NHC Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.
Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
J Glob Health. 2022 Aug 3;12:11009. doi: 10.7189/jogh.12.11009.
Prior studies suggested that maternal smoking before and during pregnancy could be associated with increased risks of congenital heart diseases (CHDs) in offspring. However, the results were inconsistent, and the existence of a causal relationship was not confirmed. Our study aimed to estimate the associations of maternal active and passive smoking during the pre-pregnancy/early-pregnancy period with CHDs as well as its common phenotypes in offspring.
This study was based on data from a prospective cohort study conducted in Central China. A total of 49 158 eligible pregnant women between the 8th and 14th weeks of gestation were invited to join the cohort and were planned to be followed up until 3 months postpartum. The exposure of interest was maternal smoking status, including active and passive smoking status in 3 months before pregnancy as well as in early pregnancy. Self-reported maternal smoking status was ascertained via an in-person interview after recruitment. CHDs were diagnosed by pediatric cardiologists and classified according to ICD-10. Multivariable Poisson regression models were used to estimate the relative risks (RRs) with 95% confidence intervals (CIs) of all CHDs and their common phenotypes associated with maternal smoking status, adjusting for potential confounding factors identified by directed acyclic graphs.
CHDs were diagnosed in 564 children. After adjusting for potential confounding factors and comparing with the unexposed groups, CHDs incidence was 165% higher (adjusted RR = 2.65; 95% CI = 1.76-3.98) in offspring exposed to maternal active smoking in 3 months before pregnancy, 69% higher (adjusted-RR = 1.69; 95% CI = 1.39-2.05) in offspring exposed to maternal passive smoking in 3 months before pregnancy, 133% higher (adjusted RR = 2.33; 95% CI = 1.46-3.70) for offspring exposed to maternal active smoking in early pregnancy, and 98% higher (adjusted-RR = 1.98; 95% CI = 1.56-2.51) for offspring exposed to maternal passive smoking in early pregnancy. More specifically, the offspring exposed to maternal active smoking in early pregnancy had the highest risk of Tetralogy of Fallot (adjusted RR = 9.84; 95% CI = 2.49-38.84). These findings were recapitulated in analyses that further adjusted for other behaviour variables apart from the characteristic being assessed and were also confirmed by sensitivity analyses.
Our findings add to the existing body of evidence that implicates maternal pre-pregnancy/early-pregnancy smoking as a significant risk factor for CHDs and their select phenotypes.
先前的研究表明，母亲在怀孕前和怀孕期间吸烟可能会增加后代患先天性心脏病 (CHD) 的风险。然而，结果并不一致，因果关系也未得到证实。我们的研究旨在估计母亲在孕前/孕早期主动和被动吸烟与后代 CHD 及其常见表型的关联。
本研究基于中国中部一项前瞻性队列研究的数据。在妊娠 8-14 周期间，共邀请了 49158 名符合条件的孕妇参加该队列，并计划随访至产后 3 个月。感兴趣的暴露因素是母亲的吸烟状况，包括怀孕前 3 个月和孕早期的主动和被动吸烟状况。通过招募后的面对面访谈来确定母亲的自我报告吸烟状况。由儿科心脏病专家诊断 CHD，并根据 ICD-10 进行分类。多变量泊松回归模型用于估计与母亲吸烟状况相关的所有 CHD 及其常见表型的相对风险 (RR)，调整了有向无环图确定的潜在混杂因素。
564 名儿童被诊断出患有 CHD。在调整潜在混杂因素并与未暴露组比较后，与未暴露组相比，母亲在怀孕前 3 个月主动吸烟的子女 CHD 发病率高出 165%（调整 RR=2.65；95%CI=1.76-3.98），母亲在怀孕前 3 个月被动吸烟的子女 CHD 发病率高出 69%（调整 RR=1.69；95%CI=1.39-2.05），母亲在孕早期主动吸烟的子女 CHD 发病率高出 133%（调整 RR=2.33；95%CI=1.46-3.70），母亲在孕早期被动吸烟的子女 CHD 发病率高出 98%（调整 RR=1.98；95%CI=1.56-2.51）。更具体地说，暴露于母亲孕早期主动吸烟的子女患法洛四联症的风险最高（调整 RR=9.84；95%CI=2.49-38.84）。这些发现通过进一步调整评估特征以外的其他行为变量进行的分析得到了证实，并且通过敏感性分析也得到了证实。
我们的研究结果进一步证实了现有证据，表明母亲孕前/孕早期吸烟是 CHD 及其某些表型的重要危险因素。
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