背景:煙對兒童呼吸系統和出生結果有害是眾所周知。但是,香煙暴露包括二手煙(ETS)及母親懷孕期抽煙對異位性皮膚炎的影響不是很清楚。 宗旨:這項研究的目的將依據臍帶血cotinine值來評估懷孕期香煙暴露對小孩異位性皮膚炎之影響。 方法: 在2004年我們收集了261對母親和新生兒。臍帶血和孩子的資料在出生時即被取得。在2歲時收集後天環境暴露資料及判定小孩是否得過異位性皮膚炎。我們用高性能色層分析質譜儀(HPLC-MS/MS)測量並比較得病與沒得病小孩之臍帶血及母血cotinine濃度。多重邏輯氏迴歸被用來評估cotinine濃度和異位性皮膚炎之關係。 結果: 150對母親和小孩完成了追蹤研究及抽血。38個(25.3%)孩子得異位性皮膚炎。2個(1.3%)母親在懷孕期間抽煙, 38個(25.3%)母親在懷孕期間有二手煙之暴露。臍帶血Cotinine濃度和母親血濃度高度相關(r=0.71,p<0.001)。我們發現當臍帶血cotinine值上升時，異位性皮膚炎之風險便會增加，且以劑量趨勢反應方式增加(p for trend=0.01)。尤其對於暴露濃度高於第75百分位者，異位性皮膚炎的風險更是顯著增加。 結論: 懷孕期香煙暴露會增加小孩異位性皮膚炎的風險。產前避免香煙暴露對於早期預防異位性皮膚炎是很重要的。
Background: The adverse impact of smoking on respiratory diseases and birth outcomes in children is well-known. However, the influence of smoke exposure including environmental tobacco smoke (ETS) and maternal smoking during pregnancy on atopic dermatitis (AD) is not clear. Objective: The purpose of this study was to evaluate the effect of gestational smoke exposure on the development of AD in the offspring on the basis of the maternal and cord blood cotinine. Methods: We recruited 261 mother and newborn pairs in 2004. Cord blood and information on perinatal factors of children were gathered at birth. At 2 years of age, information about development of AD and environmental exposures were collected. We compared AD with non-AD children for the concentration of cotinine in cord and maternal blood measured by high performance chromatography-mass spectrometry (HPLC-MS/MS). Multiple logistic regressions were performed to estimate the relationship of cotinine levels and AD. Results: 150 mother and child pairs completed the follow-up study and specimen collection with 38 (25.3%) children developing AD. Two (1.3%) out of 150 mothers smoked during pregnancy while 38 (25.3%) mothers reported having ETS exposure. Cotinine levels in cord blood and maternal blood were highly correlated (r=0.71, p<0.001). The risk of AD was found to increase with maternal and cord blood cotinine levels in a dose-response-manner (p for trend=0.01). Children exposed to high levels (> 75th percentile) had a significantly increased risk of AD. Conclusions: Smoke exposure during pregnancy might increase the risk of AD in children. Avoidance of prenatal smoke exposure may be warranted for early prevention.
