The impact on infant birth weight and gestational age of cotinine-validated smoking reduction during pregnancy.
The impact on infant birth weight and gestational age of cotinine-validated smoking reduction during pregnancy.
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DOI：
10.1001/jama.1993.03500120057026
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发表时间：
1993-03
期刊：
影响因子：
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通讯作者：
C. Li;R. Windsor;L. Perkins;Robert L. Goldenberg;J. Lowe
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文献类型：
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作者：
C. Li;R. Windsor;L. Perkins;Robert L. Goldenberg;J. Lowe
目的探讨孕期经可替宁确认的减烟治疗对新生儿出生体重和出生时胎龄的影响。设计组分析了一项前瞻性、随机的戒烟干预试验，使用可替宁水平来评估戒烟和减少吸烟。在阿拉巴马州伯明翰设立了杰斐逊县卫生局的四家妇产科诊所。患者共有803名孕妇吸烟者和474名从未吸烟者在第一次产前到诊所就诊时胎儿孕周不超过32周。主要指标婴儿出生体重和出生时胎龄。结果戒烟者(戒烟者)所生婴儿平均出生体重最高(3371±-581g)，其次为不改变吸烟行为(不改变者)者(3043+/-587g)。根据母亲的年龄、种族、身高、基线体重和分娩时胎龄调整后，戒烟者所生婴儿的平均出生体重比没有改变的婴儿重241g(P=.0008)，比减肥者重167g(P=0.04)。使用减压剂的婴儿调整后的平均出生体重比不使用减压器的婴儿重92g(P=0.08)。基线可替宁水平高于100 ng/ml的白色减肥剂的婴儿比没有变化的白色减肥剂的婴儿重241克。在基线可替宁水平为100 ng/mL或更低的黑色减肥剂中也发现了220克的差异。尽管戒烟使婴儿出生时的胎龄增加了1周，但减少吸烟的效果很小。结论可替宁验证的减烟率与婴儿出生体重的增加呈正相关。虽然戒烟必须继续是怀孕吸烟者的主要目标，但也应该针对无法戒烟的女性采取特定的干预方法来减少吸烟。
OBJECTIVE To evaluate the impact of cotinine-confirmed smoking reduction during pregnancy on infant birth weight and gestational age at birth. DESIGN Group analyses from a prospective, randomized smoking-cessation intervention trial using cotinine levels to assess smoking cessation and reduction. SETTING Four maternity clinics of Jefferson County Health Department in Birmingham, Ala. PATIENTS A total of 803 pregnant smokers and 474 never smokers with a fetal gestational age of 32 weeks or less at the first prenatal visit to a clinic. MAIN OUTCOME MEASURES Infant birth weight and gestational age at birth. RESULTS Infants who were born to women who quit smoking (quitters) had the highest mean birth weight (3371 +/- 581 g), followed by infants who were born to women who did not change smoking behavior (no changers) (3043 +/- 587 g). The mean infant birth weight of infants born to the quitters, adjusted by mother's age, race, height, weight at baseline, and gestational age at delivery was 241 g heavier than that among the no changers (P = .0008) and 167 g heavier than the reducers (P = .04). The adjusted mean infant birth weight of infants born to the reducers was 92 g heavier than that among the no changers (P = .08). White reducers with baseline cotinine levels greater than 100 ng/mL had infants who were 241 g heavier than did white no changers. A 220-g difference was also seen in black reducers with a baseline cotinine level of 100 ng/mL or less. Although smoking cessation increased infant gestational age at delivery by 1 week, smoking reduction had little effect. CONCLUSION Cotinine-validated smoking reduction rates were positively associated with an increase in infant birth weight. While smoking cessation must continue to be the primary objective for pregnant smokers, specific intervention methods should also be directed toward smoking reduction for women who cannot quit.