目的：产前吸烟与儿童行为问题的关系已经在学龄儿童和更大的儿童中做了研究，但是还缺乏在更小的儿童中做的前瞻性研究。使用基于人群的前瞻性的挪威母子队列研究，对有过孕期母体内吸烟暴露的18个月的儿童的表面化行为问题的风险进行检测。
方法：参与者有22,545名母亲和她们18个月龄的孩子。这些母亲报道其怀孕第17周时的吸烟习惯，在其孩子18月龄时通过标准化问卷评价表面化行为。使用logistic回归模型分析数据，以表面化行为评分超过88.6%的百分位数作为因变量，母亲自报吸烟作为自变量。将儿童的性别作为可能的调节变量。
结论：母亲怀孕期吸烟增加下一代后来在18月龄时表面化行为问题的风险，该风险在男孩、女孩间没有差别。该研究提示人群归因危险度为17.5%，即如果产前吸烟被戒除或者减少到每天少于10支后孩子的表面化行为问题可能会避免的比例为17.5%。
方法：参与者有22,545名母亲和她们18个月龄的孩子。这些母亲报道其怀孕第17周时的吸烟习惯，在其孩子18月龄时通过标准化问卷评价表面化行为。使用logistic回归模型分析数据，以表面化行为评分超过88.6%的百分位数作为因变量，母亲自报吸烟作为自变量。将儿童的性别作为可能的调节变量。
结论：母亲怀孕期吸烟增加下一代后来在18月龄时表面化行为问题的风险，该风险在男孩、女孩间没有差别。该研究提示人群归因危险度为17.5%，即如果产前吸烟被戒除或者减少到每天少于10支后孩子的表面化行为问题可能会避免的比例为17.5%。
（张永明编译 刘国梁审校）
Journal of the American Academy of Child & Adolescent Psychiatry. 48(3):283-289, March 2009.
Maternal Smoking in Pregnancy and Externalizing Behavior in 18-Month-Old Children: Results From a Population-Based Prospective Study.
STENE-LARSEN, KIM M.Sc.; BORGE, ANNE I.H. Ph.D.; VOLLRATH, MARGARETE E. Ph.D.
Mr. Stene-Larsen and Dr. Vollrath are with the Norwegian Institute of Public Health, Department of Psychosomatics and Health Behavior; Dr. Borge is with the Psychological Institute, University of Oslo.
Objective: The relation between prenatal smoking and child behavioral problems has been investigated in children of school age and older, but prospective studies in younger children are lacking. Using the population-based prospective Norwegian Mother and Child Cohort Study, we examined the risk for externalizing behaviors among 18-month-old children after exposure to maternal smoking during pregnancy.
Method: Participants were 22,545 mothers and their 18-month-old children. Mothers reported their smoking habits at the 17th week of gestation and their child’s externalizing behavior at 18 months of age by means of standardized questionnaires. Data were analyzed using logistic regression, with scores of externalizing behavior above the 88.6th percentile as the dependent variable and self-reported smoking as the independent variable. We examined the child’s sex as a possible moderator.
Results: We documented a threshold effect of smoking 10 cigarettes or more per day during pregnancy on subsequent externalizing behaviors among 18-month-old children, even after adjusting for relevant confounders (odds ratio 1.32, 95% confidence interval 1.03-1.70). The child’s sex did not moderate these effects (odds ratio 0.98, 95% confidence interval 0.83-1.16).
Conclusions: Maternal smoking during pregnancy increases offspring’s subsequent risk for externalizing behavior problems at 18 months of age. The pattern of risk does not differ between boys and girls. Our findings suggest a population attributable risk of 17.5% (i.e., the proportion of externalizing cases that could potentially be avoided if prenatal smoking was eliminated or reduced to fewer than 10 cigarettes per day).
STENE-LARSEN, KIM M.Sc.; BORGE, ANNE I.H. Ph.D.; VOLLRATH, MARGARETE E. Ph.D.
Mr. Stene-Larsen and Dr. Vollrath are with the Norwegian Institute of Public Health, Department of Psychosomatics and Health Behavior; Dr. Borge is with the Psychological Institute, University of Oslo.
Objective: The relation between prenatal smoking and child behavioral problems has been investigated in children of school age and older, but prospective studies in younger children are lacking. Using the population-based prospective Norwegian Mother and Child Cohort Study, we examined the risk for externalizing behaviors among 18-month-old children after exposure to maternal smoking during pregnancy.
Method: Participants were 22,545 mothers and their 18-month-old children. Mothers reported their smoking habits at the 17th week of gestation and their child’s externalizing behavior at 18 months of age by means of standardized questionnaires. Data were analyzed using logistic regression, with scores of externalizing behavior above the 88.6th percentile as the dependent variable and self-reported smoking as the independent variable. We examined the child’s sex as a possible moderator.
Results: We documented a threshold effect of smoking 10 cigarettes or more per day during pregnancy on subsequent externalizing behaviors among 18-month-old children, even after adjusting for relevant confounders (odds ratio 1.32, 95% confidence interval 1.03-1.70). The child’s sex did not moderate these effects (odds ratio 0.98, 95% confidence interval 0.83-1.16).
Conclusions: Maternal smoking during pregnancy increases offspring’s subsequent risk for externalizing behavior problems at 18 months of age. The pattern of risk does not differ between boys and girls. Our findings suggest a population attributable risk of 17.5% (i.e., the proportion of externalizing cases that could potentially be avoided if prenatal smoking was eliminated or reduced to fewer than 10 cigarettes per day).
Accession Number 00004583-200903000-00008.
DOI Number 10.1097/CHI.0b013e318195bcfb
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