Hoyt Adrienne T, Canfield Mark A, Romitti Paul A, Botto Lorenzo D, Anderka Marlene T, Krikov Sergey V, Feldkamp Marcia L
Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, 1100 W. 49th St., Austin, TX, 78714-9347, USA.
Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA.
Matern Child Health J. 2018 Oct;22(10):1418-1429. doi: 10.1007/s10995-018-2522-1.
Introduction While associations between active smoking and various adverse birth outcomes (ABOs) have been reported in the literature, less is known about the impact of secondhand smoke (SHS) on many pregnancy outcomes. Methods We examined the relationship between maternal exposure to SHS during pregnancy and preterm (< 37 weeks gestation) and small-for-gestational age (SGA; assessed using sex-, race/ethnic-, and parity-specific growth curves) singleton births using non-smoking controls from the National Birth Defects Prevention Study (1997-2011). Multivariable logistic regression models for household, workplace/school, and combined SHS exposure-controlled for maternal education, race/ethnicity, pre-pregnancy body mass index, and high blood pressure-were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Interaction was assessed for maternal folic acid supplementation, alcohol use, age at delivery, and infant sex. Results Infants of 8855 mothers were examined in the preterm birth analysis with 666 (7.5%) categorized as preterm, 574 moderately preterm (32-36 weeks), and 92 very preterm (< 32 weeks). For the SGA analysis, infants of 8684 mothers were examined with 670 (7.7%) categorized as SGA. The aORs for mothers reporting both household and workplace/school SHS were elevated for preterm (aOR 1.99; 95% CI 1.13-3.50) and moderately preterm birth (32-36 weeks) (aOR 2.17; 95% CI 1.22-3.88). No results for the SGA analysis achieved significance, nor was evidence of interaction evident. Conclusion The findings suggest an association between SHS from multiple exposure sources and preterm birth, but no evidence for association with SGA births. Continued study of SHS and ABOs is needed to best inform public health prevention programs.
引言 虽然文献中已报道了主动吸烟与各种不良出生结局（ABO）之间的关联，但关于二手烟（SHS）对许多妊娠结局的影响，人们了解较少。方法 我们利用国家出生缺陷预防研究（1997 - 2011年）中的非吸烟对照，研究了孕期母亲接触二手烟与早产（妊娠<37周）和小于胎龄儿（SGA；使用按性别、种族/族裔和产次特定的生长曲线评估）单胎出生之间的关系。使用多变量逻辑回归模型对家庭、工作场所/学校以及综合二手烟暴露情况进行分析，并对母亲教育程度、种族/族裔、孕前体重指数和高血压进行控制，以估计调整后的优势比（aOR）和95%置信区间（CI）。对母亲叶酸补充、饮酒、分娩年龄和婴儿性别进行了交互作用评估。结果 在早产分析中，对8855名母亲的婴儿进行了检查，其中666名（7.5%）被归类为早产，574名中度早产（32 - 36周），92名极早产（<32周）。在SGA分析中，对8684名母亲的婴儿进行了检查，其中670名（7.7%）被归类为SGA。报告家庭和工作场所/学校二手烟暴露的母亲，其早产（aOR 1.99；95% CI 1.13 - 3.50）和中度早产（32 - 36周）（aOR 2.17；95% CI 1.22 - 3.88）的aOR值升高。SGA分析的结果均未达到显著水平，也没有明显的交互作用证据。结论 研究结果表明，来自多种暴露源的二手烟与早产之间存在关联，但没有证据表明与小于胎龄儿出生有关。需要继续研究二手烟与不良出生结局，以便为公共卫生预防项目提供最佳信息。
