懷孕期間吸煙和新生兒出生缺陷的影響

2018 年 7 月 19 日陳啟煌

人類生殖最新報導(生殖期刊第一名) 2011年07月11日搶鮮版

孕婦在懷孕期間吸煙和新生兒出生缺陷的影響:一項基於以系統性回顧的基礎上研究173687畸形的病例和1170萬控制組(無畸形的病例)

英國倫敦大學的研究

摘要
背景存在著不確定性，究竟孕婦吸煙與出生缺陷。我們進行的第一次全面系統的審查，以確定哪些具體的畸形都與吸煙。公佈 1959至2010年的觀測研究方法進行鑑定（MEDLINE），包括如果他們報導的比值比（OR）為具有非染色體出生缺陷，婦女在懷孕期間吸煙誰比非吸煙者。潛在的混雜因素調整 OR值分別提取（如產婦年齡和酒精），否則使用未經調整的估計數。172篇文獻使用了綜合分析：共173687例畸形11 674332例未畸形的控制組比較。結果母親吸煙與畸形顯著正相關，被發現包含：心血管/心臟缺損 [OR 1.09，95％可信區間（CI）1.02-1.17];肌肉骨骼缺陷（OR 1.16，95％CI 1.05-1.27）;肢體減少缺陷（或1.26，95％CI 1.15-1.39），馬蹄內翻足（OR 1.28，95％CI 1.10-1.47），顱缺陷（OR 1.33，95％CI 1.03-1.73 ）;面部缺陷（OR 1.19，95％CI 1.06-1.35）;眼睛缺陷（OR 1.25，95％CI 1.11-1.40）;口面裂（OR 1.28，95％CI 1.20-1.36），胃腸道缺陷（OR 1.27， 95％CI 1.18-1.36）;腹裂（OR 1.50，95％CI 1.28-1.76），肛門閉鎖（OR 1.20，95％CI 1.06-1.36）;疝氣（OR 1.40，95％CI 1.23-1.59）及隱睾症（OR 1.13，95％CI 1.02-1.25）。反而吸煙者產下尿道下裂(OR 0.90，95％CI 0.85-0.95）和皮膚缺損（OR 0.82，0.75-0.89）的風險降低。對於所有缺陷相結合的OR為 1.01（0.96-1.07），由於其中的缺陷與降低風險和無關聯者（包括染色體缺陷）。結論出生缺陷是正與母親吸煙相關，現在應該包括在公眾健康教育議題，以鼓勵更多的婦女在懷孕期間或之前戒煙。

PS: 要懷孕，戒煙吧!

原文

Hum Reprod Update. 2011 Jul 11. [Epub ahead of print]

Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls.

Hackshaw A, Rodeck C, Boniface S.

SourceCRUK & UCL Trials Centre, University College London , 5th Floor, 90 Tottenham Court Road, London W1T 4TJ , UK .

Abstract

BACKGROUND There is uncertainty over whether maternal smoking is associated with birth defects. We conducted the first ever comprehensive systematic review to establish which specific malformations are associated with smoking. METHODS Observational studies published 1959-2010 were identified (Medline), and included if they reported the odds ratio (OR) for having a non-chromosomal birth defect among women who smoked during pregnancy compared with non-smokers. ORs adjusted for potential confounders were extracted (e.g. maternal age and alcohol), otherwise unadjusted estimates were used. One hundred and seventy-two articles were used in the meta-analyses: a total of 173 687 malformed cases and 11 674 332 unaffected controls. RESULTS Significant positive associations with maternal smoking were found for: cardiovascular/heart defects [OR 1.09, 95% confidence interval (CI) 1.02-1.17]; musculoskeletal defects (OR 1.16, 95% CI 1.05-1.27); limb reduction defects (OR 1.26, 95% CI 1.15-1.39); missing/extra digits (OR 1.18, 95% CI 0.99-1.41); clubfoot (OR 1.28, 95% CI 1.10-1.47); craniosynostosis (OR 1.33, 95% CI 1.03-1.73); facial defects (OR 1.19, 95% CI 1.06-1.35); eye defects (OR 1.25, 95% CI 1.11-1.40); orofacial clefts (OR 1.28, 95% CI 1.20-1.36); gastrointestinal defects (OR 1.27, 95% CI 1.18-1.36); gastroschisis (OR 1.50, 95% CI 1.28-1.76); anal atresia (OR 1.20, 95% CI 1.06-1.36); hernia (OR 1.40, 95% CI 1.23-1.59); and undescended testes (OR 1.13, 95% CI 1.02-1.25). There was a reduced risk for hypospadias (OR 0.90, 95% CI 0.85-0.95) and skin defects (OR 0.82, 0.75-0.89). For all defects combined the OR was 1.01 (0.96-1.07), due to including defects with a reduced risk and those with no association (including chromosomal defects). CONCLUSIONS Birth defects that are positively associated with maternal smoking should now be included in public health educational materials to encourage more women to quit before or during pregnancy.