Association of Reported Trimester-Specific Smoking Cessation With Fetal Growth Restriction
Association of Reported Trimester-Specific Smoking Cessation With Fetal Growth Restriction
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DOI：
10.1097/aog.0000000000000679
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发表时间：
2015-06-01
影响因子：
7.2
通讯作者：
DeFranco, Emily A.
中科院分区：
文献类型：
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作者：
Blatt, Kaitlin;Moore, Elizabeth;DeFranco, Emily A.
目的：评估孕期不同时间点报告的戒烟与胎儿生长受限的关系。方法：这是一项以人群为基础的回顾性队列研究，使用俄亥俄州出生证明对2006-2012年的单胎非异常活产进行研究。只在怀孕前3个月报告吸烟的妇女和在怀孕第一、第二或第三个月报告吸烟的妇女的结果与非吸烟者的参照组进行比较。多因素Logistic回归分析孕期不同时间戒烟与胎儿生长受限小于10%和5%之间的关系。结果：在分析的927,424名新生儿中，75%的母亲不吸烟。在吸烟者中，24%的人只吸先入为主的烟，10%的人在怀孕前三个月后戒烟，4%的人在第二个月后戒烟，59%的人在怀孕期间吸烟。非吸烟者胎儿生长受限小于第10百分位数和第5百分位数的比例分别为8.1%和3.6%。虽然仅在未孕期吸烟不会显著增加胎儿生长受限的风险，但在任何三个月内吸烟都会增加。调整后的优势比(95%可信区间)，胎儿生长受限小于第10和第5百分位数分别为1.19(1.13~1.24)和1.25(1.17~1.33)和1.67(1.57~1.78)和1.83(1.68，1.99)。在考虑了种族、低社会经济地位和医学合并症的影响后，报告在整个孕期吸烟的妇女发生胎儿生长受限的风险最高，分别为2.26(2.22-2.31)和2.44(2.37-2.51)。结论：孕期任何时期吸烟都会增加胎儿生长受限的风险，戒烟越早风险越低。戒烟计划应该把重点放在怀孕早期戒烟的好处上。
OBJECTIVE: To assess the association of reported smoking cessation at various time points during pregnancy with fetal growth restriction.METHODS: This was a population-based retrospective cohort study of singleton nonanomalous live births using Ohio birth certificates, 2006-2012. Outcomes of women who reported smoking only in the 3 months before conception and women who reported smoking through the first, second, or third trimester were compared with a referent group of nonsmokers. Multivariate logistic regression assessed the association between smoking cessation at various times in pregnancy and fetal growth restriction less than the 10th and 5th percentiles.RESULTS: Of 927,424 births analyzed, 75% of mothers did not smoke. Of smokers, 24% smoked preconception only, 10% quit after the first trimester, 4% quit after the second trimester, and 59% smoked throughout pregnancy. The rate of fetal growth restriction less than the 10th and 5th percentiles among nonsmokers was 8.1% and 3.6%, respectively. Although smoking only in the preconception period did not significantly increase fetal growth restriction risk, smoking in any trimester did. The adjusted odds ratio (95% confidence interval) for fetal growth restriction less than the 10th and 5th percentiles, respectively, of cessation after the first trimester was 1.19 (1.13-1.24) and 1.25 (1.17-1.33) and 1.67 (1.57-1.78) and 1.83 (1.68, 1.99) for cessation after the second trimester. Women who reported smoking throughout pregnancy had the highest risks of fetal growth restriction, 2.26 (2.22-2.31) and 2.44 (2.37-2.51), after accounting for the influence of race, low socioeconomic status, and medical comorbidities.CONCLUSION: Smoking of any duration during pregnancy is associated with an increased risk of fetal growth restriction with decreasing risk the earlier that cessation occurs. Smoking cessation programs should focus on the benefit of quitting as early in pregnancy as possible.