目的 评估孕前父亲烟草暴露对6岁儿童智力的影响,为指导优生优育服务提供循证依据。方法 本研究纳入2012年建立的上海闵行出生队列的530对母子,在孕妇建大卡时通过结构式问卷获得了孕前3个月父亲烟草暴露情况,在儿童6岁时利用第四版《儿童韦氏智力测试量表》中文版简版考察儿童智力水平。采用多因素线性回归模型分析孕前父亲烟草暴露对6岁儿童智力水平的影响。结果 调整协变量后,孕前父亲烟草暴露使儿童总智商下降2.83分(95%CI:-5.51～-0.16),其中孕前父亲吸烟的效应值(OR=3.15,95%CI:-6.32～0.03)略高于孕前父亲二手烟暴露(OR=2.62,95%CI:-5.54～0.30)。孕前父亲吸烟对儿童总智商和知觉推理的影响呈剂量反应关系(趋势检验P<0.05),父亲每天吸烟5支以上的儿童,总智商下降6.57分(95%CI:-10.88～-2.26),知觉推理下降5.83分(95%CI:-10.61～-1.05)。此外,儿童性别和胎龄与孕前父亲烟草暴露在对儿童智商的影响中表现出显著的交互作用(P<0.05),即父亲烟草暴露对女童、胎龄<39周的儿童的智力影响更强。结论 本研究发现孕前3个月父亲的烟草暴露与6岁儿童智力水平的下降有关,提示孕前健康指导应加强对备孕期间丈夫控烟的宣传,倡导夫妻双方共同承担起优生优育的责任。
Abstract
Objective To explore the effect of paternal exposure to cigarette smoke prior to pregnancy on children's intelligence at 6 years old, so as to provide epidemiological evidence for prenatal and postnatal care services. Methods A total of 530 mother-child pairs were included in this study from the Shanghai-Minhang Birth Cohort Study (S-MBCS) established in 2012. Information on paternal exposure to cigarette smoke 3 months prior to pregnancy was obtained through a structured questionnaire at the first antenatal checkup. Intelligence of children at 6 years old was assessed using the Simplified Chinese Version of (the Wechsler Intelligence Scale for Children, Fourth Edition,WISC-Ⅳ). Multivariate linear regression model was used to analyze the effect of paternal cigarette smoke exposure prior to pregnancy on children's intelligence at 6 years old. Results After adjusting for covariates, paternal exposure to cigarette smoke prior to pregnancy was associated with a decrease of 2.83 points (95%CI:-5.51 to -0.16) of children's Full-Scale Intelligence Quotient (FSIQ). The effect of paternal smoking (OR=3.15, 95%CI:-6.32 to 0.03) was slightly stronger than that of paternal exposure to second-hand smoking (OR=2.62, 95%CI:-5.54 to 0.30). The effect of paternal smoking prior to pregnancy on children's FSIQ and Perceptual Reasoning Index (PRI) showed statistically significant dose-effect relationships (Pfor trend<0.05). Children whose fathers smoked more than 5 cigarettes per day prior to pregnancy had a FSIQ decrease of 6.57 points (95%CI:-10.88 to -2.26) and a PRI decrease of 5.83 points (95%CI:-10.61 to -1.05). Besides, the sex and gestational weeks of children showed significant interactions with paternal exposure to cigarette smoke prior to pregnancy in the effects on children's intelligence (Pfor interaction<0.05). The effects of paternal exposure to cigarette smoke prior to pregnancy on the intelligence of girls, or of children with less than 39 gestational weeks, were stronger. Conclusions Paternal exposure to cigarette smoke 3 months prior to pregnancy was associated with decreased children's intelligence at 6 years old. Our findings suggest that pre-pregnancy health guidance should strengthen the propaganda of husband's tobacco control before pregnancy, and both husband and wife should jointly assume the responsibility for prenatal and postnatal care.
