目標：環境菸煙(Environmental tobacco smoke, ETS)是種常見的室內空氣污染，且嬰幼童是暴露於ETS的高危險群。故本研究目的在評估出生前後暴露於ETS，對出生結果，含早產、低出生體重、與small for gestational age(SGA)，及兒童健康，含急診與住院的影響。方法：我們是「台灣出生世代研究(Taiwan Birth Cohort Study)」的前導研究，在母親產後6個月，以自答式問卷訪談了2,048位研究對象，最後共有1,725份含母親及其活產胎兒的完整資料。研究中利用regression models分析出生前後暴露於ETS對出生結果與兒童健康的不良影響，並以test for trend探討暴露於ETS的頻率與兩者間的關係。結果：研究發現母親在懷孕期間暴露到ETS的頻率，會與嬰兒的早產、SGA、急診和住院有顯著相關。再者，懷孕期間或生產後為主動吸菸的母親，會與嬰兒的低出生體重、SGA、急診和住院相關，但該相關除SGA外，其他則在校正後消失。此外，若父親在母親懷孕期間或生產後為主動吸菸者，嬰兒會呈現較高的住院風險，並與父親的抽菸量成正比。最後，研究發現在懷孕期間暴露到ETS的母親，比沒有暴露到的母親其嬰兒之出生體重較少222.3克。結論：在台灣，雖然母親的抽菸率非常低，但研究中仍發現，出生前後所暴露到的ETS會對兒童造成影響。為此，出生前後的ETS暴露在公共衛生上所造成地潛在不良效應，應該更被重視。

Objectives: Environmental tobacco smoke (ETS) is a common indoor pollutant. Fetuses, neonates, and young children are most at risk from ETS exposure. In this study, we evaluated the relationship of exposure to prenatal and postnatal ETS to birth outcomes (including preterm delivery [PTD], low birth weight [LBW], and small for gestational age [SGA]) and child health outcomes (including emergency visits and hospitalizations). Methods: In this pilot project of the Taiwan Birth Cohort Study, we used a self-reported questionnaire. We interviewed 2,048 mothers 6 months after their deliveries and recruited 1,725 mother-newborn pairs. We analyzed the association of adverse birth outcome and child health with exposure to prenatal and postnatal ETS using regression models, and analyzed relationships between birth outcome and child health and frequency of exposure to prenatal and postnatal ETS using the test for trend. Results: We found a significant association between exposure to ETS during pregnancy and PTD, SGA, emergency visits, and hospitalizations of infants. In addition, infant exposure to ETS via maternal smoking during or after pregnancy contributed to significant crude relationships between LBW, SGA, emergency visits, and hospitalizations, but these relationships were completely explained by the effects of covariates other than SGA. We also observed that paternal smoking during or after pregnancy dose-dependently increased hospitalization risks of infants. Moreover, the mean adjusted BW decrement was 222.3 g in newborns exposed to ETS from maternal smokers. Conclusions: Although maternal smoking risks are very low in Taiwan, prenatal or postnatal ETS exposure still impacts children. Our findings highlight the emerging challenge of prenatal and postnatal ETS exposure to the public health.

環境菸煙 ； 出生結果 ； 嬰兒健康

environmental tobacco smoke, birth outcomes, infant health