=977) were identified from a national registry and matched 1:1 to controls on date of birth, sex, and residence. Maternal serum cotinine levels were prospectively measured, using quantitative immunoassay, from early- to mid-gestation serum specimens archived in a national biobank.
A higher maternal cotinine level, measured as a continuous variable, was associated with an increased odds of schizophrenia (odds ratio=3.41, 95% confidence interval, 1.86-6.24). Categorically defined heavy maternal nicotine exposure was related to a 38% increased odds of schizophrenia. These findings were not accounted for by maternal age, maternal or parental psychiatric disorders, socioeconomic status, and other covariates. There was no clear evidence that weight for gestational age mediated the associations.
To the authors' knowledge, this is the first study of the relationship between a maternal smoking biomarker and schizophrenia. It provides the most definitive evidence to date that smoking during pregnancy is associated with schizophrenia. If replicated, these findings suggest that preventing smoking during pregnancy may decrease the incidence of schizophrenia.
孕期吸烟是一个主要的公共卫生问题，会导致后代健康状况不佳和神经发育异常。其在美国和欧洲的流行率为 12%-25%。本研究检测了在一个全国性出生队列中，孕妇血清中储存的产前尼古丁暴露（可替宁水平）与后代精神分裂症之间的关系。
作者对芬兰 1983 年至 1998 年所有活产儿进行了基于人群的巢式病例对照研究。通过国家登记册确定了后代精神分裂症病例（977 例），并根据出生日期、性别和居住地与对照组进行 1:1 匹配。使用定量免疫分析法，从全国生物库中储存的妊娠早期至中期血清标本中前瞻性测量母体血清可替宁水平。
以连续变量衡量，较高的母体可替宁水平与精神分裂症的发病几率增加相关（比值比=3.41，95%置信区间，1.86-6.24）。母体尼古丁重度暴露的分类定义与精神分裂症发病几率增加 38%相关。这些发现不受母亲年龄、母亲或父母精神障碍、社会经济地位和其他协变量的影响。没有明确的证据表明体重与胎龄与这些关联有关。
据作者所知，这是首次研究母亲吸烟生物标志物与精神分裂症之间的关系。它提供了迄今为止最明确的证据，证明孕期吸烟与精神分裂症有关。如果得到证实，这些发现表明，预防孕期吸烟可能会降低精神分裂症的发病率。
