Wehby George L, Uribe Lina M Moreno, Wilcox Allen J, Christensen Kaare, Romitti Paul A, Munger Ronald G, Lie Rolv T
Department of Health Management and Policy, University of Iowa, Iowa City; Department of Economics, University of Iowa, Iowa City; Department of Preventive & Community Dentistry, University of Iowa, Iowa City; Public Policy Center, University of Iowa, Iowa City.
Department of Orthodontics, College of Dentistry, University of Iowa, Iowa City.
Ann Epidemiol. 2017 Feb;27(2):103-107.e2. doi: 10.1016/j.annepidem.2016.11.009. Epub 2016 Dec 9.
To examine maternal smoking and body mass index (BMI) interactions in contributing to risk of oral clefts.
We studied 4935 cases and 10,557 controls from six population-based studies and estimated a pooled logistic regression of individual-level data, controlling for study fixed effects and individual-level risk factors.
We found a significant negative smoking-BMI interaction, with cleft risk with smoking generally declining with higher BMI. For all clefts combined, the odds ratio for smoking was 1.61 (95% confidence interval [CI]: 1.39-1.86) at BMI 17 (underweight), 1.47 (95% CI: 1.34-1.62) at BMI 22 (normal weight), 1.35 (95% CI: 1.22-1.48) at BMI 27 (overweight), 1.21 (95% CI: 1.04-1.41) at BMI 33 (obese), and 1.13 (95% CI: 0.92-1.38) at BMI 37 (very obese). A negative interaction was also observed for isolated clefts and across cleft types but was more pronounced for cleft lip only and cleft palate only.
Our findings suggest that the risk of oral clefts associated with maternal smoking is largest among underweight mothers, although the smoking-BMI interaction is strongest for cleft lip only and cleft palate only. BMI was not protective for the effects of smoking; a clinically relevant increase in smoking-related cleft risk was still present among heavier women.
研究孕妇吸烟与体重指数（BMI）之间的相互作用对唇腭裂风险的影响。
我们对来自六项基于人群的研究中的4935例病例和10557例对照进行了研究，并对个体水平的数据进行了汇总逻辑回归分析，同时控制了研究固定效应和个体水平的风险因素。
我们发现吸烟与BMI之间存在显著的负向相互作用，一般来说，随着BMI升高，吸烟导致的唇腭裂风险会下降。对于所有类型的唇腭裂综合来看，BMI为17（体重过轻）时，吸烟的比值比为1.61（95%置信区间[CI]：1.39 - 1.86）；BMI为22（正常体重）时，比值比为1.47（95%CI：1.34 - 1.62）；BMI为27（超重）时，比值比为1.35（95%CI：1.22 - 1.48）；BMI为33（肥胖）时，比值比为1.21（95%CI：1.04 - 1.41）；BMI为37（极度肥胖）时，比值比为1.13（95%CI：0.92 - 1.38）。在单纯性唇腭裂以及不同类型的唇腭裂中也观察到了负向相互作用，但仅唇裂和仅腭裂的负向相互作用更为明显。
我们的研究结果表明，孕妇吸烟导致的唇腭裂风险在体重过轻的母亲中最高，尽管吸烟与BMI之间的相互作用在仅唇裂和仅腭裂中最为显著。BMI对吸烟的影响没有保护作用；体重较重的女性中，吸烟相关的唇腭裂风险仍有临床意义上的增加。
