Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
Sci Rep. 2024 Jan 16;14(1):1397. doi: 10.1038/s41598-024-51263-9.
Prenatal tobacco smoke exposure (TSE) and prematurity are independent risk factors for abnormal neurodevelopment. The objectives were to compare differences in Bayley-III cognitive, language, and motor scores at 2 years corrected age (CA) in 395 infants born very preterm (≤ 32 weeks gestation) with and without prenatal TSE. We performed multivariable linear regression analyses to examine associations between prenatal TSE and neurodevelopmental outcomes and a mediation analysis to estimate direct effects of prenatal TSE on outcomes and indirect effects through preterm birth. In total, 50 (12.6%) infants had prenatal TSE. Infants with prenatal TSE had lower mean [95% CI] Cognitive score (82.8 [78.6, 87.1]) vs. nonexposed infants (91.7 [90.1, 93.4]). In children with and without prenatal TSE, there were significant differences in mean [95% CI] Language scores (81.7 [76.0, 87.4] vs. 92.4 [90.2, 94.6], respectively) and mean [95% CI] Motor scores (86.5 [82.2, 90.7] vs. 93.4 [91.8, 95.0], respectively); scores remained significant after controlling for confounders. Preterm birth indirectly mediated 9.0% of the total effect of prenatal TSE on Cognitive score (P = NS). However, 91% of the remaining total effect was significant and attributable to TSE's direct harmful effects on cognitive development (β = - 5.17 [95% CI - 9.97, - 0.38]). The significant association is largely due to TSE's direct effect on cognitive development and not primarily due to TSE's indirect effect on preterm birth.
产前烟草暴露（TSE）和早产是神经发育异常的独立危险因素。本研究的目的是比较有和无产前 TSE 的 395 名极早产儿（≤32 周妊娠）在 2 岁校正年龄（CA）时贝利 III 认知、语言和运动评分的差异。我们进行了多变量线性回归分析，以研究产前 TSE 与神经发育结局之间的关联，并进行中介分析，以估计产前 TSE 对结局的直接影响以及通过早产的间接影响。共有 50 名（12.6%）婴儿有产前 TSE。有产前 TSE 的婴儿的平均[95%CI]认知评分（82.8 [78.6, 87.1]）低于未暴露组（91.7 [90.1, 93.4]）。在有和无产前 TSE 的儿童中，语言评分的均值[95%CI]存在显著差异（分别为 81.7 [76.0, 87.4]和 92.4 [90.2, 94.6]）和运动评分的均值[95%CI]（分别为 86.5 [82.2, 90.7]和 93.4 [91.8, 95.0]）；在控制混杂因素后，这些差异仍然显著。早产间接介导了产前 TSE 对认知评分的总效应的 9.0%（P = NS）。然而，其余总效应的 91%是显著的，归因于 TSE 对认知发育的直接有害影响（β = -5.17 [95%CI -9.97, -0.38]）。这种显著的关联主要是由于 TSE 对认知发育的直接影响，而不是主要由于 TSE 对早产的间接影响。
