BMJ:孕期吸烟或可增加后代骨折风险
  • 纳入瑞典国家登记数据库中168万余孕妇的数据,其中22.5%的孕妇报告在孕期吸烟,随访后代至32岁;
  • 随访期间共有37万余人发生骨折,累积发病率为11.8/千人年,年龄分布呈倒U型,12-15岁为骨折高发年龄段;
  • 吸烟孕妇的后代婴儿在1岁前发生骨折的风险是非吸烟孕妇的1.27倍,且该风险随着吸烟量的增加而增加;
  • 后代5-32岁期间,母亲吸烟组骨折的风险较非吸烟组高,但不存在剂量反应关系;
  • 兄弟姐妹分析结果显示上述所有关联均无统计学意义。
主编推荐语
小笋干儿
该研究结合国家登记数据库和医疗信息系统,发现孕期吸烟的孕妇,其后代在1岁前发生骨折的风险增高,其可能与照顾不当有关。而在5岁以后的骨折风险也增高,其可能与发育不良有关。然而有趣的是,在兄弟姐们模型的分析中发现,上述关联不存在统计学意义,提示骨折风险可能与成长环境、基因等因素也存在关联。研究烟草暴露和骨折风险的关联,可能还需要考虑更多的混杂因素。
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Maternal smoking during pregnancy and fractures in offspring: national register based sibling comparison study

母亲孕期吸烟和后代骨折之间的关联:基于全国登记数据库的兄弟姐间比较研究

10.1136/bmj.l7057

01-29, Article

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OBJECTIVE: To study the impact of maternal smoking during pregnancy on fractures in offspring during different developmental stages of life.
DESIGN: National register based birth cohort study with a sibling comparison design.
SETTING: Sweden.
PARTICIPANTS: 1 680 307 people born in Sweden between 1983 and 2000 to women who smoked (n=377 367, 22.5%) and did not smoke (n=1 302 940) in early pregnancy. Follow-up was until 31 December 2014.
RESULTS: During a median follow-up of 21.1 years, 377 970 fractures were observed (the overall incidence rate for fracture standardised by calendar year of birth was 11.8 per 1000 person years). The association between maternal smoking during pregnancy and risk of fracture in offspring differed by attained age. Maternal smoking was associated with a higher rate of fractures in offspring before 1 year of age in the entire cohort (birth year standardised fracture rates in those exposed and unexposed to maternal smoking were 1.59 and 1.28 per 1000 person years, respectively). After adjustment for potential confounders the hazard ratio for maternal smoking compared with no smoking was 1.27 (95% confidence interval 1.12 to 1.45). This association followed a dose dependent pattern (compared with no smoking, hazard ratios for 1-9 cigarettes/day and ≥10 cigarettes/day were 1.20 (95% confidence interval 1.03 to 1.39) and 1.41 (1.18 to 1.69), respectively) and persisted in within-sibship comparisons although with wider confidence intervals (compared with no smoking, 1.58 (1.01 to 2.46)). Maternal smoking during pregnancy was also associated with an increased fracture incidence in offspring from age 5 to 32 years in whole cohort analyses, but these associations did not follow a dose dependent gradient. In within-sibship analyses, which controls for confounding by measured and unmeasured shared familial factors, corresponding point estimates were all close to null. Maternal smoking was not associated with risk of fracture in offspring between the ages of 1 and 5 years in any of the models.
CONCLUSION: Prenatal exposure to maternal smoking is associated with an increased rate of fracture during the first year of life but does not seem to have a long lasting biological influence on fractures later in childhood and up to early adulthood.

First Authors:
Judith S Brand

Correspondence Authors:
Judith S Brand

All Authors:
Judith S Brand,Ayako Hiyoshi,Yang Cao,Deborah A Lawlor,Sven Cnattingius,Scott Montgomery

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