Changes in e-cigarette and cigarette use during pregnancy and their association with small-for-gestational-age birth.
Changes in e-cigarette and cigarette use during pregnancy and their association with small-for-gestational-age birth.
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DOI：
10.1016/j.ajog.2021.11.1354
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发表时间：
2022-05
影响因子：
9.8
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中科院分区：
文献类型：
--
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尽管电子烟的使用有所增加，但有限的研究集中在怀孕期间电子烟和可燃香烟使用的变化以及随后对婴儿健康的影响。描述从怀孕前到怀孕期间电子烟和香烟使用的变化，并检查它们与小于胎龄儿出生的关系。这是对美国妊娠风险评估监测系统2016-2018年数据的二次数据分析。我们分析了最近活产的 18 岁或以上的女性（未加权 N=105,438，加权 N=5,446,900）。根据女性在怀孕前 3 个月自我报告的电子烟和/或香烟使用情况（专门使用电子烟、专门吸烟者、双重使用者和非使用者）以及怀孕期间电子烟和香烟使用情况的变化（继续使用、戒烟、转换、开始使用）进行分组。小于胎龄的定义是同性别同胎龄的婴儿出生体重低于第 10 个百分位。我们描述了加权和未加权样本中女性社会人口统计学和怀孕特征的分布。我们使用多变量对数二项式回归模型来估计怀孕期间电子烟/香烟使用变化与小于胎龄风险之间关联的相对风险（RR），并调整显着协变量。怀孕期间戒烟率最高的是只使用电子烟的人（加权百分比80.7% [49,378/61,173]），其次是只使用香烟的人（54.4% [421,094/773,586]），然后是双重使用者（46.4% [69,136/149,152]）。在专门使用电子烟的人群中，怀孕期间持续使用电子烟的小于胎龄儿的风险高于不使用电子烟的风险（16.5% [1,849/11,206]） vs. 8.8% [384,338/4,371,664]；混杂因素调整后的 RR，1.52 [95% 置信区间，1.45-1.60]），而电子烟戒烟者与非电子烟戒烟者的小于胎龄风险相似（7.7% [3,730/48,587] vs. 8.8% [384,338/4,371,664]；RR，0.84 [0.82-0.87]）。在只吸烟的人中，那些在怀孕期间完全改用电子烟的人也有与不吸烟者相似的小于胎龄的风险（7.6% [259/3,412] vs. 8.8% [384,338/4,371,664]；RR，0.83 [0.73-0.93]）。在怀孕前双重使用者中，小于胎龄的风险从继续使用电子烟的 23.2% (7,240/31,208) (RR, 2.53 [2.47-2.58]) 下降到仅戒烟或仅使用电子烟的 16.9% (6,617/39,142) (RR, 1.88 [1.83-1.92])。与非使用者相比，如果仅戒烟，则为 15.1% (1,254/8,289) (RR, 1.61 [1.52-1.70])，如果在怀孕期间同时戒掉电子烟和香烟，则进一步达到 11.2% (7,589/67,880) (RR, 1.23 [1.20-1.25])。在专门使用电子烟的人中，怀孕期间戒掉电子烟可能会使小于胎龄的风险正常化。对于只吸烟的人来说，戒烟或完全改用电子烟也可能使小于胎龄的风险正常化。在双重使用者中，戒烟比仅戒电子烟的效果更大，尽管停止使用两者可能会最大程度地降低小于胎龄的风险。在美国怀孕风险评估监测系统中，怀孕期间戒掉电子烟或从卷烟改用电子烟与 SGA 风险降低相关。
Despite increased e-cigarette use, limited research has focused on changes in e-cigarette and combustible cigarette use around pregnancy and the subsequent effects on infant health. To characterize changes in e-cigarette and cigarette use from before to during pregnancy and examine their associations with small-for-gestational-age birth. This is a secondary data analysis of 2016-2018 data of the U.S. Pregnancy Risk Assessment Monitoring System. We analyzed women aged 18 years or older who had a recent live birth (unweighted N=105,438, weighted N=5,446,900). Women were grouped based on their self-reported e-cigarette and/or cigarette use 3 months before pregnancy (exclusive e-cigarette users, exclusive cigarette smokers, dual users, and non-users) and change in e-cigarette and cigarette use during pregnancy (continuing use, quitting, switching, initiating use). Small-for-gestational-age was defined as birth weight below the 10th percentile for infants of the same sex and gestational age. We described the distributions of women’s sociodemographic and pregnancy