妊娠期吸烟能增加各种产科并发症风险：来自日本围产期注册网络数据库的病例队列研究
2010/12/29
摘要
背景：妊娠期妇女吸烟对健康的不良影响已经进行按照疾病类型进行了广泛研究。本试验旨在评价妊娠期吸烟对多种产科并发症的影响，数据来自于一项大型医学数据库；同时研究使用病例队列设计进行此类分析的可行性。
方法：基于日本围产期注册网络数据库进行一项病例队列研究。婴儿围产期信息输入日本125个医学中心的数据库。研究的基本人群包括2001年～2005年数据库注册的180855名孕妇。检测的结果包括11种产科并发症的发生率。Logistic 回归模型用于评价经年龄校正后的风险比(aRRs)和相对超额发病率(REIs)。
结果：妊娠期吸烟的发生率在基础队列中总体为5.8%，年轻女性中更高。病例与对照比较后显示，妊娠期吸烟者羊膜过早破裂(aRR: 1.67, 95% 可信区间 [CI]: 1.43-1.96; REI: 40.2%, 95% CI: 29.9%-49.1%)、绒毛膜羊膜炎(1.65, 1.36-2.00; 39.4%, 26.4%-50.0%),子宫颈闭锁不全(1.63, 1.35-1.96; 38.5%, 25.8%-49.1%)、先兆早产(1.38, 1.17-1.64; 27.7%, 14.5%-38.9%)、胎盘早剥(1.37, 1.10-1.72; 27.1%, 8.8%-41.7%)、妊高症(1.20, 1.01-1.41; 16.4%, 1.2%-29.3%)风险显著增加。
结论：妊娠期妇女吸烟与一些产科并发症相关。这也强调了妊娠期戒烟的重要性。此外，病例队列分析显示，评价大型数据中多项结果的RRs具有重要作用。
（陈欣 审校）
J Epidemiol. 2010 Nov 13. [Epub ahead of print]
Smoking During Pregnancy Increases Risks of Various Obstetric Complications: A Case-Cohort Study of the Japan Perinatal Registry Network Database.
Hayashi K, Matsuda Y, Kawamichi Y, Shiozaki A, Saito S.
Department of Basic Medical Sciences, School of Health Sciences, Faculty of Medicine, Gunma University.
Abstract
Background: The adverse effects of maternal smoking on the health of pregnant women have been examined mostly on a disease-by-disease basis. The aims of this study were to evaluate simultaneously the effects of smoking during pregnancy on various obstetric complications, using data from a large medical database, and to investigate the expediency of using a case-cohort design for such an analysis.
Methods: A case-cohort study was conducted within the Japan Perinatal Registry Network database. Perinatal information on infant deliveries was entered into the database at 125 medical centers in Japan. The base population of the study was 180 855 pregnant women registered in the database from 2001 through 2005. The outcome measures were the incidences of 11 different obstetric complications. Logistic regression models were used to estimate age-adjusted risk ratios (aRRs) and relative excess incidence proportions (REIs).
Results: The overall prevalence of smoking during pregnancy was 5.8% in the base cohort, and the prevalence was higher among younger women. A comparison of the cases and control cohort showed that smokers during pregnancy had statistically significant higher risks for preterm rupture of the membrane (aRR: 1.67, 95% confidence interval [CI]: 1.43-1.96; REI: 40.2%, 95% CI: 29.9%-49.1%), chorioamnionitis (1.65, 1.36-2.00; 39.4%, 26.4%-50.0%), incompetent cervix (1.63, 1.35-1.96; 38.5%, 25.8%-49.1%), threatened premature delivery (1.38, 1.17-1.64; 27.7%, 14.5%-38.9%), placental abruption (1.37, 1.10-1.72; 27.1%, 8.8%-41.7%), and pregnancy-induced hypertension (1.20, 1.01-1.41; 16.4%, 1.2%-29.3%).
Conclusions: Maternal smoking was associated with a number of obstetric complications. This highlights the importance of smoking cessation during pregnancy. In addition, case-cohort analysis proved useful in estimating RRs for multiple outcomes in a large database.