关键词
孕前 /
父亲烟草暴露 /
儿童智力 /
队列研究
Key words
prior to pregnancy /
paternal exposure to cigarette smoke /
children's intelligence /
cohort study
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Alati R, Macleod J, Hickman M,et al. Intrauterine exposure to alcohol and tobacco use and childhood IQ: Findings from a parental-offspring comparison within the Avon Longitudinal Study of Parents and Children[J]. Pediatr Res, 2008, 64(6):659-666.
[2] Ozmert EN, Yurdakök K, Soysal S, et al. Relationship between physical, environmental and sociodemographic factors and school performance in primary schoolchildren[J].J Trop Pediatr,2005,51(1):25-32.
[3] Falgreen Eriksen HL, Kesmodel US, Wimberley T, et al.Effects of tobacco smoking in pregnancy on offspring intelligence at the age of 5[J].J Pregnancy,2012,2012:945196.
[4] 杨锦蓉,王菁.父母接触CS2与子女智能发育的关系[J].工业卫生与职业病,2003,29(6):338-341.
[5] Oken E, Thompson JW, Rifas-Shiman SL, et al. Analysis of maternal prenatal weight and offspring cognition and behavior:results from the promotion of breastfeeding intervention trial(PROBIT) cohort[J].JAMA Netw Open,2021, 4(8):e2121429.
[6] 施旭,喻才骞,黄东晖.吸烟对妊娠及后代发育的影响[J].生殖医学杂志,2020,29(4):550-554.
[7] 杨杰,姜丽娜,袁振丽,等.被动吸烟对子代小鼠学习记忆的影响及抗氧化物干预研究[J].营养学报,2006,28(4):314-317.
[8] Fogelman KR, Manor O. Smoking in pregnancy and development into early adulthood[J].BMJ,1988,297(6658):1233-1236.
[9] 《中国吸烟危害健康报告2020》编写组,《中国吸烟危害健康报告2020》概要[J].中国循环杂志,2021,36(10):937-952.
[10] 陈霄雯,陈昊,施莉莉,等.妊娠期家庭控烟现状调查及影响因素分析[J].中国全科医学,2015,18(30):3697-3703.
[11] Roeleveld N, Vingerhoets E, Zielhuis GA, et al. Mental retardation associated with parental smoking and alcohol consumption before, during, and after pregnancy[J].Prev Med,1992,21(1):110-119.
[12] 李毓秋,张厚粲,朱建军.韦氏儿童智力量表第4版(中文版)六分测验简版及其在智力残疾评定中的作用[J].中国康复理论与实践,2011,17(12):1101-1104.
[13] The American College of Obstetricians and Gynecologists Committee on Obstetric Practice Society for Maternal-Fetal Medicine. Definition of term pregnancy[EB/OL].(2013-11).https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/11/definition-of-term-pregnancy.
[14] Spong CY. Defining "term"pregnancy:recommendations from the defining "term" pregnancy workgroup[J].JAMA,2013,309(23):2445-2446.
[15] 倪玲玲.孕前、孕期生活与职业环境暴露对学龄前儿童执行功能影响的队列研究[D].安徽:安徽医科大学,2016.
[16] Hawkey AB, White H, Pippen E, et al. Paternal nicotine exposure in rats produces long-lasting neurobehavioral effects in the offspring[J].Neurotoxicol Teratol,2019,74:106808.
[17] Liu Y, Chen S, Pang D, et al. Effects of paternal exposure to cigarette smoke on sperm DNA methylation and long-term metabolic syndrome in offspring[J].EpigeneticsChromatin,2022,15(1):3.
[18] Murphy PJ, Guo J, Jenkins TG, et al.NRF2 loss recapitulates heritable impacts of paternal cigarette smoke exposure[J].PLoS Genet,2020,16(6):e1008756.
[19] 张美幸,乔中东.吸烟对生育能力及后代影响的研究进展[J].中国热带医学,2019,19(10):912-915.
[20] 王俊龙,田汝辉,杨施,等.人精原干细胞研究进展[J].中华医学杂志,2015,95(36):2994-2997.
基金
国家科技部重点研发计划项目(2021YFC2701003);上海市卫生健康委员会课题(202104333);国家卫生健康委员会计划生育药具重点实验室创新能力专项资助(CX2022-OX)
PDF(656 KB)
