论文标题
胎龄的孕产妇教育和后代出生体重：怀孕期间吸烟的介导作用
Maternal education and offspring birthweight for gestational age: the mediating effect of smoking during pregnancy
论文作者
论文摘要
胎龄（SGA）出生体重的背景是婴儿死亡率和儿童发育延迟的危险因素，与孕产妇的教育程度有关。孕妇在怀孕期间吸烟可能会导致这种关联。我们旨在量化怀孕期间孕产妇吸烟对胎龄（GA）儿童出生体重的社会不平等现象的贡献。方法数据来自法国全国性ELFE队列研究，其中包括17,155个单例。使用Z分数计算GA的出生体重。使用调解分析确定了孕产妇的教育程度，怀孕期间吸烟和儿童出生体重之间的关联。还通过母体孕前体重指数对中介分析进行了分层。分子低母亲的教育程度与怀孕期间烟草吸烟的奇数增加有关（调整后或（ORA）= 2.58 [95％CI 2.34，2.84]）以及儿童出生的降低（降低儿童的出生）（rra = 0.94 [95％] [95％] [95％] [95％] [95％] [95％]。怀孕期间吸烟与GA的后代出生体重减少有关（RRA = 0.73 [95％CI 0.70，0.76]）。调解分析表明，低母亲教育程度对GA的后代出生体重的影响的39％是通过怀孕期间吸烟介导的。在体重不足妇女中观察到孕产妇教育成果对GA儿童体重的更重要的直接影响（RRA = 0.82 [95％CI 0.72，0.93]）。结论结论是，孕产妇的教育疗法与GA的儿童体力体重之间的关系是通过吸烟在怀孕期间吸烟的强烈调节的。减少孕产妇的吸烟可以减少婴儿SGA的发生，并减少GA的出生体重的社会经济不平等。
Background Small for gestational age (SGA) birthweight, a risk factor of infant mortality and delayed child development, is associated with maternal educational attainment. Maternal tobacco smoking during pregnancy could contribute to this association. We aimed to quantify the contribution of maternal smoking during pregnancy to social inequalities in child birthweight for gestational age (GA). Methods Data come from the French nation-wide ELFE cohort study, which included 17,155 singletons. Birthweights for GA were calculated using z-scores. Associations between maternal educational attainment, tobacco smoking during pregnancy and child birthweight for GA were ascertained using mediation analysis. Mediation analyses were also stratified by maternal pre-pregnancy body mass index.Results Low maternal educational attainment was associated with an increased odd of tobacco smoking during pregnancy (adjusted OR (ORa)=2.58 [95% CI 2.34, 2.84]) as well as a decrease in child birthweight for GA (RRa=0.94 [95% 0.91, 0.98]). Tobacco smoking during pregnancy was associated with a decrease in offspring birthweight for GA (RRa=0.73 [95% CI 0.70, 0.76]). Mediation analysis suggests that 39% of the effect of low maternal educational attainment on offspring birthweight for GA was mediated by smoking during pregnancy. A more important direct effect of maternal educational attainment on child birthweight for GA was observed among underweight women (RRa=0.82 [95%CI 0.72, 0.93]).Conclusions The relationship between maternal educational attainment and child birthweight for GA is strongly mediated by smoking during pregnancy. Reducing maternal smoking could lessen the occurrence of infant SGA and decrease socioeconomic inequalities in birthweight for GA.Keywords Birthweight, educational attainment, tobacco smoking, pregnancy, mediation analysis, health inequalities
