孕期母体血液中的可铁宁含量高与亚洲队列中从出生到五岁身高持续较短有关。
High Maternal Circulating Cotinine During Pregnancy is Associated With Persistently Shorter Stature From Birth to Five Years in an Asian Cohort.
机构信息
Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore.
出版信息
Nicotine Tob Res. 2019 Jul 17;21(8):1103-1112. doi: 10.1093/ntr/nty148.
BACKGROUND
Self-reported maternal active smoking has been associated with reduced offspring birth length and shorter stature in early and late childhood.
OBJECTIVE
To use circulating cotinine as an objective biomarker to investigate the association between smoking and environmental tobacco smoke (ETS) exposure in pregnancy and longitudinal measures of offspring length/height from birth to 60 months.
METHODS
In 969 maternal-offspring dyads from the GUSTO cohort, maternal plasma cotinine at 26-28 weeks' gestation was measured by LC/MS/MS and categorized into four groups: Group 1: cotinine <0.17 ng/mL (the assay's detection limit) and no ETS exposure; Group 2: cotinine <0.17 ng/mL but self-reported ETS; Group 3: cotinine 0.17-13.99 ng/mL (ETS or light smoking); Group 4: cotinine ≥14 ng/mL (active smoking).
RESULTS
Adjusting for infant sex, gestational age at birth, ethnicity, maternal age, education, parity, BMI, and height, Group 4 offspring were shorter at birth [z-score β = -0.42 SD units (SDs) (95% CI = -0.77 to -0.06)] than Group 1 offspring. Group 4 offspring continued to be shorter at older ages, with similar effect sizes at 3 months [-0.57 SDs (-0.95 to -0.20)], 36 months [-0.53 SDs (-0.92 to -0.15)], 48 months [-0.43 SDs (-0.81 to -0.04)], and 60 months [-0.57 SDs (-0.96 to -0.17)]. Associations were particularly marked in boys. No significant differences in stature were observed in Groups 2 or 3 compared with Group 1.
CONCLUSIONS
This Asian longitudinal study associated high prenatal cotinine with persistently shorter stature in offspring from birth and into early childhood, whilst low prenatal cotinine levels and ETS exposure showed no such association.
IMPLICATIONS
Little is known about the long-term effects of prenatal tobacco exposure on offspring stature in Asia where passive smoking is common. This study has used an objective biomarker to reveal that the association of prenatal tobacco exposure with offspring length/height mainly occurs at a high maternal cotinine level of greater than 14 ng/mL in pregnancy, consistent with active smoking, but no significant associations were found with lower cotinine levels, consistent with passive smoking. Encouraging women to quit smoking prior to or during pregnancy may avert the long-term negative impact on their child's height despite appreciable prenatal ETS exposure.
背景
自我报告的母亲主动吸烟与后代出生时的身长和幼儿期的身高较矮有关。
目的
使用循环可替宁作为客观生物标志物，调查妊娠期间吸烟和环境烟草烟雾（ETS）暴露与后代从出生到 60 个月的长度/身高的纵向测量值之间的关系。
方法
在 GUSTO 队列的 969 对母婴对子中，在 26-28 周妊娠时通过 LC/MS/MS 测量母体血浆可替宁，并将其分为四组：组 1：可替宁<0.17ng/ml（检测限）且无 ETS 暴露；组 2：可替宁<0.17ng/ml，但自我报告的 ETS 暴露；组 3：可替宁 0.17-13.99ng/ml（ETS 或轻度吸烟）；组 4：可替宁≥14ng/ml（主动吸烟）。
结果
调整婴儿性别、出生时的胎龄、种族、母亲年龄、教育程度、产次、BMI 和身高后，组 4 的后代出生时较组 1 后代矮[Z 分数β=-0.42SD 单位（SD）（95%CI=-0.77 至-0.06）]。组 4 的后代在年龄较大时仍较矮，3 个月时的效应大小相似[-0.57SDs（-0.95 至-0.20）]、36 个月时[-0.53SDs（-0.92 至-0.15）]、48 个月时[-0.43SDs（-0.81 至-0.04）]和 60 个月时[-0.57SDs（-0.96 至-0.17）]。在男孩中观察到的关联更为明显。与组 1 相比，组 2 或组 3 的后代在身高上没有显著差异。
结论
这项来自亚洲的纵向研究表明，高孕期可替宁与后代出生时和幼儿期的身高持续较矮有关，而低孕期可替宁水平和 ETS 暴露则没有这种关联。
启示
亚洲普遍存在被动吸烟，对于孕期烟草暴露对后代身高的长期影响知之甚少。本研究使用客观生物标志物揭示，孕期烟草暴露与后代的长度/身高的关联主要发生在母体可替宁水平较高（大于 14ng/ml）时，与主动吸烟一致，但与较低的可替宁水平无显著关联，与被动吸烟一致。鼓励女性在怀孕前或怀孕期间戒烟，可能会避免尽管有可观的产前 ETS 暴露，但对孩子身高的长期负面影响。
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