Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA.
Department of Obstetrics and Gynecology, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Paediatr Perinat Epidemiol. 2024 May;38(4):316-326. doi: 10.1111/ppe.13075. Epub 2024 Apr 1.
Although many studies suggested the benefit of smoking cessation among pregnant women in reducing the risk of preterm birth (PTB), the timing of the effect of the cessation remains inconclusive.
To examine the association of trimester-specific smoking cessation behaviours with PTB risk.
We included 199,453 live births in Western New York between 2004 and 2018. Based on self-reported cigarette smoking during preconception and in each trimester, we created six mutually exclusive groups: non-smokers, quitters in each trimester, those who smoked throughout pregnancy, and inconsistent smokers. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated using Poisson regression to examine the association between smoking cessation and PTB. Effect modification by illegal drug use, maternal age, race and ethnicity and pre-pregnancy body mass index (BMI) was investigated multiplicatively by ratio of relative risk and additively by relative excess risk due to interaction (RERI).
Overall, 6.7% of women had a PTB; 14.1% smoked throughout pregnancy and 3.4%, 1.8% and 0.8% reported quitting smoking during the first, second and third trimesters, respectively. Compared to non-smokers, third-trimester cessation (RR 1.20, 95% CI 1.01, 1.43) and smoking throughout pregnancy (RR 1.27, 95% CI 1.21, 1.33) were associated with a higher PTB risk, while quitting smoking during the first or second trimester, or inconsistent smoking was not associated with PTB. A positive additive interaction was identified for maternal age and late smoking cessation or smoking throughout pregnancy on PTB risk (RERI 0.17, 95% CI 0.00, 0.36), and a negative interaction was observed for pre-pregnancy BMI ≥30 kg/m (ratio of relative risk 0.70, 95% CI 0.63, 0.78; RERI -0.42, 95% CI -0.56, -0.30).
Compared to non-smokers, smoking throughout pregnancy and third-trimester smoking cessation are associated with an increased risk of PTB, while quitting before the third trimester may not increase PTB risk.
尽管许多研究表明，孕妇戒烟可降低早产（PTB）的风险，但戒烟效果的时间仍不确定。
研究特定孕期戒烟行为与 PTB 风险的关系。
我们纳入了 2004 年至 2018 年在纽约西部的 199453 例活产儿。根据受孕前和每个孕期的自我报告吸烟情况，我们创建了 6 个相互排斥的组别：不吸烟者、每个孕期戒烟者、整个孕期吸烟者和不规律吸烟者。采用泊松回归估计风险比（RR）和 95%置信区间（CI），以检查戒烟与 PTB 之间的关系。通过相对危险比的比值和交互作用的超额相对风险（RERI）的附加作用，分别对非法药物使用、母亲年龄、种族和民族以及孕前体重指数（BMI）进行效应修饰。
总体而言，6.7%的女性发生 PTB；14.1%的女性整个孕期吸烟，3.4%、1.8%和 0.8%的女性分别在孕期第一、二、三期戒烟。与不吸烟者相比，孕期第三期戒烟（RR 1.20，95%CI 1.01，1.43）和整个孕期吸烟（RR 1.27，95%CI 1.21，1.33）与更高的 PTB 风险相关，而孕期第一或第二期戒烟或不规律吸烟与 PTB 无关。对于母亲年龄和晚期戒烟或整个孕期吸烟对 PTB 风险的影响，发现了一个正的相加交互作用（RERI 0.17，95%CI 0.00，0.36），而对于孕前 BMI≥30kg/m（RR 0.70，95%CI 0.63，0.78；RERI -0.42，95%CI -0.56，-0.30），则观察到一个负的交互作用。
与不吸烟者相比，整个孕期吸烟和孕期第三期戒烟与 PTB 风险增加相关，而孕晚期之前戒烟可能不会增加 PTB 风险。
