1.Maternal smoking during pregnancy of risk factor avascular necrosis of the femoral head disease
Otgonchimeg T ; Naranbat L ; Budee B ; Otgonsaikhan N ; Erdenbileg A ; Jargalsaikhan B ; Zulai D ; Gantuya D
Innovation 2020;14(2):40-45
Purpose:
The etiology of Legg-Calve-Perthes disease (LCPD) remains unknown until today. A few
studies have suggested passive smoke inhalation may be a risk factor, although the association
is not confirmed and a causal relationship has not been established. Most mothers who smoke
during pregnancy may continue smoking after giving a birth, it would be difficult to determine
to what extent passive smoke inhalation adds to the risk of LCPD in these children. The causes
of Legg-Calve-Perthes disease are largely unknown, but this pediatric disease seems to result
from interruption of the blood supply to the proximal femur and is considered a vascular disease.
Because maternal smoking during pregnancy influences fetal development and is associated
with cardiovascular diseases in offspring, we hypothesized that this exposure and passive Tabaco
smoke exposure are risk factors for Legg-Calve-Perthes disease and also investigated other
markers of impaired fetal development and early-life exposures.
Methods:
We prospectively recruited total 96 patients, among those 32 patients with LCPD as
a case group and 64 patients attending the hospital for other orthopedic complaints as control
group. Conditional logistic regression was used to assess the association between the exposures
and risk of LCPD.
Results:
The main risk factors for LCPD were family background, indoor use of a wood stove,
having a family member who smoked indoors (passive smoke) and smoke during pregnancy.
Children from the middle socioeconomic group appeared to be at a greater risk of developing
LCPD.
Conclusions
This study provides further evidence that environmental tobacco smoke is
associated with an increased risk of LCPD. Family background and exposure to wood smoke
also appears to be risk factors. Maternal smoking during pregnancy and other factors indicated
by impaired fetal development may be associated with an increased risk of Legg-Calvé-Perthes
disease. However, it remains unclear why there are profound differences in the incidence of
the disease between regions when the prevalence of smoking is comparable and why bilateral
involvement is infrequent, and it needs further study.