孕期被动吸烟对妊娠并发症及妊娠结局的影响

王雪茵; 张小松; 周敏; 隽娟; 王旭

doi:10.16462/j.cnki.zhjbkz.2020.04.010

孕期被动吸烟对妊娠并发症及妊娠结局的影响

doi: 10.16462/j.cnki.zhjbkz.2020.04.010

100034 北京, 北京大学第一医院妇产科妊娠合并糖尿病母胎医学北京市重点实验室

详细信息

通讯作者:
王雪茵, E-mail:xueyin0925@163.com

中图分类号: R714;R714.25
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出版历程
- 收稿日期: 2019-09-05
- 修回日期: 2019-11-28
- 刊出日期: 2020-04-10

The effect of passive smoking during pregnancy on pregnancy complications and outcomes

Department of Gynecology and Obstetrics, Peking University First Hospital, Beijing Key Laboratory of Maternal Fetal Medicine of Gestational Diabetes Mellitus, Beijing 100034, China

More Information

Corresponding author: WANG Xue-yin, E-mail:xueyin0925@163.com

摘要

摘要: 目的了解孕期被动吸烟发生情况, 并探讨其对妊娠并发症及结局的影响。方法选取2012年4月-2013年3月在我国15家医疗保健机构分娩的8 926例单胎活产产妇作为研究对象, 使用自制调查问卷收集孕期被动吸烟发生情况、妊娠并发症和结局等信息, 采用单因素和多因素Logistic回归分析模型分析孕期被动吸烟对妊娠并发症及结局的影响。结果共1 801例产妇在孕期经历被动吸烟。控制混杂因素后, 孕期经历被动吸烟的产妇妊娠期糖尿病(gestational diabetes mellitus, GDM)的发生风险是非被动吸烟者的1.359倍(95%CI:1.146~1.612, P < 0.001), 胎膜早破的风险为1.290倍(95%CI:1.095~1.520, P=0.002), 早产的风险为1.367倍(95%CI:1.155~1.619, P < 0.001), 娩出低出生体重儿的风险为1.341倍(95%CI:1.079~1.668, P=0.008)。与非被动吸烟者相比, 平均每周被动吸烟天数≥4天者胎膜早破、早产和低出生体重儿的发生风险分别为非被动吸烟者的1.402倍(95%CI:1.104~1.780, P=0.006)、1.690倍(95%CI:1.339~2.132, P < 0.001)和1.584倍(95%CI:1.172~2.141, P=0.023)。结论被调查产妇孕期被动吸烟率较高, 孕期经历被动吸烟能够增加妊娠期糖尿病、胎膜早破、早产和低出生体重儿的发生风险。
- 被动吸烟 /
- 妊娠期 /
- 妊娠并发症 /
- 妊娠结局
Abstract: Objective To assess the prevalence of passive smoking during pregnancy, and toexplore the effect of passive smoking during pregnancy on pregnancy complications and outcomes. Methods A total of 8 926 postpartum women who delivered live singletons between April, 2012 to March, 2013 in 15 hospitals were enrolled. A self-made questionnaire was used to collect general information, occurrence of passive smoking during pregnancy, pregnancy complications and outcomes. Logistic regression models were used to analyze the effect of passive smoking during pregnancy on pregnancy complications and outcomes. Results A total of 1 801 women had experienced passive smoking during pregnancy. After adjusting for covariates, women who experienced passive smoking during pregnancy had an increased risk of gestational diabetes mellitus(OR=1.359, 95% CI:1.146-1.612, P < 0.001), premature rupture of membranes(OR=1.290, 95% CI:1.095-1.520, P=0.002), preterm birth(OR=1.367, 95% CI:1.155-1.619, P < 0.001), and delivering low birth weight infants(OR=1.341, 95% CI:1.079-1.668, P=0.008). Compared to those who did not experience passive smoking, women experienced passive smoking≥4 days/week had an increased risk of premature rupture of membranes(OR=1.402, 95% CI:1.104-1.780, P=0.006), preterm birth(OR=1.690, 95% CI:1.339-2.132, P < 0.001), and low birth weight(OR=1.584, 95% CI:1.172-2.141, P=0.023). Conclusions In this study, passive smoking during pregnancy is prevalent, and passive smoking during pregnancy may increase the risk of pregnancy outcomes like gestational diabetes mellitus, premature rupture of membranes, preterm birth and low birth weight.
- Passive smoking /
- Pregnancy /
- Pregnancy complications /
- Pregnancy outcomes

