孕婦吸菸與暴露二手菸對其胎兒出生結果的影響; Effects of Maternal Cigarette Smoking and Environmental Tobacco Smoke during Pregnancy on Birth Outcomes

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题名:	孕婦吸菸與暴露二手菸對其胎兒出生結果的影響;Effects of Maternal Cigarette Smoking and Environmental Tobacco Smoke during Pregnancy on Birth Outcomes
作者:	邱顯財;Hsien-Tsai Chiu
贡献者:	中國醫藥大學環境醫學研究所
关键词:	孕婦吸菸;尿液可丁寧;血液可丁寧;廣義估計式;出生結果
日期:	2004
上传时间:	2010-01-20 16:00:21 (UTC+8)
摘要:	背景：孕婦吸菸與暴露二手菸對於胎兒健康有許多危害，為重要的公共衛生問題。本研究以前瞻式之研究設計，探討孕婦在懷孕期間吸菸與暴露二手菸對胎兒的出生結果有何危害。方法：研究對象為參加產檢的孕婦（共685名），來自台中兩家醫學中心與兩家區域醫院。經孕婦同意，採集尿液與血液檢體以測定可丁寧濃度。關於孕婦的人口學資料、懷孕史、疾病史、吸菸暴露量、一般健康行為以及自覺健康狀態等訊息，皆以自填式問卷取得。在孕婦分娩時，胎兒生產結果由護士或醫事人員紀錄在問卷上。結果：根據探索性資料分析的結果，菸暴露分為吸菸組、二手菸組以及非吸菸組。第二孕期的平均尿液可丁寧濃度在吸菸組（n = 46, 4.39 ± 5.65 ng/mL）、二手菸組（n = 240, 3.00 ± 4.27 ng/mL）與非吸菸組（n = 235, 2.11 ± 3.13 ng/mL）之間的差異相當顯著（p=0.001）；而第二孕期的平均血液可丁寧濃度也有相同的趨勢，在各暴露組別之間有顯著差異（p<0.001）。在三個孕期中，可丁寧濃度都隨著菸暴露的嚴重程度而增加。由廣義估計式分析的結果顯示，可丁寧濃度有隨著懷孕進行而升高的趨勢，懷孕週數愈大，平均可丁寧濃度也愈高。就各孕期的可丁寧濃度來看，以第二孕期的濃度與胎兒出生體重與身長的關係較為顯著。在複迴歸模式中，若和第二孕期可丁寧濃度較低的組別相比，第二孕期可丁寧濃度較高的組別（尿液可丁寧≧0.284 ng/mL，血液可丁寧≧0.022 ng/mL）其平均出生體重顯著減少168至189克，平均身長顯著減少0.64至1.12公分。結論：孕婦在懷孕期間吸菸與暴露二手菸可能會影響胎兒的生長發育，懷孕中後期的菸暴露對胎兒出生體重與身長的影響最大。若和自我報告的菸暴露狀態相比，可丁寧濃度對胎兒出生體重與身長的解釋能力較佳。; Background: This is a prospective study designed to investigate the adverse effects of maternal cigarette smoking and environmental tobacco smoke (ETS) during pregnancy on birth outcomes of neonates. Methods: Pregnant women seeking for prenatal care at two medical centers and two regional hospitals in Taichung were recruited as study subjects voluntarily. With subject consents, the cotinine levels in urine and serum were determined at three trimesters of gestation. Information was obtained on demographic characteristics, history of pregnancy, history of disease, volume of cigarette smoking, ETS exposure, and life style using a self-administrated questionnaire. Birth outcomes of the neonates were recorded by nurses at delivery. Results: The average urinary cotinine level at the second trimester were higher for smoking group (n = 46, 4.39 ± 5.65 ng/mL) than ETS group (n = 240, 3.00 ± 4.27 ng/mL) and non-smoking group (n = 235, 2.11 ± 3.13 ng/mL) (p=0.001). The average serum cotinine level at the second trimester also had the same trend among these groups. At all three trimesters, the urinary and serum cotinine levels elevated as the exposure to smoking and ETS increased. Results from generalized linear model with generalized estimating equation (GEE) approach showed that cotinine level increased as the gestation processed. In adjusted linear regression model, the neonates born to pregnant women of higher urinary cotinine level at the second trimester were 189 grams lighter in mean birth weight (p<0.001) and 1.12 centimeters shorter in mean body length (p<0.001), compared to the lowest quartile (urine cotinine of the second trimester were less than 0.284 ng/ml). Conclusions: Maternal smoking and ETS exposure in pregnant women may slow fetal growth. Cotinine level in serum or urine is a better predictor for birth weight and length than self-reported smoking status.
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