Department of Pediatrics, Section of Pediatric Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR; Arkansas Children's Research Institute, Little Rock, AR.
Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR.
J Pediatr. 2022 Jan;240:79-86.e1. doi: 10.1016/j.jpeds.2021.09.005. Epub 2021 Sep 8.
To assess associations between maternal smoking and congenital heart defects (CHDs) in offspring.
We performed a retrospective case-control study using data for cases of CHD (n = 8339) and nonmalformed controls (n = 11 020) from all years (1997-2011) of the National Birth Defects Prevention Study. Maternal self-reported smoking 1 month before through 3 months after conception was evaluated as a binary (none, any) and categorical (light, medium, heavy) exposure. Multivariable logistic regression was used to estimate aOR and 95% CIs. Stratified analyses were performed for septal defects according to maternal age, prepregnancy body mass index, and maternal race/ethnicity.
Multiple CHDs displayed modest associations with any level of maternal periconceptional smoking independent of potential confounders; the strongest associations were for aggregated septal defects (OR, 1.5; 95% CI, 1.3-1.7), tricuspid atresia (OR, 1.7; 95% CI, 1.0-2.7), and double outlet right ventricle (DORV) (OR, 1.5; 95% CI, 1.1-2.1). Tricuspid atresia and DORV also displayed dose-response relationships. Among heavy smokers, the highest odds were again observed for tricuspid atresia (aOR 3.0; 95% CI, 1.5-6.1) and DORV (aOR 1.5; 95% CI, 1.1-2.2). Heavy smokers ≥35 years old more frequently had a child with a septal defect when compared with similarly aged nonsmokers (aOR 2.3; 95% CI, 1.4-3.9).
Maternal periconceptional smoking is most strongly associated with septal defects, tricuspid atresia, and DORV; the risk for septal defects is modified by maternal age.
评估母亲吸烟与子女先天性心脏病（CHD）之间的关联。
我们使用了全国出生缺陷预防研究（1997 年至 2011 年）所有年份的 CHD 病例（n=8339）和非畸形对照（n=11020）的数据，进行了回顾性病例对照研究。母亲在受孕前 1 个月至受孕后 3 个月期间自我报告的吸烟情况被评估为二项（无、有）和分类（轻、中、重）暴露。多变量逻辑回归用于估计比值比（OR）和 95%置信区间（CI）。根据母亲年龄、孕前体重指数和母亲种族/民族，对隔瓣缺损进行了分层分析。
多种 CHD 与任何水平的围孕期母亲吸烟均有独立于潜在混杂因素的适度关联；与聚合性隔瓣缺损（OR，1.5；95%CI，1.3-1.7）、三尖瓣闭锁（OR，1.7；95%CI，1.0-2.7）和右心室双出口（DORV）（OR，1.5；95%CI，1.1-2.1）的关联最强。三尖瓣闭锁和 DORV 也显示出剂量-反应关系。在重度吸烟者中，三尖瓣闭锁（aOR，3.0；95%CI，1.5-6.1）和 DORV（aOR，1.5；95%CI，1.1-2.2）的最高比值比再次被观察到。与年龄相仿的不吸烟者相比，年龄≥35 岁的重度吸烟者更常生育有隔瓣缺损的孩子（aOR，2.3；95%CI，1.4-3.9）。
母亲围孕期吸烟与隔瓣缺损、三尖瓣闭锁和 DORV 关系最密切；隔瓣缺损的风险受母亲年龄的影响。
