Alderman B W, Zamudio S, Barón A E, Joshua S C, Fernbach S K, Greene C, Mangione E J
Department of Epidemiology, University of Washington, Seattle, USA.
Int J Epidemiol. 1995 Apr;24(2):420-6. doi: 10.1093/ije/24.2.420.
During the 1980s, the Colorado Department of Health received reports from several high-altitude communities of clusters of the malformation craniosynostosis. In a population-based, case-control study, we examined the association between overall and trimester-specific maternal antenatal altitude exposure and the occurrence of infant craniosynostosis.
We identified case children through a statewide registry and randomly sampled control children from birth records. By telephone interview, each mother provided data on the locations of all antenatal residences and places of employment as well as other factors. Staff mapped all locations and abstracted the corresponding altitudes.
The odds ratio (OR) of any synostosis for a time-weighted mean antenatal altitude of > or = 2000 metres (high altitude) versus < 2000 metres (low altitude) was 1.4 (lower bound of the one-sided 95% test-based confidence interval (CI): 0.9). The OR was elevated in smokers but not in non-smokers. As compared to non-smokers, the OR of any synostosis for high-altitude smokers was 4.6 (lower bound of the 95% one-sided exact CI: 1.7). Particularly elevated were the corresponding OR of coronal (18.1, 4.4) and metopic synostosis (16.3, 2.8), and OR for high-altitude exposure during the second trimester (any synostosis: 6.4, 1.99; coronal: 28.6, 6.1; metopic: 26.7, 4.1).
Antenatal maternal high-altitude exposure and smoking are associated with increased risk of infant craniosynostosis, perhaps through generation of intermittent hypoxaemia.
20世纪80年代，科罗拉多州卫生部收到来自几个高海拔社区的关于颅骨缝早闭畸形群集的报告。在一项基于人群的病例对照研究中，我们研究了孕妇孕期总体及各孕期的产前海拔暴露与婴儿颅骨缝早闭发生之间的关联。
我们通过全州登记处确定病例儿童，并从出生记录中随机抽取对照儿童。通过电话访谈，每位母亲提供了所有产前居住和工作地点以及其他因素的数据。工作人员绘制了所有地点的地图并提取了相应的海拔高度。
产前时间加权平均海拔≥2000米（高海拔）与<2000米（低海拔）相比，任何缝早闭的比值比（OR）为1.4（基于单侧95%检验的置信区间（CI）下限：0.9）。吸烟者的OR升高，而非吸烟者则未升高。与非吸烟者相比，高海拔吸烟者任何缝早闭的OR为4.6（95%单侧精确CI下限：1.7）。冠状缝（18.1，4.4）和额缝早闭（16.3，2.8）的相应OR尤其升高，以及孕中期高海拔暴露的OR（任何缝早闭：6.4，1.99；冠状缝：28.6，6.1；额缝：26.7，4.1）。
产前孕妇高海拔暴露和吸烟与婴儿颅骨缝早闭风险增加有关，可能是通过产生间歇性低氧血症所致。
