| 摘要: | 背景 在懷孕期間抽菸或暴露於二手菸，除了對孕婦本身造成危害外，對新生兒也會帶來負面影響，而這種危害是可以事先避免的。孕婦抽菸或暴露於二手菸者，可以檢測母親尿液或血液及新生兒臍血中可丁寧濃度，對於新生兒的體重、身高、頭圍及懷孕週數，來評估懷孕期間抽菸或暴露於二手菸對胎兒造成的危害程度。 材料與方法 本研究是橫斷式研究，以台灣中部一所私立醫院自2002年12月至2003年4月間生產孕婦為取樣來源，孕婦入院生產時經產婦同意行問卷調查，併留取母體尿液、血液以及新生兒臍血為樣本，依問卷調查分成有二手菸暴露與無二手菸暴露，並檢測孕婦尿液、血液及新生兒臍血中可丁寧(cotinie)濃度，對新生兒體重、身高、頭圍、懷孕週數等的影響。 結果 有效問卷總數為386人，基本資料中孕婦年齡、身高、教育程度、職業類別、喝咖啡習慣，在有與無二手菸曝露的統計上均有顯著差異(P < 0.05)。年齡愈年輕者二手菸曝露比例愈高；大專教育程度以上者比高中以下者，二手菸曝露少約一半；職業上以上班族最少，再次為家庭主婦，最多是其它職業者最多；喝咖啡習慣在比例上，以喝咖啡及二手菸曝露者比無喝咖啡無二手菸曝露者為多。 孕婦各變項與新生兒各變項之相關性中，母親的身高、體重與新生兒之體重、身高、頭圍均有顯著性相關。母親血液與新生兒臍血中可丁寧濃度亦有明顯相關 (r = 0.809)。有二手菸曝露者，母親尿液中可丁寧濃度之高與低，對新生兒體重有107公克，身高有1公分及懷孕週數有0.7週的差異。母親血液中可丁寧濃度高與低，對新生兒體重有61公克，身高有0.7公分，頭圍有0.4公分，及懷孕週數有0.3週之差異；而胎兒臍血中可丁寧濃度高與低，對新生兒身高有0.5公分，及懷孕週數有0.2週的差異，頭圍雖沒有顯著性差別但P 值為 0.083。 孕婦二手菸暴露來源，包括先生抽菸、家人抽菸、以及工作場所菸味之有無。孕婦尿液中可丁寧濃度與工作場所菸味之有無，相差1 ug/mg creatinine；孕婦血液中可丁寧濃度與先生抽菸之有無相差0.1 ng/ml；新生兒臍血中可丁寧濃度，與工作場所菸味之有無，相差0.2 ng/ml；但上述均無統計上的意義。對新生兒體重的影響與家人吸菸有關，家人有吸菸會減少新生兒體重相差14公克左右。 如果調整胎次，教育程度後的多變項線性迴歸分析，母親尿液中可丁寧濃度高低，對新生兒體重相差28公克，身高相差0.7公分；母親血液中可丁寧濃度高低，對新生兒身高相差0.3公分，懷孕週數差0.1週；新生兒臍血中可丁寧濃度高低，對新生兒身高相差0.1公分；但以上差異均無統計上的意義。 結論 孕婦於懷孕期間曝露二手菸者，在年齡層上有年輕化的趨勢，教育程度愈高者愈少有二手菸曝露。母親血液與新生兒臍血中可丁寧濃度相關性很高，二手菸曝露之孕婦，其尿液、血液及其新生兒臍血中可丁寧濃度，均較無二手菸曝露之孕婦為高，且其新生兒體重、身高、頭圍及懷孕週數，均比無二手菸曝露孕婦之新生兒為低。顯示孕婦於懷孕期間吸菸或暴露二手菸可能，對新生兒之結果有不同程度的影響。 關鍵字: 懷孕婦女二手菸暴露，可丁寧(cotinine)，懷孕週數，低出生體重，新生兒頭圍，新生兒身高; Back ground: Maternal smoking or environmental tobacco smoke (ETS) exposure during pregnancy result in health risks for pregnant women, also cause impacts for newborn babies, while these adverse effects toward health should be prevented. To evaluate the impact on infant birthweight, body length, head circumference and gestational age, maternal smoking or ETS exposure will be measured by cotinine level in maternal urine, blood and infant umbilical cord blood. Material and methods: This is a cross-sectional study, samples were from a private hospital in Changhwa city, from November 2002 to April 2003. Questionnaire, maternal urines, bloods and neonatal umbilical cord bloods were collected. All together there were 386 participants. According to self-report from questionnaire, participants were divided into ETS exposure and non-ETS exposure groups. HPLC method evaluated the cotinine levels of all specimens. Different adverse impacts for newborn outcomes including birth weight, body length, head circumference and gestational age could be evaluated and associated with cotinine levels in various specimen. Result: There were significant statistical as association (p < 0.05) between ETS exposure and concerning maternal age, height, education, occupation, and consumption of coffee. The smoking habit for pregnant women showed more younger in Taiwan. Pregnant women with higher education had more less ETS exposure. Regarding to occupational status there was significant difference between with ETS exposure and non-ETS exposure groups, the participants of ETS exposure showed smaller percentage in housewife, and office-working class, abut higher in other occupations. Pregnant women without coffee drinking habit and non-ETS exposure were more than pregnant women with coffee drinking habit and ETS exposure. The correlation between maternal height, body weight and newborn birth weight, body length were prominent. The cotinine level of maternal blood and infant umbilical cord blood had a close correlation (r = 0.809). Compared to the cotinine level of maternal urine, the birth weight was 107 gm lighter, 1 cm shorter, 0.7 wk less of gestational age in high cotinine level group. The lower cotinine level of maternal blood group, the birth weight was 61 gm heavier, the body length was 0.7 cm taller, the head circumference was 0.4 cm bigger, and the gestational age was 0.3 wk longer. The cotinine level of umbilical cord blood, in high and low group, there were a 0.5 cm in body length, and 0.2 wk of gestational age in differences. |