characteristics in both weighted and unweighted samples. We used multivariable log-binomial regression models to estimate relative risks (RR) for the associations between changes in e-cigarette/cigarette use during pregnancy and risk of small-for-gestational-age, adjusting for significant covariates. Rates of cessation during pregnancy were highest among exclusive e-cigarette users (weighted percentage 80.7% [49,378/61,173]), followed by exclusive cigarette users (54.4% [421,094/773,586]) and then dual users (46.4% [69,136/149,152). Among exclusive e-cigarette users, continued users of e-cigarettes during pregnancy had a higher risk of small-for-gestational-age than non-users (16.5% [1,849/11,206]) vs. 8.8% [384,338/4,371,664]; confounder-adjusted RR, 1.52 [95% confidence interval, 1.45-1.60]), whereas quitters of e-cigarettes had a similar risk of small-for-gestational-age to non-users (7.7% [3,730/48,587] vs. 8.8% [384,338/4,371,664]; RR, 0.84 [0.82-0.87]). Among exclusive cigarette users, those who completely switched to e-cigarettes during pregnancy also had a similar risk of small-for-gestational-age to non-users (7.6% [259/3,412] vs. 8.8% [384,338/4,371,664]; RR, 0.83 [0.73-0.93]). Among dual users before pregnancy, risk of small-for-gestational-age decreased from 23.2% (7,240/31,208) (RR, 2.53 [2.47-2.58]) if continuing use to 16.9% (6,617/39,142) (RR, 1.88 [1.83-1.92]) if only e-cigarettes were quit or 15.1% (1,254/8,289) (RR, 1.61 [1.52-1.70]) if only cigarettes were quit, and further to 11.2% (7,589/67,880) (RR, 1.23 [1.20-1.25]) if both e-cigarettes and cigarettes were quit during pregnancy, compared to non-users. Among exclusive e-cigarette users, quitting e-cigarettes during pregnancy may normalize small-for-gestational-age risk. Among exclusive cigarette users, quitting smoking or completely switching to e-cigarettes may also normalize small-for-gestational-age risk. Among dual users, smoking cessation has a greater effect than quitting e-cigarettes only, although discontinuing the use of both may lead to the greatest reduction in small-for-gestational-age risk. Within the U.S. Pregnancy Risk Assessment Monitoring System, quitting e-cigarettes or switching from cigarettes to e-cigarettes during pregnancy was associated with reduced risk of SGA.
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DOI：
10.1097/00001648-199001000-00010
发表时间：
1990-01-01
期刊：
Epidemiology (Cambridge, Mass.)
影响因子：
--
作者：
Rothman, K J
通讯作者：
Rothman, K J
影响因子：
2.3
作者：
Ashford K;McCubbin A;Barnett J;Blair LM;Lei F;Bush H;Breland A
通讯作者：
Breland A
影响因子：
7.4
作者：
Banderali G;Martelli A;Landi M;Moretti F;Betti F;Radaelli G;Lassandro C;Verduci E
通讯作者：
Verduci E
影响因子：
2
作者：
Ratnasiri, Anura W. G.;Gordon, Lauren;Basford, Kaye E.
通讯作者：
Basford, Kaye E.
影响因子：
9.8
作者：
Ciobanu, Anca;Rouvali, Angeliki;Nicolaides, Kypros H.
通讯作者：
Nicolaides, Kypros H.