Information Services Division, NHS National Services Scotland, Edinburgh, UK.
Glasgow Centre for Population Health, University of Glasgow, Glasgow, UK.
BMJ Open. 2019 Mar 20;9(3):e023213. doi: 10.1136/bmjopen-2018-023213.
Smoking during pregnancy is associated with adverse health impacts on mother and child. We used a large linked Scottish dataset to produce contemporary estimates of the impact on child health, particularly hospitalisation.
Retrospective cohort study linking birth, death, maternity, infant health, child health surveillance and admission records. We examined the association between smoking status at maternity booking and pregnancy outcomes, hospital admission and death during the first 5 years of life. Models were adjusted for maternal age, socioeconomic status, infant feeding, country of birth, sex, parity and delivery mode. We calculated population attributable fraction (PAF) for each outcome.
Scotland, UK.
Singleton births between 1997 and 2009 (n=697 003) followed to March 2012.
332 386 children had at least one admission by 31 March 2012. There were 56 588 born small for gestational age, 40 492 prematurely and 1074 postneonatal deaths. Within the first 5 years of life, 56 615 children had at least one admission for acute respiratory infections, 24 088 for bronchiolitis and 7549 for asthma. Maternal smoking significantly increased admission for acute respiratory infections (adjusted HR 1.29, 95% CI 1.25 to 1.34, PAF 6.7%) and bronchiolitis (HR 1.43, 95% CI 1.38 to 1.48 under 1 year, PAF 10.1%), asthma (HR 1.29, 95% CI 1.22 to 1.37 age 1-5 years, PAF 7.1%) and bacterial meningitis (HR 1.49, 95% CI 1.30 to 1.71, PAF 11.8%) age 0-5 years. Neonatal mortality (adjusted OR 1.32, 95% CI 1.17 to 1.49, PAF 6.7%), postneonatal mortality (OR 2.18, 95% CI 1.87 to 2.53, PAF 22.3%), small for gestational age (OR 2.67, 95% CI 2.62 to 2.73, PAF 27.5%) and prematurity (OR 1.41, 95% CI 1.37 to 1.44, PAF 8.8%) were higher among the offspring of smokers.
Smoking during pregnancy causes significant ill health and death among children born in Scotland. These findings support continued investment to reduce smoking among women before, during and after pregnancy as 50% of women will go on to have further children.
孕期吸烟会对母婴健康产生不良影响。我们利用苏格兰一个大型的关联数据集，对儿童健康的影响进行了当代评估，尤其是住院情况。
我们将出生、死亡、产科、婴儿健康、儿童健康监测和入院记录进行了链接，以回顾性队列研究的形式，调查了产妇入院时的吸烟状况与妊娠结局、住院和 5 岁以下儿童死亡之间的关联。模型根据母亲年龄、社会经济状况、婴儿喂养方式、出生国、性别、产次和分娩方式进行了调整。我们计算了每个结局的人群归因分数（PAF）。
英国苏格兰。
1997 年至 2009 年间出生的单胎（n=697003），随访至 2012 年 3 月。
在截至 2012 年 3 月 31 日，有 332386 名儿童至少有一次入院。56588 名儿童出生时体重小于胎龄，40492 名儿童早产，1074 名儿童新生儿期后死亡。在 5 岁以下的儿童中，56615 名儿童至少有一次因急性呼吸道感染入院，24088 名儿童因细支气管炎入院，7549 名儿童因哮喘入院。母亲吸烟显著增加了儿童急性呼吸道感染（调整后的 HR 1.29，95%CI 1.25 至 1.34，PAF 6.7%）、细支气管炎（1 岁以下 HR 1.43，95%CI 1.38 至 1.48，PAF 10.1%）、哮喘（1 至 5 岁 HR 1.29，95%CI 1.22 至 1.37，PAF 7.1%）和细菌性脑膜炎（0 至 5 岁 HR 1.49，95%CI 1.30 至 1.71，PAF 11.8%）的住院率。新生儿死亡率（调整后的 OR 1.32，95%CI 1.17 至 1.49，PAF 6.7%）、新生儿后死亡率（OR 2.18，95%CI 1.87 至 2.53，PAF 22.3%）、小于胎龄儿（OR 2.67，95%CI 2.62 至 2.73，PAF 27.5%）和早产（OR 1.41，95%CI 1.37 至 1.44，PAF 8.8%）的发生率在吸烟者的后代中更高。
孕期吸烟会导致苏格兰出生的儿童健康状况不佳和死亡。这些发现支持继续投资，以减少女性在怀孕前、怀孕中和怀孕后吸烟，因为 50%的女性会继续生育。
