为了宝宝健康,孕妈妈需戒烟
  • 纳入两个队列共8621对欧洲母婴数据进行二次分析;
  • 多变量模型分析结果显示,孕期继续吸烟的孕妇的胎儿比非吸烟的胎儿小,胎儿减小程度与吸烟量呈剂量反应关系,其中股骨长度的减短最为明显;
  • 孕早期戒烟的孕妇与非吸烟孕妇相比,大部分胎儿发育指标是一致的;
  • 利用rs1051730位点基因进行孟德尔随机化研究显示,孕妇吸烟量每增加1支/天,胎儿平均体重增长量降低;
  • 暂无证据表明配偶吸烟与胎儿生长指标间存在关联。
主编推荐语
小笋干儿
本研究利用队列研究数据,进行了三种模型的分析,提示孕期女性吸烟对胎儿的宫内增长具有影响,并发现了剂量反应关系证据。值得注意的是,孕早期戒烟的女性其对胎儿的影响最小,提示女性在孕前或者孕早期戒烟对胎儿生长非常重要。
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PLoS Medicine [IF:11.048]

Associations of maternal quitting, reducing, and continuing smoking during pregnancy with longitudinal fetal growth: Findings from Mendelian randomization and ...

母亲在孕期戒烟、减少吸烟和继续吸烟与胎儿纵向生长发育的关联:一项孟德尔随机化和阴性对照研究

10.1371/journal.pmed.1002972

2019-11-13, Article

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BACKGROUND: Maternal smoking during pregnancy is an established risk factor for low infant birth weight, but evidence on critical exposure windows and timing of fetal growth restriction is limited. Here we investigate the associations of maternal quitting, reducing, and continuing smoking during pregnancy with longitudinal fetal growth by triangulating evidence from 3 analytical approaches to strengthen causal inference.
METHODS AND FINDINGS: We analysed data from 8,621 European liveborn singletons in 2 population-based pregnancy cohorts (the Generation R Study, the Netherlands 2002-2006 [n = 4,682]) and the Born in Bradford study, United Kingdom 2007-2010 [n = 3,939]) with fetal ultrasound and birth anthropometric measures, parental smoking during pregnancy, and maternal genetic data. Associations with trajectories of estimated fetal weight (EFW) and individual fetal parameters (head circumference, femur length [FL], and abdominal circumference [AC]) from 12-16 to 40 weeks' gestation were analysed using multilevel fractional polynomial models. We compared results from (1) confounder-adjusted multivariable analyses, (2) a Mendelian randomization (MR) analysis using maternal rs1051730 genotype as an instrument for smoking quantity and ease of quitting, and (3) a negative control analysis comparing maternal and mother's partner's smoking associations. In multivariable analyses, women who continued smoking during pregnancy had a smaller fetal size than non-smokers from early gestation (16-20 weeks) through to birth (p-value for each parameter < 0.001). Fetal size reductions in continuing smokers followed a dose-dependent pattern (compared to non-smokers, difference in mean EFW [95% CI] at 40 weeks' gestation was -144 g [-182 to -106], -215 g [-248 to -182], and -290 g [-334 to -247] for light, moderate, and heavy smoking, respectively). Overall, fetal size reductions were most pronounced for FL. The fetal growth trajectory in women who quit smoking in early pregnancy was similar to that of non-smokers, except for a shorter FL and greater AC around 36-40 weeks' gestation. In MR analyses, each genetically determined 1-cigarette-per-day increase was associated with a smaller EFW from 20 weeks' gestation to birth in smokers (p = 0.01, difference in mean EFW at 40 weeks = -45 g [95% CI -81 to -10]) and a greater EFW from 32 weeks' gestation onwards in non-smokers (p = 0.03, difference in mean EFW at 40 weeks = 26 g [95% CI 5 to 47]). There was no evidence that partner smoking was associated with fetal growth. Study limitations include measurement error due to maternal self-report of smoking and the modest sample size for MR analyses resulting in unconfounded estimates being less precise. The apparent positive association of the genetic instrument with fetal growth in non-smokers suggests that genetic pleiotropy may have masked a stronger association in smokers.
CONCLUSIONS: A consistent linear dose-dependent association of maternal smoking with fetal growth was observed from the early second trimester onwards, while no major growth deficit was found in women who quit smoking early in pregnancy except for a shorter FL during late gestation. These findings reinforce the importance of smoking cessation advice in preconception and antenatal care and show that smoking reduction can lower the risk of impaired fetal growth in women who struggle to quit.

First Authors:
Judith S Brand

Correspondence Authors:
Deborah A Lawlor

All Authors:
Judith S Brand,Romy Gaillard,Jane West,Rosemary R C McEachan,John Wright,Ellis Voerman,Janine F Felix,Kate Tilling,Deborah A Lawlor

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