OBJECTIVELY MEASURED TOBACCO EXPOSURE DURING PREGNANCY - NEONATAL EFFECTS AND RELATION TO MATERNAL SMOKING
OBJECTIVELY MEASURED TOBACCO EXPOSURE DURING PREGNANCY - NEONATAL EFFECTS AND RELATION TO MATERNAL SMOKING
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DOI：
10.1111/j.1471-0528.1993.tb14262.x
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发表时间：
1993-08-01
期刊：
影响因子：
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通讯作者：
HIILESMAA, VK
中科院分区：
文献类型：
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作者：
BARDY, AH;SEPPALA, T;HIILESMAA, VK
目的 定量、客观地测量母体和胎儿的烟草暴露情况，通过测量尼古丁代谢物可替宁的浓度，从怀孕前半期获得的母体血清样本和分娩时获得的脐带血清样本中评估烟草暴露。各个孕妇和新生儿的数据均从芬兰医学出生登记处收集。设置芬兰。受试者 1237 名孕妇和新生儿，代表一个国家一周内产下活产婴儿的所有妊娠。主要结果指标为胎龄、出生体重和新生儿头跟长度。结果 在 300 名孕妇或脐带血清中检测到可替宁 (>6 微克/升)怀孕，这些母亲和新生儿被归类为暴露者。测量的暴露量和报告的吸烟行为之间存在重要差异。在暴露的母亲中，38% 不吸烟，未暴露的母亲中有 3.4% 吸烟。接触烟草与胎龄较短、出生体重减轻和新生儿冠跟长较短有关。校正胎次、性别和胎龄后，暴露的新生儿比未暴露的新生儿平均轻 188 克（95% 置信区间 (CI) 123-253 克），矮 10 毫米（95% CI 7-13 毫米）。母体血清中每毫升 1 杯可替宁可导致出生体重平均减少 1.29 克（95% CI 0.55-2.02 克），出生身长平均减少 0-059 毫米（95% CI 0.035-0.083 毫米）。与报告的吸烟习惯相比，母亲可替宁浓度更好地解释了新生儿的发现。 结论 烟草暴露与出生胎龄和新生儿体型下降之间存在定量剂量效应关系。母亲自己报告的吸烟习惯并不能准确衡量胎儿烟草暴露情况。
Objectives To measure quantitatively and objectively the maternal and fetal toDesign Tobacco exposure was assessed from maternal serum samples, obtained during the first half of pregnancy and from umbilical serum samples obtained at delivery, by measuring the concentration of nicotine metabolite, cotinine. Data on the respective pregnancies and neonates were collected from the Finnish Medical Birth Registry.Setting Finland.Subjects One thousand two hundred and thirty-seven pregnancies and newborns, representing all pregnancies resulting in a liveborn infant during one week in one country.Main outcome measures Gestational age, birthweight and crown-heel length of newborns.Results Cotinine (>6 mug/l) was detected in either maternal or umbilical serum in 300 pregnancies, and these mothers and newborns were classified as exposed. Important differences occurred between measured exposure and reported smoking behaviour. Of the exposed mothers, 38% were nonsmokers and 3.4% of the nonexposed mothers were smokers. Tobacco exposure was associated with shorter gestational age, reduced birthweight and shorter crown-heel length of the newborns. After correction for parity, gender, and gestational age, the exposed newborns were on average 188 g (95% confidence interval (CI) 123-253 g) lighter and 10 mm (95% CI 7-13 mm) shorter than the nonexposed newborns. One mug/ml of cotinine in maternal serum resulted in a mean decrease of 1.29 g (95% CI 0.55-2.02 g) in birthweight and in a mean decrease of 0-059 mm (95% CI 0.035-0.083 mm) in birth length. Maternal cotinine concentrations better explained the neonatal findings than the reported smoking habits.Conclusions There is a quantitative dose and effect relation between tobacco exposure and a decrease in the gestational age at birth and size of the neonate. The smoking habit reported by mothers themselves is not an accurate measure of fetal tobacco exposure.