Schilling Chris, Hedges Mary R, Carr Polly Atatoa, Morton Susan
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Centre for Longitudinal Research, The University of Auckland, Auckland, New Zealand.
Matern Child Health J. 2018 May;22(5):660-669. doi: 10.1007/s10995-018-2434-0.
Introduction Maternal smoking remains a modifiable cause of adverse maternal and child health outcomes. This study investigated smoking transitions across pregnancy. Methods Data from the contemporary child cohort study Growing Up in New Zealand (n = 6822) were used to analyse smoking status across three points across a pregnancy: pre-pregnancy, during pregnancy and after pregnancy. Odds-ratios (OR) were calculated for maternal, socio-economic and pregnancy-related factors associated with each transition using multivariate logistic regression. Results The prevalence of smoking pre-pregnancy was 20.3%. The cessation rate during pregnancy was 48.5%, while the postpartum relapse rate was 36.0%. Heavy smokers were less likely to quit during pregnancy (OR 0.13, 95% CI 0.08-0.20), and more likely to relapse at 9 months (OR 2.63, CI 1.60-4.32), relative to light smokers. Women in households with another smoker were less likely to quit during pregnancy (OR 0.35, CI 0.25-0.48), and more likely to relapse postpartum (OR 2.00, CI 1.14-3.51), relative to women in a smoke-free household. Women without high school qualifications were less likely to quit during pregnancy than women with bachelor degrees (OR 0.21, CI 0.11-0.41) but no more likely to relapse. Maori women were less likely to quit during pregnancy than European women (OR 0.35, CI 0.25-0.49) but no more likely to relapse. Conclusion Heavy smokers and those with another smoker in the household are at high risk of smoking during pregnancy or relapsing after pregnancy. Decreasing smoking across a pregnancy therefore requires a focus on cessation in all households with heavy smokers of child-bearing age. The association between smoking and ethnicity may be confounded as it not consistent across the pregnancy.
引言 孕妇吸烟仍然是导致不良母婴健康结局的一个可改变的因素。本研究调查了孕期吸烟情况的转变。方法 利用来自新西兰当代儿童队列研究（n = 6822）的数据，分析孕期三个阶段的吸烟状况：孕前、孕期和产后。使用多变量逻辑回归计算与每次转变相关的孕产妇、社会经济和孕期相关因素的比值比（OR）。结果 孕前吸烟率为20.3%。孕期戒烟率为48.5%，而产后复发率为36.0%。与轻度吸烟者相比，重度吸烟者在孕期戒烟的可能性较小（OR 0.13，95% CI 0.08 - 0.20），在产后9个月复发的可能性较大（OR 2.63，CI 1.60 - 4.32）。与无烟家庭的女性相比，家中有其他吸烟者的女性在孕期戒烟的可能性较小（OR 0.35，CI 0.25 - 0.48），产后复发的可能性较大（OR 2.00，CI 1.14 - 3.51）。没有高中学历的女性在孕期戒烟的可能性低于拥有本科学历的女性（OR 0.21，CI 0.11 - 0.41），但复发可能性没有更高。毛利女性在孕期戒烟的可能性低于欧洲女性（OR 0.35，CI 0.25 - 0.49），但复发可能性没有更高。结论 重度吸烟者以及家中有其他吸烟者的人在孕期吸烟或产后复发的风险较高。因此，要在整个孕期减少吸烟，需要关注所有有育龄重度吸烟者的家庭的戒烟情况。吸烟与种族之间的关联可能存在混淆，因为在整个孕期并不一致。
