纵向研究产前烟草转换行为与出生结局，包括电子烟和双重使用。
Longitudinal Examination of Prenatal Tobacco Switching Behaviors and Birth Outcomes, Including Electronic Nicotine Delivery System (ENDS) and Dual Use.
机构信息
Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 751 Rose Street, #447, Lexington, KY, 40536, USA.
Department of Biostatistics, University of Kentucky College of Public Health, Lexington, KY, USA.
出版信息
Matern Child Health J. 2021 Aug;25(8):1175-1181. doi: 10.1007/s10995-021-03161-z. Epub 2021 May 10.
INTRODUCTION
In the US, approximately 8% of pregnant women smoke, and 5-11.9% currently use ENDS products. The health effects of ENDS use are debated; however, most contain nicotine which is known to cause adverse perinatal outcomes. Studies have shown adult ENDS users significantly alter use behaviors over time (switch to conventional cigarettes-only or dual use) thus complicating efforts to examine health effects of ENDS use. The purpose of this study was to describe switching behaviors and associated birth outcomes among infants of women using conventional cigarettes only, ENDS-only, or both.
METHODS
This was a multisite, longitudinal study of biologically confirmed perinatal tobacco users, with nicotine product use assessed each trimester. For the purpose of analysis, participants were defined as switchers, no-switchers, or quitters. Birth outcomes were abstracted from electronic medical records. Analysis included descriptive statistics, linear and multivariate logistic regression adjusted for age, preterm birth, smoking behavior in the first trimester, and an interaction between smoking switching behavior and smoking behavior in the first trimester. Analysis was conducted using SAS v9.4 with significance determined as p < 0.05.
RESULTS
At enrollment, 48.6% of participants used only conventional cigarettes, 41.7% were dual users, and 10% used ENDS-only. While almost two-thirds of participants used the same tobacco product throughout pregnancy, 26% reported switching behaviors that were complex and not easily clustered. No differences were found in birth outcomes between switchers and no-switchers; however, a difference emerged in birth weight between no-switchers and quitters.
DISCUSSION
Given the limited data on health effects of ENDS use, and the known harmful consequences of perinatal nicotine use, capturing and classifying product switching behaviors is imperative to inform public health, and remains a challenge requiring further research.
简介
在美国，约有 8%的孕妇吸烟，目前有 5-11.9%的孕妇使用ENDS 产品。ENDS 使用的健康影响仍存在争议；然而，大多数 ENDS 产品都含有尼古丁，已知尼古丁会对围产期结局产生不良影响。研究表明，成人 ENDS 用户随着时间的推移会显著改变使用行为（转为仅使用传统香烟或同时使用），这使得研究 ENDS 使用的健康影响变得更加复杂。本研究的目的是描述仅使用传统香烟、ENDS 或两者均使用的孕妇的转换行为及其相关的出生结局。
方法
这是一项多地点、纵向研究，对生物确认的围产期烟草使用者进行研究，每个孕期评估尼古丁产品的使用情况。为了分析的目的，参与者被定义为转换者、非转换者或戒烟者。从电子病历中提取出生结局。分析包括描述性统计、线性和多变量逻辑回归，调整了年龄、早产、孕早期吸烟行为以及吸烟转换行为与孕早期吸烟行为之间的交互作用。使用 SAS v9.4 进行分析，显著性水平定为 p<0.05。
结果
在入组时，48.6%的参与者仅使用传统香烟，41.7%为双重使用者，10%仅使用ENDS。虽然近三分之二的参与者在整个孕期使用相同的烟草产品，但有 26%的人报告了复杂且不易聚类的转换行为。转换者和非转换者之间的出生结局没有差异；然而，非转换者和戒烟者之间的出生体重出现了差异。
讨论
鉴于关于 ENDS 使用健康影响的有限数据，以及围产期尼古丁使用的已知有害后果，捕捉和分类产品转换行为对于告知公共卫生至关重要，并且仍然是一个需要进一步研究的挑战。
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