Passive Smoke Exposure as a Risk Factor for Oral Clefts-A Large International Population-Based Study
Passive Smoke Exposure as a Risk Factor for Oral Clefts-A Large International Population-Based Study
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DOI：
10.1093/aje/kwv279
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发表时间：
2016-05-01
影响因子：
5
通讯作者：
Wehby, George L.
中科院分区：
文献类型：
--
作者：
Kummet, Colleen M.;Moreno, Lina M.;Wehby, George L.
母亲吸烟是唇裂的一个公认的危险因素。被动（二手）烟雾暴露的证据不太清楚。我们结合了来自4项基于人群的研究的个体水平数据，（挪威面裂研究，1996-2001年;犹他州儿童和家庭健康研究，1995-2004年;挪威母亲和儿童队列研究，1999-2009年;和国家出生缺陷预防研究（美国），1999-2007），以获得4,508例唇裂病例和9,626例对照。我们将孕早期被动和主动烟雾暴露进行了分类。多变量logistic模型校正了可能的混杂因素（母亲饮酒，叶酸补充剂的使用，年龄，体型，教育和就业，加上研究固定效应）。母亲积极吸烟的儿童发生唇腭裂的风险增加（比值比（OR）= 1.27，95%置信区间（CI）：1.11，1.46）。被动暴露的非吸烟母亲的儿童也有增加的风险（OR = 1.14，95%CI：1.02，1.27）。母亲吸烟且暴露于被动吸烟环境的婴儿，其患唇裂的风险进一步升高（OR = 1.51，95%CI：1.35，1.70）。使用一个大型的汇总数据集，我们发现孕早期被动吸烟和唇腭裂之间存在适度的相关性，这在不同人群、不同研究设计和唇腭裂亚型之间是一致的。虽然这种关联可能反映了微妙的混淆或偏见，但我们不能排除怀孕期间被动吸烟暴露是致畸的可能性。
Maternal cigarette smoking is a well-established risk factor for oral clefts. Evidence is less clear for passive (secondhand) smoke exposure. We combined individual-level data from 4 population-based studies (the Norway Facial Clefts Study, 1996-2001; the Utah Child and Family Health Study, 1995-2004; the Norwegian Mother and Child Cohort Study, 1999-2009; and the National Birth Defects Prevention Study (United States), 1999-2007) to obtain 4,508 cleft cases and 9,626 controls. We categorized first-trimester passive and active smoke exposure. Multivariable logistic models adjusted for possible confounders (maternal alcohol consumption, use of folic acid supplements, age, body size, education, and employment, plus study fixed effects). Children whose mothers actively smoked had an increased risk of oral clefts (odds ratio (OR) = 1.27, 95% confidence interval (CI): 1.11, 1.46). Children of passively exposed nonsmoking mothers also had an increased risk (OR = 1.14, 95% CI: 1.02, 1.27). Cleft risk was further elevated among babies of smoking mothers who were exposed to passive smoke (OR = 1.51, 95% CI: 1.35, 1.70). Using a large pooled data set, we found a modest association between first-trimester passive smoking and oral clefts that was consistent across populations, diverse study designs, and cleft subtypes. While this association may reflect subtle confounding or bias, we cannot rule out the possibility that passive smoke exposure during pregnancy is teratogenic.