J Epidemiol. 2010 Nov 13. [Epub ahead of print]
背景：妊娠期妇女吸烟对健康的不良影响已经进行按照疾病类型进行了广泛研究。本试验旨在评价妊娠期吸烟对多种产科并发症的影响，数据来自于一项大型医学数据库；同时研究使用病例队列设计进行此类分析的可行性。
方法：基于日本围产期注册网络数据库进行一项病例队列研究。婴儿围产期信息输入日本125个医学中心的数据库。研究的基本人群包括2001年～2005年数据库注册的180855名孕妇。检测的结果包括11种产科并发症的发生率。Logistic 回归模型用于评价经年龄校正后的风险比(aRRs)和相对超额发病率(REIs)。
结果：妊娠期吸烟的发生率在基础队列中总体为5.8%，年轻女性中更高。病例与对照比较后显示，妊娠期吸烟者羊膜过早破裂(aRR: 1.67, 95% 可信区间 [CI]: 1.43-1.96; REI: 40.2%, 95% CI: 29.9%-49.1%)、绒毛膜羊膜炎(1.65, 1.36-2.00; 39.4%, 26.4%-50.0%),子宫颈闭锁不全(1.63, 1.35-1.96; 38.5%, 25.8%-49.1%)、先兆早产(1.38, 1.17-1.64; 27.7%, 14.5%-38.9%)、胎盘早剥(1.37, 1.10-1.72; 27.1%, 8.8%-41.7%)、妊高症(1.20, 1.01-1.41; 16.4%, 1.2%-29.3%)风险显著增加。
结论：妊娠期妇女吸烟与一些产科并发症相关。这也强调了妊娠期戒烟的重要性。此外，病例队列分析显示，评价大型数据中多项结果的RRs具有重要作用。
（陈欣 审校）
J Epidemiol. 2010 Nov 13. [Epub ahead of print]
Smoking During Pregnancy Increases Risks of Various Obstetric Complications: A Case-Cohort Study of the Japan Perinatal Registry Network Database.
Hayashi K, Matsuda Y, Kawamichi Y, Shiozaki A, Saito S.
Department of Basic Medical Sciences, School of Health Sciences, Faculty of Medicine, Gunma University.
Abstract
Background: The adverse effects of maternal smoking on the health of pregnant women have been examined mostly on a disease-by-disease basis. The aims of this study were to evaluate simultaneously the effects of smoking during pregnancy on various obstetric complications, using data from a large medical database, and to investigate the expediency of using a case-cohort design for such an analysis.
Methods: A case-cohort study was conducted within the Japan Perinatal Registry Network database. Perinatal information on infant deliveries was entered into the database at 125 medical centers in Japan. The base population of the study was 180 855 pregnant women registered in the database from 2001 through 2005. The outcome measures were the incidences of 11 different obstetric complications. Logistic regression models were used to estimate age-adjusted risk ratios (aRRs) and relative excess incidence proportions (REIs).
Results: The overall prevalence of smoking during pregnancy was 5.8% in the base cohort, and the prevalence was higher among younger women. A comparison of the cases and control cohort showed that smokers during pregnancy had statistically significant higher risks for preterm rupture of the membrane (aRR: 1.67, 95% confidence interval [CI]: 1.43-1.96; REI: 40.2%, 95% CI: 29.9%-49.1%), chorioamnionitis (1.65, 1.36-2.00; 39.4%, 26.4%-50.0%), incompetent cervix (1.63, 1.35-1.96; 38.5%, 25.8%-49.1%), threatened premature delivery (1.38, 1.17-1.64; 27.7%, 14.5%-38.9%), placental abruption (1.37, 1.10-1.72; 27.1%, 8.8%-41.7%), and pregnancy-induced hypertension (1.20, 1.01-1.41; 16.4%, 1.2%-29.3%).
Conclusions: Maternal smoking was associated with a number of obstetric complications. This highlights the importance of smoking cessation during pregnancy. In addition, case-cohort analysis proved useful in estimating RRs for multiple outcomes in a large database.
J Epidemiol. 2010 Nov 13. [Epub ahead of print]
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戒烟和体重增加对血浆脂联素水平和胰岛素抵抗的早期影响
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男性戒烟与内脏脂肪面积和代谢综合征发病率之间的关系：Hitachi健康研究
