Maternal smoking during pregnancy and offspring intellectual disability: sibling analysis in an intergenerational Danish cohort.
Maternal smoking during pregnancy and offspring intellectual disability: sibling analysis in an intergenerational Danish cohort.
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怀孕期间母亲吸烟与后代智力障碍：丹麦代际队列的兄弟姐妹分析。
DOI：
10.1017/s0033291720003621
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发表时间：
2022-07
影响因子：
6.9
通讯作者：
Schendel D
中科院分区：
文献类型：
--
作者：
Madley-Dowd P;Kalkbrenner AE;Heuvelman H;Heron J;Zammit S;Rai D;Schendel D
已知母亲吸烟对胎儿发育有不良影响。然而，关于母亲怀孕期间吸烟与后代智力残疾（ID）之间关系的研究有限，并且尚不清楚任何联系是否是由于因果效应或残余混杂因素造成的。对1995年至2012年期间所有丹麦出生的人进行的队列研究（排除后来自658335个家庭的1066989人），前瞻性记录了队列成员、父母和兄弟姐妹的数据。我们使用logistic广义估计方程回归模型评估了母亲在怀孕期间吸烟（18.6%暴露，在产前访视期间收集）和后代ID（8051例，使用ICD-10诊断代码F70-F79测量）之间的关联。模型调整混杂因素，包括社会经济地位和父母的精神病诊断的措施，并调整家庭之间的兄弟姐妹平均暴露。家庭平均暴露的调整允许计算家庭内吸烟对儿童结局的影响，这对兄弟姐妹之间共享的混杂因素是稳健的。我们发现，在调整混杂因素后（OR 1.35，95%CI 1.28-1.42），暴露于母亲吸烟的孕妇ID的几率增加，而在调整家庭平均暴露后（OR 0.91，95%CI 0.78-1.06），其效应减弱为零。我们的研究结果与母亲在怀孕期间吸烟对后代ID风险的因果关系不一致。通过估计家庭内的影响，我们的研究结果表明，先前的协会是未测量的遗传或环境特征的家庭中，母亲在怀孕期间吸烟的结果。
Maternal smoking has known adverse effects on fetal development. However, research on the association between maternal smoking during pregnancy and offspring intellectual disability (ID) is limited, and whether any associations are due to a causal effect or residual confounding is unknown. Cohort study of all Danish births between 1995 and 2012 (1 066 989 persons from 658 335 families after exclusions), with prospectively recorded data for cohort members, parents and siblings. We assessed the association between maternal smoking during pregnancy (18.6% exposed, collected during prenatal visits) and offspring ID (8051 cases, measured using ICD-10 diagnosis codes F70–F79) using logistic generalised estimating equation regression models. Models were adjusted for confounders including measures of socio-economic status and parental psychiatric diagnoses and were adjusted for family averaged exposure between full siblings. Adjustment for a family averaged exposure allows calculation of the within-family effect of smoking on child outcomes which is robust against confounders that are shared between siblings. We found increased odds of ID among those exposed to maternal smoking in pregnancy after confounder adjustment (OR 1.35, 95% CI 1.28–1.42) which attenuated to a null effect following adjustment for family averaged exposure (OR 0.91, 95% CI 0.78–1.06). Our findings are inconsistent with a causal effect of maternal smoking during pregnancy on offspring ID risk. By estimating a within-family effect, our results suggest that prior associations were the result of unmeasured genetic or environmental characteristics of families in which the mother smokes during pregnancy.