Maternal active and passive smoking and hypertensive disorders of pregnancy: risk with trimester-specific exposures.
Maternal active and passive smoking and hypertensive disorders of pregnancy: risk with trimester-specific exposures.
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DOI：
10.1097/ede.0b013e3182873a73
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发表时间：
2013-05
期刊：
影响因子：
--
通讯作者：
Magnus P
中科院分区：
文献类型：
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作者：
Engel SM;Scher E;Wallenstein S;Savitz DA;Alsaker ER;Trogstad L;Magnus P
鉴于吸烟和先兆子痫都会增加早产和低出生体重的风险，因此产前吸烟与先兆子痫之间的负相关性令人费解。我们分析了挪威母婴出生队列 (MoBa)，以确定这种关联是否因产前吸烟时间而异。我们对 74,439 例单胎妊娠进行了分析，并完成了孕中期和孕晚期问卷调查。妊娠期的主动和被动吸烟暴露情况由母亲的自我报告确定，涵盖从怀孕前到妊娠约 30 周的时期。计算调整后的比值比 (OR) 和 95% 置信区间 (CI)。怀孕期间主动吸烟的比例急剧下降：第 1 个月为 23%；第 2 学期，9%；第三学期，8%。妊娠晚期主动吸烟与先兆子痫和妊娠高血压的发生率降低相关，其中持续吸烟者的相关性最强（对于先兆子痫，OR = 0.57 [95% CI = 0.46–0.70]）。在妊娠晚期之前戒烟的女性患先兆子痫和妊娠期高血压的风险与不吸烟者大致相同。有一些剂量反应的证据，吸烟最多的人（每天超过八支烟）患先兆子痫（0.48 [0.32–0.73]）和妊娠高血压（0.51 [0.28–0.95]）的风险最低。几乎没有证据表明与被动吸烟暴露有关。吸烟与先兆子痫之间的关联根据暴露的时间和强度而有很大差异。更好地了解这些关联背后的生物学途径可能为先兆子痫的病因学和有效临床干预措施的开发提供重要线索。
The inverse association between prenatal smoking and preeclampsia is puzzling, given the increased risks of prematurity and low birthweight associated with both smoking and preeclampsia. We analyzed the Norwegian Mother and Child Birth Cohort (MoBa) to determine whether the associations varied by timing of prenatal smoking. We conducted an analysis of 74,439 singleton pregnancies with completed second- and third- trimester questionnaires. Active and passive smoke exposure by trimester were determined by maternal self-report, and covered the period of preconception through approximately 30 weeks’ gestation. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Rates of active smoking declined dramatically during pregnancy: for trimester 1, 23%; trimester 2, 9%; and trimester 3, 8%. Active smoking in the third trimester was associated with reduced odds of preeclampsia and gestational hypertension, with the strongest association among continuous smokers (for preeclampsia, OR = 0.57 [95% CI = 0.46–0.70]). Women who quit smoking before the third trimester had approximately the same risk of preeclampsia and gestational hypertension as nonsmokers. There was some evidence of dose-response, with the heaviest smokers (more than eight cigarettes per day) having the lowest risks of preeclampsia (0.48 [0.32–0.73]) and gestational hypertension (0.51 [0.28–0.95]). There was little evidence of an association with passive smoking exposure. The association between smoking and preeclampsia varies substantially according to the timing and intensity of exposure. A better understanding of the biologic pathways that underlie these associations may provide important clues to the etiology of preeclampsia and the development of effective clinical interventions.