孕期吸烟：完全戒烟与少量吸烟对出生体重的影响相似吗？
Cigarette Smoking During Pregnancy: Do Complete Abstinence and Low Level Cigarette Smoking Have Similar Impact on Birth Weight?
作者信息
Berlin Ivan, Golmard Jean-Louis, Jacob Nelly, Tanguy Marie-Laure, Heishman Stephen J
机构信息
Département de Pharmacologie, Université P. and M. Curie, Faculté de médecine-Hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France.
Département de Biostatistique, Université P. and M. Curie, Faculté de médecine-Hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France.
出版信息
Nicotine Tob Res. 2017 May 1;19(5):518-524. doi: 10.1093/ntr/ntx033.
OBJECTIVES
Despite awareness of negative health outcomes associated with smoking, pregnant smokers might reduce their tobacco consumption thinking that a low smoking rate reduces smoking-related negative birth outcomes. We aimed to assess in a clinical sample whether there is a smoking rate that would not impact on birth weight (BW).
METHODS
Pregnant smokers ≥18 years, gestational age of 9-20 weeks of amenorrhea, motivated to quit smoking, smoking ≥5 cigarettes/day (cpd) and their newborns (381 singleton, live births) were included in this secondary analysis of a French smoking cessation trial.
RESULTS
The mean BW when the mother quit smoking was 3417 g (95 % CI: 3098-3738 g); when smoking >0<5 cpd, 3081g (3003-3159 g); when smoking 5-9 cpd, 3043 g (2930-3157 g); and when smoking ≥10 cpd, 2831 g (2596-3157 g) (p = .006). The corresponding effect sizes ranged from medium to large (Cohen's d for BW: 0.54, 0.57 and 0.85) compared to BW when the mother quit. In the multivariable analysis, adjusted for all significant confounders, when the mother smoked on average >0<5 cpd, the loss in BW was 228 g; when smoking 5-9 cpd, 251 g; and when smoking ≥10 cpd, 262 g (all p ≤ .02) compared to newborns' BW of mothers who stopped smoking since quit date.
CONCLUSIONS
Even low cigarette consumption during pregnancy is associated with BW loss. All efforts should be made to help pregnant smokers quit completely during their pregnancy.
IMPLICATIONS
As an alternative to quitting smoking, pregnant smokers reduce their smoking rate thinking that this diminishes smoking-related negative health outcomes. No study has established whether low smoking rate (more than 0 but less than 5 cpd) during pregnancy impacts BW compared to abstinence from smoking. Among treatment-seeking pregnant smokers BW of newborns of mothers who smoked even less than 5 cpd was significantly lower than of those whose mothers quit; effect sizes of different consumption levels on BW ranged from moderate (>0<5 cpd) to large (≥10 cpd). Even low smoking rate is associated with reduced BW compared to complete maternal smoking abstinence.
目的
尽管人们已意识到吸烟会对健康产生负面影响，但怀孕的吸烟者可能会认为较低的吸烟率能降低与吸烟相关的不良出生结局，从而减少烟草消费。我们旨在通过一个临床样本评估是否存在不会影响出生体重（BW）的吸烟率。
方法
本研究为一项法国戒烟试验的二次分析，纳入了年龄≥18岁、停经9 - 20周、有戒烟意愿、每天吸烟≥5支（cpd）的怀孕吸烟者及其新生儿（381例单胎活产）。
结果
母亲戒烟时新生儿的平均出生体重为3417克（95%可信区间：3098 - 3738克）；母亲每天吸烟>0<5支时，出生体重为3081克（3003 - 3159克）；母亲每天吸烟5 - 9支时，出生体重为3043克（2930 - 3157克）；母亲每天吸烟≥10支时，出生体重为2831克（2596 - 3157克）（p = 0.006）。与母亲戒烟时的出生体重相比，相应的效应大小从中等至大不等（出生体重的科恩d值分别为：0.54、0.57和0.85）。在多变量分析中，对所有显著的混杂因素进行校正后，与自戒烟之日起就戒烟的母亲所生新生儿的出生体重相比，母亲平均每天吸烟>0<5支时，出生体重减少228克；母亲每天吸烟5 - 9支时，出生体重减少251克；母亲每天吸烟≥支时，出生体重减少262克（所有p≤0.02）。
结论
即使孕期吸烟量较低也与出生体重降低有关。应尽一切努力帮助怀孕吸烟者在孕期完全戒烟。
启示
作为戒烟的替代方法，怀孕吸烟者认为降低吸烟率可减少与吸烟相关的负面健康结局。尚无研究确定孕期低吸烟率（每天吸烟超过0支但少于5支）与戒烟相比是否会影响出生体重。在寻求治疗的怀孕吸烟者中，母亲每天吸烟少于5支的新生儿出生体重显著低于母亲戒烟者的新生儿；不同吸烟量对出生体重的效应大小从中等（>0<5支/天）至大（≥10支/天）不等。与母亲完全戒烟相比，即使低吸烟率也与出生体重降低有关。
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