Fu Tong-Tong, Luo Han-Xiao, Na Zhi-Jing, Xia Chun-Ling, Fan Ling
Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
Acta Obstet Gynecol Scand. 2025 Jul;104(7):1244-1253. doi: 10.1111/aogs.15126. Epub 2025 Apr 18.
The purpose of this systematic review and meta-analysis is to evaluate the global risk of preterm birth associated with passive smoking. Specifically, the study aims to examine whether passive smoking continues to impact preterm birth rates, with particular attention to the potential effects following the implementation of stricter smoking bans in recent years.
This systematic review and meta-analysis followed PRISMA guidelines and was preregistered in PROSPERO. A comprehensive literature search was conducted in PubMed, Embase, CINAHL, and Web of Science up to February 17, 2024, using keywords related to passive smoking and preterm birth. Eligible observational studies were selected, and data were independently extracted and assessed for quality by two authors. Statistical analysis used odds ratios (ORs) and the I statistic for heterogeneity. Subgroup analyses and publication bias assessments were conducted. Review Manager and Stata were used for the analysis, with significance set at p < 0.05.
Meta-analysis showed a 21% increase in the odds of preterm birth in women exposed to environmental tobacco smoke (ETS) (OR, 1.21; 95% CI, 1.10-1.32) with significant heterogeneity (I = 76.2%). Stronger associations were found in cohort and cross-sectional studies, studies in Asia, larger sample sizes, and recent publications. Findings were robust across various analyses.
Prenatal environmental tobacco smoke exposure significantly increases preterm birth risk. Effective public health interventions, including stringent smoke-free policies, public education, and awareness campaigns, are needed to reduce environmental tobacco smoke exposure and improve maternal and infant health outcomes.
本系统评价和荟萃分析的目的是评估与被动吸烟相关的全球早产风险。具体而言，该研究旨在探讨被动吸烟是否持续影响早产率，尤其关注近年来实施更严格禁烟令后的潜在影响。
本系统评价和荟萃分析遵循PRISMA指南，并在PROSPERO中进行了预注册。截至2024年2月17日，在PubMed、Embase、CINAHL和Web of Science中进行了全面的文献检索，使用了与被动吸烟和早产相关的关键词。选择符合条件的观察性研究，由两位作者独立提取数据并评估质量。统计分析使用比值比（OR）和异质性I统计量。进行了亚组分析和发表偏倚评估。使用Review Manager和Stata进行分析，显著性设定为p < 0.05。
荟萃分析显示，暴露于环境烟草烟雾（ETS）的女性早产几率增加21%（OR，1.21；95%CI，1.10 - 1.32），存在显著异质性（I = 76.2%）。在队列研究和横断面研究、亚洲的研究、样本量较大的研究以及近期发表的研究中发现了更强的关联。各项分析结果均很稳健。
产前暴露于环境烟草烟雾会显著增加早产风险。需要采取有效的公共卫生干预措施，包括严格的无烟政策、公众教育和宣传活动，以减少环境烟草烟雾暴露，改善母婴健康结局。
