Data_Sheet_1_Association Between Smoking and Premenstrual Syndrome: A Meta-Analysis.XLSX

Results of basic science studies demonstrate shared actions of endogenous neuroactive steroid hormones and drugs of abuse on neurotransmission. As such, premenstrual syndrome (PMS) may be associated with smoking, however, results from studies examining this relationship have been mixed. Following PRISMA guidelines, we extracted unique studies examining the relationship between smoking and PMS. We used the escalc () function in R to compute the log odds ratios and corresponding sampling variance for each study. We based quality assessment on the nature of PMS diagnosis and smoking estimation, confounding adjustment, participation rate, and a priori specification of target population. Our final sample included 13 studies, involving 25,828 study participants. Smoking was associated with an increased risk for PMS [OR = 1.56 (95% CI: 1.25–1.93), p < 0.0001]. Stratified by diagnosis, the effect size estimate was higher for Premenstrual Dysphoric Disorder (PMDD) [OR = 3.15 (95% CI: 2.20–4.52), p < 0.0001] than for PMS [OR = 1.27 (95% CI: 1.16–1.39), p < 0.0001]. We review some of the basic mechanisms for the observed association between smoking and PMS. Given nicotine's rewarding effects, increased smoking behavior may be a mechanism to alleviate affective symptoms of PMS. However, smoking may lead to worsening of PMS symptoms because nicotine has effects on neurocircuitry that increases susceptibility to environmental stressors. Indeed, prior evidence shows that the hypothalamic-pituitary-adrenal (HPA) axis is already sub-optimal in PMS, hence, smoking likely further deteriorates it. Combined, this complicates the clinical course for the treatment of both PMS and Tobacco Use Disorder in this population.

基础科学研究结果表明，内源性神经活性类固醇激素（endogenous neuroactive steroid hormones）与成瘾药物在神经传递过程中发挥着共同作用。据此，经前期综合征（premenstrual syndrome, PMS）或与吸烟存在关联，但既往针对该关联的研究结论并不一致。本研究遵循PRISMA指南（PRISMA guidelines），提取了探讨吸烟与经前期综合征关联的独立研究。我们使用R语言中的escalc()函数计算每项研究的对数比值比及其对应的抽样方差。质量评估基于经前期综合征诊断与吸烟评估的方式、混杂因素调整情况、研究参与率以及目标人群的先验设定。本研究最终纳入13项研究，共计25828名研究参与者。结果显示，吸烟与经前期综合征的风险升高显著相关[比值比（OR）=1.56，95%置信区间（CI）：1.25~1.93，p<0.0001]。按诊断类型分层分析后，经前期烦躁障碍（Premenstrual Dysphoric Disorder, PMDD）的效应量估计值[OR=3.15，95%CI：2.20~4.52，p<0.0001]高于经前期综合征[OR=1.27，95%CI：1.16~1.39，p<0.0001]。我们对吸烟与经前期综合征之间观测到的关联的部分潜在生物学机制进行了综述。鉴于尼古丁的奖赏效应，吸烟行为的增加可能是缓解经前期综合征情感症状的一种代偿机制。然而，吸烟或会加重经前期综合征的症状，这是因为尼古丁可作用于神经回路，增加个体对环境应激源的易感性。已有研究证实，经前期综合征患者的下丘脑-垂体-肾上腺（hypothalamic-pituitary-adrenal, HPA）轴功能已处于亚最优状态，因此吸烟可能会进一步损害该轴的功能。综合来看，这使得该人群中经前期综合征与烟草使用障碍的临床治疗过程更为复杂。