Smoking in pregnancy

2015. 10 전임의 최은정

Introduction

In the US : about 16 % of pregnant women smoke In Korea : 8-10%

Smoking during pregnancy in US About 910 infant deaths annually from 1997 through

2001 More than $350 million per year for neonatal care costs

In cigarette smoke Carbon monoxide Nicotine Cotinine Cyanide Arsenic Lead Propylene glycol Thiocyanate More than 4,000 chemicals

Fetal high concentra-tions of

carboxyhemoglobin

Decrease amount of oxygen carried to cells

Affects intracellular processes by impairing cytochrome enzymes

Carboxyhemoglobin in fetus & adult

or

Acetylcholine (ACh) on embryo Initiation of axons and dendrites, migration of nerve cells,

synaps function and localization of specific nerve cell popu-lations.

Later, effects on hippocampal, cerebellar, and sensory cor-tex development.

Nicotine stimulates nicotine acetylcholine receptor(nAChR)

Intensity and timing of brain cell development

Programming of neurodevelopmental events on a cellular level

Prenatal nicotine exposure and nervous system development

Adverse effects of smoking during regnancy

Intrauterine growth retardation (2-3 fold) Low birth weight (200gm light on average) : DOSE DEPENDENT!!

Stop during the first half of GA : virtually normal Long-term effects

Physical growth, mental development, and behavioral prob-lem

Mean 8-point decrement in IQ test in heavy smokers Nicotine dependence in 40 year old daughters (not son)

Malformation : not major teratogen Club foot Craniosynostosis : “moderately increased” risk

(odds ratio 1.5) Premature closure of sagittal suture

Facial clefts Hydrocephaly, microcephaly Omphalocele, gastroschisis Hand abnormalites

Placenta previa, placenta abruption and preterm de-livery

Spontaneous abortion Sudden infant death syndrome (SIDS)

After birth : lactation and neonatal period

Nicotine from cigarettes : concentrated in human milk

Nicotine patch vs. smoking : comparable or less Impeded iodine transport into milk in smoking

mother

After birth : childhood Childhood cancer (leukemia)

Paternal smoking around conception : prior to 5YO child cancer

(leukemias, lymphomas, and brain tumors) Pulmonary function With schizophrenic parents(A 2014 study)

Later schizophrenia : double percentage as controls Higher food allergic sensitization (OR : 2.2)

Reproduction Male

Erectile function impair by compromising arterial flow to penis

Sperm abnormalities Female

Greater variation in menstrual cycle Childhood exposure : adversely affect fecundity Exposure to cigarette smoking actively or passively

Higher serum FSH concentration Poorer follicle function when undergoing ART