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已发表论文
孕前高血压与母亲戒烟时机对胎儿生长受限的交互作用：一项全国人群队列研究
Authors Chen J, Sun Y, Zhou J, Meng M, Zhou F, He J, Zou G
Received 14 January 2026
Accepted for publication 2 April 2026
Published 20 April 2026 Volume 2026:18 596174
DOI https://doi.org/10.2147/CLEP.S596174
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Thomas Ahern
Jianping Chen,1 Yuanqiao Sun,2 Jia Zhou,1 Meng Meng,1 Fenhe Zhou,1 Jia He,3 Gang Zou1
1Department of Fetal Medicine and Prenatal Diagnosis Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 2Department of Tobacco Control and Monitoring & Evaluation, Shanghai Municipal Center for Health Promotion, Shanghai, People’s Republic of China; 3School of Medicine, Tongji University, Shanghai, People’s Republic of China
Correspondence: Gang Zou, Email zougangshcn@sina.com Jia He, Email hejia63@yeah.net
Background: Maternal smoking is a major preventable cause of fetal growth restriction (FGR). Although cessation reduces risk, the benefit depends on its timing, and the role of preexisting hypertension—sharing vascular-placental mechanisms—remains underexplored.
Patients and methods: We conducted a population-based retrospective cohort study using US birth data (2020– 2024). Maternal smoking was divided as nonsmokers, quit before pregnancy, quit in the first trimester, quit in the second trimester, or persistent smokers. FGR was defined using birth-weight-based percentiles derived from the NICHD fetal growth standards (< 3rd, < 5th, and < 10th). Poisson regression with inverse probability of treatment weighting (IPTW) was used to estimate adjusted risk ratios (aRRs). Effect modification by preexisting hypertension was examined on multiplicative and additive scales.
Results: Among 17,381,709 singleton live births, FGR-3rd incidence increased across groups (3.3%, 4.5%, 6.1%, 7.5%, and 10.0%, respectively), showing a dose–response gradient. Compared with nonsmokers, the IPTW-aRRs for FGR-3rd were 1.20 (95% CI:1.17– 1.23), 1.61 (1.57– 1.66), 2.03 (1.95– 2.11) and 2.01 (1.99– 2.04) for women who quit before pregnancy, in the first trimester, in the second trimester, and persistent smokers. Preexisting hypertension increased absolute FGR risk but modified associations on the multiplicative scale, with attenuated relative risks among hypertensive women. No meaningful interaction was observed on additive scale. Notably, hypertensive women who quit before pregnancy achieved FGR risks comparable to hypertensive nonsmokers (aRR=0.98, 0.88– 1.08). Similar patterns were observed for < 5th and < 10th percentiles.
Conclusion: Earlier smoking cessation is associated with lower risk of FGR. Preexisting hypertension modifies associations on the multiplicative scale, where relative risks were attenuated among hypertensive women, but not on the additive scale, suggesting the independence on the additive scale (a lack of departure from risk additivity). These findings support integrating smoking cessation into preconception and antenatal care, especially for high-risk women.
Keywords: maternal smoking cessation, fetal growth restriction, preexisting hypertension, modification, inverse probability of treatment weighting
1Department of Fetal Medicine and Prenatal Diagnosis Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China; 2Department of Tobacco Control and Monitoring & Evaluation, Shanghai Municipal Center for Health Promotion, Shanghai, People’s Republic of China; 3School of Medicine, Tongji University, Shanghai, People’s Republic of China
Correspondence: Gang Zou, Email zougangshcn@sina.com Jia He, Email hejia63@yeah.net
Background: Maternal smoking is a major preventable cause of fetal growth restriction (FGR). Although cessation reduces risk, the benefit depends on its timing, and the role of preexisting hypertension—sharing vascular-placental mechanisms—remains underexplored.
Patients and methods: We conducted a population-based retrospective cohort study using US birth data (2020– 2024). Maternal smoking was divided as nonsmokers, quit before pregnancy, quit in the first trimester, quit in the second trimester, or persistent smokers. FGR was defined using birth-weight-based percentiles derived from the NICHD fetal growth standards (< 3rd, < 5th, and < 10th). Poisson regression with inverse probability of treatment weighting (IPTW) was used to estimate adjusted risk ratios (aRRs). Effect modification by preexisting hypertension was examined on multiplicative and additive scales.
Results: Among 17,381,709 singleton live births, FGR-3rd incidence increased across groups (3.3%, 4.5%, 6.1%, 7.5%, and 10.0%, respectively), showing a dose–response gradient. Compared with nonsmokers, the IPTW-aRRs for FGR-3rd were 1.20 (95% CI:1.17– 1.23), 1.61 (1.57– 1.66), 2.03 (1.95– 2.11) and 2.01 (1.99– 2.04) for women who quit before pregnancy, in the first trimester, in the second trimester, and persistent smokers. Preexisting hypertension increased absolute FGR risk but modified associations on the multiplicative scale, with attenuated relative risks among hypertensive women. No meaningful interaction was observed on additive scale. Notably, hypertensive women who quit before pregnancy achieved FGR risks comparable to hypertensive nonsmokers (aRR=0.98, 0.88– 1.08). Similar patterns were observed for < 5th and < 10th percentiles.
Conclusion: Earlier smoking cessation is associated with lower risk of FGR. Preexisting hypertension modifies associations on the multiplicative scale, where relative risks were attenuated among hypertensive women, but not on the additive scale, suggesting the independence on the additive scale (a lack of departure from risk additivity). These findings support integrating smoking cessation into preconception and antenatal care, especially for high-risk women.
Keywords: maternal smoking cessation, fetal growth restriction, preexisting hypertension, modification, inverse probability of treatment weighting