RESUMO
OBJECTIVES: To conduct a population-based study examining the occurrence of congenital heart defects (CHDs) in relation to maternal smoking during the first trimester of pregnancy. STUDY DESIGN: This retrospective case-control study used Washington State birth certificates from 1989 to 2011 and linked hospital discharge International Classification of Diseases, 9th revision, codes to identify singleton nonsyndromic CHD cases and determine maternal prenatal smoking status. We calculated ORs from multivariate logistic regression models to compare maternal first-trimester smoking status (any and daily number of cigarettes) among 14,128 cases, both overall and by phenotype, and 60,938 randomly selected controls frequency matched on birth year. RESULTS: Offspring of mothers reporting cigarette use in the first trimester of pregnancy were more likely to be born with a CHD (aOR 1.16 [1.08-1.24]) independent of demographic characteristics and other prenatal risk factors for CHDs. Maternal smoking was most strongly associated with pulmonary valve anomalies (aOR 1.48 [95% CI: 1.15-1.90]), pulmonary artery anomalies (aOR 1.71 [1.40-2.09]), and isolated atrial septal defects (aOR 1.22 [1.08-1.38]). The association between maternal smoking and CHDs was stronger with increasing number of daily cigarettes and among older (35+ years) mothers compared with younger mothers. CONCLUSIONS: We provide evidence that maternal smoking during pregnancy is a risk factor for select CHD phenotypes. Maternal smoking may account for 1.4% of all CHDs. New findings include a strong dose-dependence of the association and augmented risk in older mothers.
Assuntos
Cardiopatias Congênitas/epidemiologia , Exposição Materna/efeitos adversos , Mães , Vigilância da População , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Medição de Risco/métodos , Fumar/efeitos adversos , Adolescente , Adulto , Feminino , Seguimentos , Cardiopatias Congênitas/etiologia , Humanos , Incidência , Recém-Nascido , Masculino , Gravidez , Primeiro Trimestre da Gravidez , Prevalência , Estudos Retrospectivos , Fatores de Risco , Washington/epidemiologia , Adulto JovemRESUMO
Acculturation is important to examine variables that differentiate members of ethnic groups so that interventions can be appropriately targeted. By using a population-based sample of Mexican-origin adults, we sought to validate an acculturation scale for Mexican-American populations. The acculturation instrument included eight items adapted from the Acculturation Rating Scale for Mexican Americans (ARSMA). By using principal component analysis, we calculated eigenvalues for the eight items. The first principal component accounted for 66% of the variance. Language spoken most of the time, by itself, explained 62.4% of the variance of the full model, whereas birthplace, by itself, accounted for 74%. Slight increases in correlation values were observed beyond a four-item model that included language spoken most of the time, language thought, ethnic identity, and birthplace. Future studies should compare this scale with other multidimensional scales.