妊娠早期被动吸烟与胎儿畸形关系的队列研究

Cohort study of Maternal exposure to passive smoking and risks of fetal malformations

目的探讨妊娠早期被动吸烟与胎儿畸形的关系。方法对2008年10月8日～2011年1月10日在深圳市妇幼保健院进行孕11～14周NT超声检查的8 166孕妇进行队列研究,调查其妊娠早期孕妇被动吸烟的情况,追踪随访其妊娠结局,采用卡方检验、t检验和非条件二项分类Logistic回归分析的方法,分析妊娠早期被动吸烟与胎儿畸形的关系。结果纳入最后分析的6222例单胎孕妇中,孕早期被动吸烟的暴露率是24.12%(1501/6222),其胎儿畸形发生率为5.13%(77/1501),非暴露组胎儿畸形发生率为3.09%(146/4721);校正混杂因素影响后,妊娠早期被动吸烟发生胎儿畸形的危险度是2.518(95%可信区间1.907～3.324);妊娠早期被动吸烟组胎儿心脏系统、泌尿系统和唇腭裂畸形明显高于非暴露组(P<0.05),胎儿消化系统畸形发生率明显低于非暴露组(P<0.05),胎儿肌肉骨骼系统、神经系统、染色体异常和其它畸形发生率比较,两组差异无统计学意义。结论妊娠早期被动吸烟可能是胎儿畸形的危险因素。

Objective： To explore the relationship between maternal exposure to passive smoking and risks of fetal malformations. Methods： This cohort study was carried between Oct 8, 2008 and Jan 10, 2011 in Shenzhen Maternity and Child Heahhcare Hospital, involving 8 166 pregnant women receiving fetal nuchal translucency （NT） scan at 11 -14 weeks. Maternal passive smoking statuses were investigated by a self - administered questionnaire and pregnancy outcomes were followed up. Chi - square test, t test and uncon- ditional binary logistic regression analysis were used to analyze the relationship between maternal exposure to passive smoking and risks of fetal malformations. Results ： 6222 singleton pregnant women were included in the final analysis. The percentage of maternal passive smoking in the first trimester was 24. 12% （1501/6222）. The incidence of fetal malformation was in maternal passive smoking and those non - passive smoking 5.13% （77/1501） and 3.09% （ 146/4721 ）, relatively. The adjusted relative risk for fetal malformation in the first trimester was 2. 518 （95% confidence interval （CI） = 1. 907 - 3. 324）. Significant positive associations with maternal passive smoking in the first trimester were found for： cardiovascular/heart defects, urinary system abnormalities and cheilopalatognathus （ P 〈 0. 05 ）. There was a reduced risk for fetal digestive system abnormalities （P 〈 0. 05 ）. The incidence for fetal malformations with musculoskeletal defects, nervous system abnormalities, chromosomal defects and other abnormalities was not significantly different in pregnant women with or without passive smoking. Conclusion： Maternal passive smoking in the first trimester may be a risk factor for fetal malformations.