Maternal cigarette smoking as a risk factor for placental abruption, placenta previa, and uterine bleeding in pregnancy
Maternal cigarette smoking as a risk factor for placental abruption, placenta previa, and uterine bleeding in pregnancy
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DOI：
10.1093/oxfordjournals.aje.a009022
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发表时间：
1996-11-01
影响因子：
5
通讯作者：
Luther, ER
中科院分区：
文献类型：
--
作者：
Ananth, CV;Savitz, DA;Luther, ER
作者进行了一项流行病学研究，以评估母亲吸烟作为胎盘脱垂、前置胎盘和妊娠期不明原因子宫出血的潜在危险因素的作用。这项前瞻性队列研究的数据来自1986年1月1日至1993年12月31日期间在加拿大新斯科舍省的两个三级医院、七个区域医院或17个社区医院寻求产前护理的妇女。在数据库中登记的怀孕人数为87 184人（61 667名妇女）。在怀孕期间吸烟的妇女（33%）与不吸烟的妇女进行了比较，所有妇女都被跟踪到怀孕终止。每1，000例妊娠中有9.9例胎盘破裂，而每1，000例妊娠中分别有3.6例和58.9例前置胎盘和不明原因子宫出血。与不吸烟的妇女相比，吸烟妇女流产的危险性增加2倍（相对危险度= 2.05，95%可信区间（CI）1.75-2.40），而前置胎盘的相对危险度为1.36（95% CI 1.04-1.79）。然而，未发现吸烟与不明原因子宫出血相关（相对危险度= 1.01，95%CI 0.94-1.08）。没有证据表明吸烟数量增加会增加子宫胎盘出血疾病的风险。所有分析均通过基于广义估计方程方法的logistic回归模型调整潜在混杂因素。研究证实吸烟与胎盘早剥呈正相关，与前置胎盘呈弱相关，但与其他子宫出血无关。胎盘早剥、前置胎盘和不明原因子宫出血的不同结果模式表明，这三种子宫胎盘出血疾病在吸烟方面没有共同的病因。
The authors carried out an epidemiologic study to evaluate the role of maternal cigarette smoking as a potential risk factor for placental abruption, placenta previa, and uterine bleeding of unknown etiology in pregnancy. Data for this prospective cohort study were obtained from women seeking prenatal care at any of the two tertiary, seven regional, or 17 community hospitals in the province of Nova Scotia, Canada, between January 1, 1986, and December 31, 1993. A total of 87,184 pregnancies (among 61,667 women) were registered in the database. Women who smoked during pregnancy (33%) were compared with nonsmokers, and all women were followed until the termination of pregnancy. Placental abruption was indicated in 9.9 per 1,000 pregnancies, while placenta previa and uterine bleeding of unknown etiology were indicated in 3.6 and 58.9 per 1,000 pregnancies, respectively. Women who smoked had a twofold increase in the risk of abruption (relative risk = 2.05, 95% confidence interval (CI) 1.75-2.40) in comparison with nonsmokers, while the relative risk for placenta previa was 1.36 (95% CI 1.04-1.79). However, cigarette smoking was not found to be associated with uterine bleeding of unknown etiology (relative risk = 1.01, 95% CI 0.94-1.08). There was no evidence for an increased risk of uteroplacental bleeding disorders with increasing numbers of cigarettes smoked. All analyses were adjusted for potentially confounding factors through logistic regression models based on the method of generalized estimating equations. The study confirms a positive association between cigarette smoking and placental abruption and a weak association with placenta previa but not with other uterine bleeding. The distinct pattern of results for placental abruption, placenta previa, and uterine bleeding of unknown origin suggests that these three uteroplacental bleeding disorders do not have a common etiology in relation to cigarette smoking.