怀孕期和哺乳期吸烟：危险与戒烟策略综述
2009/05/20
背景：尽管有研究发现孕期和哺乳期吸烟对胎儿和新生儿有害，但仍然有一些女性在孕期和哺乳期吸烟。
目的：分析有关孕期和哺乳期吸烟的文献，确定吸烟的负面影响及有效的干预措施，帮助女性在围产期戒烟。
研究设计：广泛查找文献，选取所有关于孕期和哺乳期吸烟的已出版的研究。在MEDLINE, EMBASE, PUBMED及科学数据库网检索1966至2008年已出版的英文文献，选取研究孕期、哺乳期吸烟及其副作用和各种形式的戒烟策略（包括行为干预、尼古丁替代治疗和药物治疗如抗抑郁药）的研究文献。
结果：有证据表示，孕期和哺乳期吸烟能在围产期、儿童甚至是成人期产生副作用，包括不育、异位妊娠、自发性流产、胎盘功能不足、低出生体重、胎儿生长受限、早产、唇腭裂、SIDS 、颅缝早闭、畸形足、儿童呼吸性疾病、注意缺陷性障碍及一些儿童期恶性肿瘤等。文献提出了一些帮助妊娠女性戒烟的措施，包括行为干预和药物治疗，如尼古丁替代和抗抑郁药物治疗。
结论：行为干预仅有部分成功率，尼古丁替代治疗和抗抑郁药物治疗在孕期使用也较为安全，但本质上也未获得较高的戒烟率。
（林江涛 审校）
Einarson A, Riordan S. Eur J Clin Pharmacol. 2009 Jan 24. [Epub ahead of print]
Smoking in pregnancy and lactation: a review of risks and cessation strategies.
BACKGROUND: Despite documented evidence of harm to fetus and infant, a substantial number of women continue to smoke during pregnancy and lactation.
OBJECTIVE: To examine the literature regarding smoking during pregnancy and breastfeeding to ascertain adverse effects as well as the efficacy of interventions to enable women to stop smoking in the perinatal period. STUDY
DESIGN: A comprehensive literature search was undertaken to identify all published studies reporting on smoking in pregnancy and lactation. MEDLINE, EMBASE, PUBMED, and Web of Science databases were searched for studies published in English from 1966 to 2008 that reported on smoking in pregnancy and breastfeeding, with information on adverse effects and on all forms of smoking cessation, including behavioral interventions, nicotine replacement therapy, and pharmacotherapy such as antidepressants.
RESULTS: There is evidence that smoking in pregnancy and lactation may cause many adverse affects in the perinatal period, childhood, and up to adulthood. These adverse effects include infertility, ectopic pregnancy, spontaneous abortion, placenta insufficiency, low birth weight, fetal growth restriction, preterm delivery, orofacial clefts, SIDS, craniosynostosis, clubfoot, childhood respiratory disease, attention deficit disorder, and some childhood cancers. A number of strategies have been developed to assist pregnant women in quitting smoking, including both behavioral interventions and pharmacological therapies, such as nicotine replacement and antidepressant therapy.
CONCLUSIONS: Behavioral interventions report only modest success rates. Nicotine replacement therapy and antidepressants appear to be safe to use in pregnancy, but do not achieve a substantially higher success rate for quitting.
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