Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Department of Pediatrics, University of Western Ontario, London, ON, Canada.
J Perinatol. 2018 Aug;38(8):1051-1059. doi: 10.1038/s41372-018-0111-1. Epub 2018 May 8.
To study the outcomes of extremely preterm infants of hypertensive mothers who smoke.
This retrospective cohort study included infants born between 2003 and 2012 at <29 weeks' gestation and admitted to neonatal intensive care units participating in the Canadian Neonatal Network. Infants were divided into four mutually exclusive groups. Infants of hypertensive mothers who smoked; infants of hypertensive, non-smoking mothers; infants of normotensive mothers who smoked; and infants of normotensive, non-smoking mothers. Using infants of normotensive, non-smoking mothers as the reference group, neonatal outcomes were compared between the groups. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated using univariate and multivariate regression analysis.
Of the 12,307 eligible infants, 172 had hypertensive mothers who smoked, 1689 had hypertensive non-smoking mothers, 1535 had normotensive mothers who smoked, and 8911 had normotensive non-smoking mothers. Compared to infants of normotensive non-smoking mothers, infants of hypertensive mothers, regardless of smoking status, had higher odds of developing bronchopulmonary dysplasia (AORs of smokers 1.62; 95% CI 1.12-2.35 and of non-smokers 1.43; 95% CI 1.24-1.64). There was no difference in the odds of mortality and retinopathy of prematurity stage ≥3 between the groups. Infants of hypertensive, non-smoking mothers had decreased odds of intraventricular hemorrhage >grade 2 and higher odds of necrotizing enterocolitis. There was decreased odds of hypertension if the mother was a smoker (AOR 0.71; 95% CI 0.59-0.85).
Maternal hypertension is associated with increased rates of bronchopulmonary dysplasia, irrespective of smoking status.
研究患有高血压的吸烟母亲所生的极早产儿的结局。
本回顾性队列研究纳入了 2003 年至 2012 年间在 29 周以下胎龄并入住参与加拿大新生儿网络的新生儿重症监护病房的婴儿。婴儿分为四个互斥组。高血压母亲吸烟的婴儿；高血压、非吸烟母亲的婴儿；血压正常的母亲吸烟的婴儿；血压正常、不吸烟的母亲的婴儿。以血压正常、不吸烟的母亲的婴儿为参考组，比较各组新生儿结局。使用单变量和多变量回归分析计算调整后的优势比（AOR）和 95%置信区间（CI）。
在 12307 名合格婴儿中，有 172 名母亲患有高血压且吸烟，1689 名母亲患有高血压且不吸烟，1535 名母亲血压正常且吸烟，8911 名母亲血压正常且不吸烟。与血压正常、不吸烟的母亲的婴儿相比，无论母亲吸烟状况如何，患有高血压的母亲的婴儿发生支气管肺发育不良的几率更高（吸烟者的 AOR 为 1.62；95%CI 为 1.12-2.35，不吸烟者的 AOR 为 1.43；95%CI 为 1.24-1.64）。各组之间的死亡率和早产儿视网膜病变≥3 分期的发生率没有差异。高血压、非吸烟母亲的婴儿发生脑室出血>2 级的几率较低，发生坏死性小肠结肠炎的几率较高。如果母亲吸烟，发生高血压的几率降低（AOR 为 0.71；95%CI 为 0.59-0.85）。
无论吸烟状况如何，母亲高血压与支气管肺发育不良发生率增加有关。