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图 1 孕期平均每周被动吸烟天数与妊娠并发症及妊娠结局的关系

注:A、B、C分别为胎膜早破、早产和低出生体重儿与孕期平均每周被动吸烟天数的关系。调整分娩年龄、孕前体质指数、文化程度、职业、家庭户平均月收入、初产、孕期饮酒; C进一步调整分娩孕周。

Figure 1. Associations of passive smoking during pregnancy (day/week) with pregnancy complications and outcomes

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表 1 研究对象的一般人口学特征[n (%)]

Table 1. Characteristics of study participants[n (%)]

项目	被动吸烟组(n=1 801)	非被动吸烟组(n=7 125)	χ² /Z值	P值
分娩年龄(岁)	28(25, 30)^a	28(26, 38)	-3.412	< 0.001
分娩孕周	39(38, 40)	39(38, 40)	-2.201	0.028
孕前体重指数(kg/m²)			-3.062	0.002
< 24	408(22.7)	1 379(19.4)
24~	1 182(65.6)	4 824(67.7)
≥28	211(11.7)	922(12.9)
文化程度			-4.639	< 0.001
大专及以下	1 270(70.5)	4 611(64.7)
本科及以上	531(29.5)	2 514(35.3)
职业			34.226	< 0.001
干部/职员/专业技术人员	890(49.4)	4 061(57.0)
工人/服务人员	252(14.0)	829(11.6)
无业	543(30.2)	1 870(26.3)
其他	116(6.4)	365(5.1)
家庭户平均月收入(元)			-3.609	< 0.001
< 10 000	1 495(83.0)	5 643(79.2)
≥10 000	306(17.0)	1 482(20.8)
初产			7.856	0.005
否	371(20.6)	1 264(17.7)
是	1 430(79.4)	5 861(82.3)
孕期饮酒			127.528	< 0.001
否	1 684(93.5)	7 004(98.3)
是	117(6.5)	121(1.7)
注:^a为M (P₂₅, P₇₅)。

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表 2 孕期被动吸烟与妊娠并发症及结局关系的Logistic回归分析模型分析

Table 2. Logistic regression model analysis for passive smoking during pregnancy and pregnancy complications and outcomes

	被动吸烟组[n (%)]	非被动吸烟组[n (%)]	调整前		调整后^a
	被动吸烟组[n (%)]	非被动吸烟组[n (%)]	OR(95%CI)值	P值	OR(95%CI)值	P值
妊娠期高血压疾病	94(5.2)	298(4.2)	1.262(0.995~1.600)	0.055	1.271(0.997~1.620)	0.053
子痫前期	44(2.4)	128(1.8)	1.370(0.969~1.937)	0.075	1.348(0.947~1.919)	0.097
妊娠期糖尿病	203(11.3)	651(9.1)	1.263(1.069~1.493)	0.006	1.359(1.146~1.612)	< 0.001
前置胎盘	39(2.2)	146(2.1)	1.058(0.740~1.512)	0.757	1.013(0.705~1.455)	0.945
胎盘早剥	10(0.6)	25(0.4)	1.568(0.760~3.308)	0.219	1.493(0.703~3.170)	0.297
胎膜早破	217(12.1)	704(9.9)	1.250(1.063~1.469)	0.007	1.290(1.095~1.520)	0.002
羊水过多	54(3.0)	160(2.3)	1.346(0.984~1.840)	0.063	1.305(0.985~1.856)	0.062
羊水过少	74(4.1)	308(4.3)	0.948(0.732~1.229)	0.689	0.934(0.719~1.215)	0.613
早产	211(11.7)	602(8.5)	1.438(1.218~1.698)	< 0.001	1.367(1.155~1.619)	< 0.001
低出生体重儿^b	120(6.7)	342(4.8)	1.416(1.142~1.755)	0.002	1.341(1.079~1.668)	0.008
巨大儿^b	110(6.1)	472(6.6)	1.009(0.851~1.195)	0.919	0.966(0.776~1.203)	0.758
SGA^b	130(7.2)	424(6.0)	1.230(1.003~1.507)	0.047	1.219(0.992~1.499)	0.060
LGA^b	187(10.4)	734(10.3)	0.917(0.740~1.136)	0.428	1.035(0.871~1.230)	0.696
新生儿窒息^b	33(1.8)	80(1.1)	1.644(1.092~2.474)	0.017	1.410(0.913~2.176)	0.121
注:^a调整分娩年龄、孕前体质指数、文化程度、职业、家庭户平均月收入、初产、孕期饮酒; ^b进一步调整分娩孕周。

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