Heyborne Kent D, Allshouse Amanda A
Department of Obstetrics and Gynecology, Denver Health, Denver, Colorado.
Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado.
Am J Perinatol. 2016 Oct;33(12):1191-7. doi: 10.1055/s-0036-1586119. Epub 2016 Jul 27.
Objective The objective of this study was to determine if maternal smoking modifies the effectiveness of 17 α-hydroxyprogesterone caproate (17OHP-C). Study Design Secondary analysis of the Maternal-Fetal Medicine Units Network trial of 17OHP-C. The prevalence of preterm birth (PTB) by smoking status and treatment group was compared by chi-squared analysis and analysis of variance was used to compare gestational age (GA) at birth. Multivariable modeling was used to estimate the effect of smoking on 17OHP-C treatment. Results In this study, 459 women were included. Maternal smoking significantly modified the effectiveness of 17OHP-C treatment. In smokers, 17OHP-C significantly reduced the prevalence of multiple outcomes (PTB < 37 and < 35 weeks, spontaneous PTB < 37 and < 35 weeks), while in nonsmokers, only PTB < 37 weeks was reduced. Delivery GA was later in 17OHP-C versus placebo treated smokers (36.4 vs. 34.3 weeks, p = 0.041) but not nonsmokers (36.3 vs. 35.5 weeks, p = nonsignificant). In multivariable modeling, 17OHP-C was more effective in smokers than nonsmokers as measured by multiple outcomes (PTB < 37 weeks [p = 0.041] and < 35 weeks [p = 0.036] and spontaneous PTB < 37 weeks [p = 0.029]). Conclusion In this cohort of women with a prior PTB, maternal smoking status significantly modified the effectiveness of 17OHP-C treatment.
目的 本研究的目的是确定母亲吸烟是否会改变己酸17α-羟孕酮（17OHP-C）的疗效。研究设计 对17OHP-C的母胎医学单位网络试验进行二次分析。通过卡方分析比较不同吸烟状态和治疗组的早产（PTB）患病率，并使用方差分析比较出生时的孕周（GA）。采用多变量建模来估计吸烟对17OHP-C治疗的影响。结果 在本研究中，纳入了459名女性。母亲吸烟显著改变了17OHP-C治疗的疗效。在吸烟者中，17OHP-C显著降低了多种结局的患病率（PTB<37周和<35周、自发性PTB<37周和<35周），而在不吸烟者中，仅PTB<37周有所降低。与安慰剂治疗的吸烟者相比，17OHP-C治疗的吸烟者分娩孕周更晚（36.4对34.3周，p=0.041），但不吸烟者无此差异（36.3对35.5周，p=无显著性）。在多变量建模中，从多种结局衡量（PTB<37周[p=0.041]、<35周[p=0.036]和自发性PTB<37周[p=0.029]），17OHP-C对吸烟者比对不吸烟者更有效。结论 在这个有既往PTB史的女性队列中，母亲吸烟状态显著改变了17OHP-C治疗的疗效。
