To investigate whether the effects of in utero exposure to maternal smoking and environmental tobacco smoke (ETS) exposure on lung function vary by sex or asthma status, we examined medical history and tobacco smoke exposure data for 5,263 participants in the Children's Health Study. At study enrollment, parents or guardians of each subject completed a questionnaire, and lung function was measured spirometrically with maximum forced expiratory flow-volume maneuvers. To assess the in utero effects of maternal smoking and ETS exposure on lung function, we used regression splines that accounted for the nonlinear relationship between pulmonary function, height, and age. In utero exposure to maternal smoking was independently associated with deficits in lung function that were larger for children with asthma. Boys and girls with a history of in utero exposure to maternal smoking showed deficits in maximum midexpiratory flow (MMEF) and a decrease in the FEV(1)/FVC ratio. As compared with children without asthma, boys with asthma had significantly larger deficits from in utero exposure in FVC, MMEF, and FEV(1)/FVC, and girls with asthma had larger decreases in FEV(1)/FVC. The effect of ETS exposure varied by children's gender and asthma status. Deficits in flows associated with current ETS exposure were present in children with and without asthma but were significant only among children without asthma. Past ETS exposure was associated with reduced FEV(1), MMEF, and FEV(1)/FVC among boys with asthma. In contrast, past ETS exposure was associated with decreased flow rates in girls without asthma. In summary, both in utero exposure to maternal smoking and ETS exposure were associated with persistent deficits in lung function. The effects of in utero exposure were greatest among children with asthma.

译文

:为了调查子宫内孕产妇吸烟和环境烟草烟雾(ETS)暴露对肺功能的影响是否因性别或哮喘状况而异,我们检查了儿童健康研究中5,263名参与者的病史和烟草烟雾暴露数据。在研究入组时,每个受试者的父母或监护人填写了一份调查表,并以最大的强制呼气流量对肺功能进行了肺活量测定。为了评估孕妇吸烟和ETS暴露对子宫功能的子宫内影响,我们使用了回归样条,该样条解释了肺功能,身高和年龄之间的非线性关系。子宫内母体吸烟与哮喘患儿的肺功能缺陷独立相关。有子宫内孕产妇吸烟史的男孩和女孩显示最大呼气中期流量不足(MMEF)和FEV(1)/ FVC比值降低。与没有哮喘的儿童相比,患有哮喘的男孩在子宫内暴露的FVC,MMEF和FEV(1)/ FVC的赤字明显更大,而患有哮喘的女孩FEV(1)/ FVC的跌幅更大。 ETS暴露的影响因儿童的性别和哮喘状况而异。哮喘患儿和非哮喘患儿当前与ETS暴露相关的血流不足,但仅在哮喘患儿中才有显着性。过去的ETS暴露与哮喘男孩中FEV(1),MMEF和FEV(1)/ FVC降低有关。相比之下,过去的ETS暴露与没有哮喘的女孩的血流量降低相关。总之,子宫内孕妇吸烟和ETS暴露均与持续的肺功能缺陷有关。子宫内暴露对哮喘患儿的影响最大。

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