Smokeless tobacco use and risk of stillbirth - A cohort study in Mumbai, India
Smokeless tobacco use and risk of stillbirth - A cohort study in Mumbai, India
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DOI：
10.1097/01.ede.0000190545.19168.c4
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发表时间：
2006-01-01
期刊：
影响因子：
5.4
通讯作者：
Subramoney, S
中科院分区：
文献类型：
--
作者：
Gupta, PC;Subramoney, S
背景：母亲吸烟与死产风险增加有因果关系。初步报告表明，死产与无烟烟草使用在pregnancy.Methods的风险增加：我们进行了一项以人口为基础的前瞻性队列研究，采用挨家挨户的方法，招募1217名妇女之间的3和7个月的怀孕，以调查这种关联。其中，96%在分娩后进行了联系，以确定妊娠结果。与死产或无烟烟草使用（OR >= 1.5）明显相关的人口统计学和母体变量被列为潜在混杂因素。死产定义为妊娠满20周后分娩死胎。我们使用时间到事件的方法来分析死产的风险。结果：在这一人群中的单胎分娩死产的总体发生率为4.1%。17%的妇女报告使用无烟烟草; 8.9%的无烟烟草使用者死产，而非使用者死产的比例为3.1%（生命表调整的危险比= 3.1; 95%置信区间= 1.7-5.6）。经考克斯比例风险程序校正年龄、教育和社会经济背景、母亲工作状况、产次、产前护理变量和分娩地点后，使用者死产的风险为2.6（95%置信区间为1.4-4.8）。大多数妇女使用mishri（一种热解烟草产品，通常用作避孕套），并且每日使用频率与死胎风险之间存在剂量反应关系。死产的风险与无烟烟草的使用是更大的妊娠早期periods.Conclusions：无烟烟草的使用在怀孕期间增加死产的风险，风险至少一样大，与母亲吸烟。
Background: Maternal cigarette smoking has been causally associated with an increased risk for stillbirth. Preliminary reports suggest an increased risk for stillbirth with smokeless tobacco use during pregnancy.Methods: We conducted a population-based prospective cohort study to investigate this association by using a house-to-house approach to recruit 1217 women who were between 3 and 7 months' gestation. Of these, 96% were contacted after delivery to determine the pregnancy outcome. Demographic and maternal variables which were apparently associated either with stillbirth or with smokeless tobacco use (OR >= 1.5) were included as potential confounders. Stillbirth was defined as any delivery of a dead fetus after 20 completed weeks of gestation. We used time-to-event methods to analyze the risk of stillbirth.Results: Overall occurrence of stillbirth among singleton deliveries in this population was 4.1%. Smokeless tobacco use was reported by 17% of women; 8.9% of smokeless tobacco users had a stillbirth compared with 3.1% among nonusers (life-table adjusted hazard ratio = 3.1; 95% confidence interval = 1.7-5.6). After adjustment by the Cox proportional hazards procedure for age, educational and socioeconomic background, working status of mother, parity, prenatal care variables, and place of delivery, the risk for stillbirth in users was 2.6 (95% confidence interval-1.4-4.8). Most women used mishri (a pyrolyzed tobacco product often used as dentifrice), and there was a dose-response relationship between the daily frequency of use and stillbirth risk. The risk of stillbirth associated with smokeless tobacco use was greater in earlier gestational periods.Conclusions: Smokeless tobacco use during pregnancy increases stillbirth risk, with a risk at least as great as that associated with maternal cigarette smoking.