Prenatal Smoking Cessation and the Risk of Delivering Preterm and Small-for-Gestational-Age Newborns
Prenatal Smoking Cessation and the Risk of Delivering Preterm and Small-for-Gestational-Age Newborns
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DOI：
10.1097/aog.0b013e3181ae9e9c
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发表时间：
2009-08-01
影响因子：
7.2
通讯作者：
Mendola, Pauline
中科院分区：
文献类型：
--
作者：
Polakowski, Laura L.;Akinbami, Lara J.;Mendola, Pauline
目的：使用修订版（2003 年）出生证明检查产前戒烟与美国大量亚人群中早产或小于胎龄 (SGA) 新生儿之间的关系，该出生证明现在按孕期评估母亲的吸烟状况。 方法：我们分析了 2005 年使用修订版出生证明的 11 个州的美国居民单胎出生队列。 （n=915,441）。自我报告的母亲吸烟状况被分类为“从不吸烟”、“在妊娠早期戒烟”、“在妊娠中期戒烟”和“整个怀孕期间吸烟”（参考）。使用多项 Logistic 回归来估计母亲吸烟状况的三种结局（早产非 SGA、足月 SGA 或早产 SGA 新生儿）的调整优势比 (aOR)。还进行了按产妇年龄分层的分析。 结果：与整个怀孕期间吸烟的女性相比，妊娠早期戒烟者生下早产非 SGA 新生儿的几率降低了 31%（aOR 0.69，95% 置信区间 [CI] 0.65-0.74），足月 SGA 新生儿的几率降低了 55%（aOR 0.45，95% CI 0.42-0.48），早产 SGA 新生儿降低 53%（aOR 0.47，95% Cl 0.40-0.55），与不吸烟者相似。妊娠中期戒烟者也降低了早产非 SGA 和足月 SGA 新生儿的几率，但幅度较小。将每个年龄段的孕早期戒烟者与吸烟者进行比较时，年长母亲出现这些结果的几率通常低于年轻母亲。结论：在孕早期戒烟的怀孕吸烟者将其早产和 SGA 新生儿的风险降低到与怀孕不吸烟者相似的水平，而且这种益处似乎随着母亲年龄的增长而增加。这些发现强化了当前鼓励怀孕吸烟者戒烟的临床指导，并作为戒烟的额外激励。 （妇产科 2009 年；114：318-25）
OBJECTIVE: To examine the association between prenatal smoking cessation and delivery of a preterm or small-for-gestational-age (SGA) newborn in a large U.S. subpopulation using the revised (2003) birth certificate, which now assesses maternal smoking status by trimester.METHODS: We analyzed a cohort of U.S.-resident, singleton births in the 11 states that used the revised birth certificate in 2005 (n=915,441). Self-reported maternal smoking status was categorized as "never smoked," "quit in the first trimester," "quit in the second trimester," and "smoked throughout" pregnancy (referent). Multinomial logistic regression was used to estimate adjusted odds ratios (aORs) for three outcomes (preterm non-SGA, term SGA, or preterm SGA newborns) by maternal smoking status. Analyses stratified by maternal age were also conducted.RESULTS: Compared with women who smoked throughout pregnancy, first-trimester quitters reduced their odds of delivering a preterm non-SGA newborn by 31% (aOR 0.69, 95% confidence interval [CI] 0.65-0.74), a term SGA newborn by 55% (aOR 0.45, 95% CI 0.42-0.48), and a preterm SGA newborn by 53% (aOR 0.47, 95% Cl 0.40-0.55), similar to nonsmokers. Second-trimester quitters also reduced their odds of delivering preterm non-SGA and term SGA newborns but to a lesser magnitude. When comparing first-trimester quitters with smokers in each age group, older mothers had generally lower odds of these outcomes than younger mothers.CONCLUSION: Pregnant smokers who quit in the first trimester lowered their risk of delivering preterm and SGA newborns to a level similar to that of pregnant nonsmokers, and this benefit appeared to increase with maternal age. These findings reinforce current clinical guidance to encourage smoking cessation among pregnant smokers and serve as an additional incentive to quit. (Obstet Gynecol 2009;114:318-25)