2020年1月29日， 瑞典厄勒布鲁大学Judith S Brand小组在《英国医学杂志》发表论文，宣布他们的最新研究分析了母亲在怀孕期间吸烟和后代骨折的关联。
为了探讨孕期吸烟对后代不同发育阶段骨折的影响，研究组基于国家注册的出生队列研究，设计了一项同胞对照实验。共招募了1680307名参与者，1983-2000年出生于瑞典，其中377367名参与者的母亲在孕早期吸烟（22.5%），1302940名参与者的母亲不吸烟。研究随访至2014年12月31日。
中位随访21.1年后，共发生377970例骨折，骨折的总发生率为每1000人年11.8例。孕期吸烟与后代骨折风险之间的关系因年龄不同而有所区别。在整个队列中，母亲孕期吸烟显著增加了后代1岁前的骨折率，母亲吸烟和不吸烟的婴儿出生年标准化骨折率分别为每1000人年1.59例和1.28例。校正混杂因素后，母亲吸烟与不吸烟的风险比为1.27。
这种关联遵循剂量依赖模式，即与不吸烟的母亲相比，孕期每天吸1-9支烟和每天超过10支烟的风险比分别为1.20和1.41，且在同胞比较中持续存在，尽管置信区间更宽。母亲孕期吸烟也与后代5-32岁骨折发病率增加相关，但这些相关性不遵循剂量依赖模式。在任何一个模式中，母亲吸烟与后代1-5岁间的骨折风险无关。
总之，孕期吸烟与出生后1年内骨折率增加相关，但对儿童晚期至成年早期骨折的生物学影响不大。
附：英文原文
Title: Maternal smoking during pregnancy and fractures in offspring: national register based sibling comparison study
Author: Judith S Brand, Ayako Hiyoshi, Yang Cao, Deborah A Lawlor, Sven Cnattingius, Scott Montgomery
Issue&Volume: 2020/01/29
Abstract:
Objective To study the impact of maternal smoking during pregnancy on fractures in offspring during different developmental stages of life.
Design National register based birth cohort study with a sibling comparison design.
Setting Sweden.
Participants 1?680?307 people born in Sweden between 1983 and 2000 to women who smoked (n=377?367, 22.5%) and did not smoke (n=1?302?940) in early pregnancy. Follow-up was until 31 December 2014.
Main outcome measure Fractures by attained age up to 32 years.
Results During a median follow-up of 21.1 years, 377?970 fractures were observed (the overall incidence rate for fracture standardised by calendar year of birth was 11.8 per 1000 person years). The association between maternal smoking during pregnancy and risk of fracture in offspring differed by attained age. Maternal smoking was associated with a higher rate of fractures in offspring before 1 year of age in the entire cohort (birth year standardised fracture rates in those exposed and unexposed to maternal smoking were 1.59 and 1.28 per 1000 person years, respectively). After adjustment for potential confounders the hazard ratio for maternal smoking compared with no smoking was 1.27 (95% confidence interval 1.12 to 1.45). This association followed a dose dependent pattern (compared with no smoking, hazard ratios for 1-9 cigarettes/day and ≥10 cigarettes/day were 1.20 (95% confidence interval 1.03 to 1.39) and 1.41 (1.18 to 1.69), respectively) and persisted in within-sibship comparisons although with wider confidence intervals (compared with no smoking, 1.58 (1.01 to 2.46)). Maternal smoking during pregnancy was also associated with an increased fracture incidence in offspring from age 5 to 32 years in whole cohort analyses, but these associations did not follow a dose dependent gradient. In within-sibship analyses, which controls for confounding by measured and unmeasured shared familial factors, corresponding point estimates were all close to null. Maternal smoking was not associated with risk of fracture in offspring between the ages of 1 and 5 years in any of the models.
Conclusion Prenatal exposure to maternal smoking is associated with an increased rate of fracture during the first year of life but does not seem to have a long lasting biological influence on fractures later in childhood and up to early adulthood.
DOI: 10.1136/bmj.l7057
Source: https://www.bmj.com/content/368/bmj.l7057
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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本期文章：《英国医学杂志》：Online/在线发表
