Maternal smoking during pregnancy, environmental tobacco smoke exposure and childhood lung function
Maternal smoking during pregnancy, environmental tobacco smoke exposure and childhood lung function
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DOI：
10.1136/thorax.55.4.271
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发表时间：
2000-04-01
期刊：
影响因子：
10
通讯作者：
Peters, JM
中科院分区：
文献类型：
--
作者：
Gilliland, FD;Berhane, K;Peters, JM
背景 - 儿童时期暴露于环境烟草烟雾（ETS）以及胎儿在子宫内暴露于母亲吸烟都与肺生长和发育的不良影响有关。
方法 - 对居住在南加州12个社区的3357名学龄儿童进行了一项研究，探讨母亲孕期吸烟、暴露于ETS与肺功能之间的关系。1993年，通过让四年级、七年级和十年级学生的家长填写自填式问卷，评估当前和过去家庭ETS暴露情况以及胎儿在子宫内暴露于母亲吸烟的情况。采用标准线性回归技术估计胎儿在子宫内暴露和ETS暴露对肺功能的影响，并对年龄、性别、种族、西班牙裔、身高、体重、哮喘、个人吸烟情况以及选定的家庭特征进行调整。
结果 - 胎儿在子宫内暴露于母亲吸烟与呼气峰流速（PEFR）降低（-3.0%，95%置信区间为 -4.4至 -1.4）、平均呼气中期流量（MMEF）降低（-4.6%，95%置信区间为 -7.0至 -2.3）以及用力呼气流量（FEF75）降低（-6.2%，95%置信区间为 -9.1至 -3.1）有关，但与一秒用力呼气容积（FEV1）无关。对家庭ETS暴露进行调整后，这些估计值没有实质性变化。与胎儿在子宫内暴露相关的流量降低在性别、种族、年级、收入、父母教育程度或个人吸烟情况方面没有显著差异。暴露于两名或更多当前家庭吸烟者与MMEF降低（-4.1%，95%置信区间为 -7.6至 -0.4）和FEF75降低（-4.4%，95%置信区间为 -9.0至0.4）有关。母亲当前或过去吸烟与PEFR和MMEF降低有关；然而，在对胎儿在子宫内暴露进行调整后，与所有ETS测量指标相关的MMEF和FEF75的不足大幅减少，且无统计学意义。
结论 - 胎儿在子宫内暴露于母亲吸烟与学龄儿童肺功能下降独立相关，尤其是小气道流量。
Background-Exposure to environmental tobacco smoke (ETS) during childhood and in utero exposure to maternal smoking are associated with adverse effects on lung growth and development.Methods-A study was undertaken of the associations between maternal smoking during pregnancy, exposure to ETS, and pulmonary function in 3357 school children residing in 12 Southern California communities. Current and past exposure to household ETS and exposure to maternal smoking in utero were assessed by at self-administered questionnaire completed by parents of 4th,7th; and 10th grade students in 1993. Standard linear regression techniques were used to estimate the effects of in utero and ETS exposure on lung function, adjusting for age, sex, race, Hispanic ethnicity, height, weight, asthma, personal smoking, and selected household characteristics.Results-In utero exposure to maternal smoking was associated with reduced peak expiratory flow rate (PEFR) (-3.0%, 95% CI -4.4 to -1.4), mean mid expiratory flow (MMEF) (-4.6%, 95% CI -7.0 to -2.3), and forced expiratory flow (FEF75) (-6.2%, 95% CI -9.1 to -3.1), but not forced expiratory volume in one second (FEV1). Adjusting for household ETS exposure did not substantially change these estimates. The reductions in flows associated with in utero exposure did not significantly vary with sex, race, grade, income, parental education, or personal smoking. Exposure to two or more current household smokers was associated with reduced MMEF (-4.1%, 95% CI -7.6 to -0.4) and FEF75 (-4.4%, 95% CI -9.0 to 0.4). Current or past maternal smoking was associated with reductions in PEFR and MMEF; however, after adjustment for in utero exposure, deficits in MMEF and FEF75 associated with all measurements of ETS were substantially reduced and were not statistically significant.Conclusions-In utero exposure to maternal smoking is independently associated with decreased lung function in children of school age, especially for small airway flows.