Objectives

To assess associations between maternal smoking and congenital heart defects (CHDs) in offspring.

Study design

We performed a retrospective case-control study using data for cases of CHD (n = 8339) and nonmalformed controls (n = 11 020) from all years (1997-2011) of the National Birth Defects Prevention Study. Maternal self-reported smoking 1 month before through 3 months after conception was evaluated as a binary (none, any) and categorical (light, medium, heavy) exposure. Multivariable logistic regression was used to estimate aOR and 95% CIs. Stratified analyses were performed for septal defects according to maternal age, prepregnancy body mass index, and maternal race/ethnicity.

Results

Multiple CHDs displayed modest associations with any level of maternal periconceptional smoking independent of potential confounders; the strongest associations were for aggregated septal defects (OR, 1.5; 95% CI, 1.3-1.7), tricuspid atresia (OR, 1.7; 95% CI, 1.0-2.7), and double outlet right ventricle (DORV) (OR, 1.5; 95% CI, 1.1-2.1). Tricuspid atresia and DORV also displayed dose-response relationships. Among heavy smokers, the highest odds were again observed for tricuspid atresia (aOR 3.0; 95% CI, 1.5-6.1) and DORV (aOR 1.5; 95% CI, 1.1-2.2). Heavy smokers ≥35 years old more frequently had a child with a septal defect when compared with similarly aged nonsmokers (aOR 2.3; 95% CI, 1.4-3.9).

Conclusions

Maternal periconceptional smoking is most strongly associated with septal defects, tricuspid atresia, and DORV; the risk for septal defects is modified by maternal age.

中文翻译：

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母亲吸烟和先天性心脏病，全国出生缺陷预防研究，1997-2011

目标

评估母亲吸烟与后代先天性心脏病 (CHD) 之间的关联。

学习规划

我们使用全国出生缺陷预防研究所有年份 (1997-2011) 的冠心病病例 (n = 8339) 和非畸形对照 (n = 11020) 的数据进行了回顾性病例对照研究。母亲在受孕前 1 个月至受孕后 3 个月自我报告的吸烟情况被评估为二元（无、任何）和分类（轻度、中度、重度）暴露。多变量逻辑回归用于估计 aOR 和 95% CI。根据产妇年龄、孕前体重指数和产妇种族/族裔对间隔缺损进行分层分析。

结果

多种 CHD 与任何水平的孕期吸烟均有适度关联，而不受潜在混杂因素的影响；最强的关联是聚集性间隔缺损（OR，1.5；95% CI，1.3-1.7）、三尖瓣闭锁（OR，1.7；95% CI，1.0-2.7）和右心室双出口 (DORV)（OR，1.5 ；95% 置信区间，1.1-2.1)。三尖瓣闭锁和 DORV 也显示出剂量反应关系。在重度吸烟者中，再次观察到三尖瓣闭锁 (aOR 3.0；95% CI，1.5-6.1) 和 DORV (aOR 1.5；95% CI，1.1-2.2) 的几率最高。与年龄相似的非吸烟者相比，年龄≥35 岁的重度吸烟者更容易生出患有间隔缺损的孩子 (aOR 2.3；95% CI，1.4-3.9)。

结论

母亲围孕期吸烟与间隔缺损、三尖瓣闭锁和 DORV 的相关性最强；产妇年龄会改变间隔缺损的风险。