Clearing the Smoke Assessing the Science Base for Tobacco Harm Reduction (2001) / Chapter Skim
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15 Reproductive and Developmental Effects
15 Reproductive and Developmental Effects
Pages 543-559
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From page 543... ...
The harmful effects of cigarette smoke exposure during pregnancy have been well known for decades; nevertheless, a significant fraction of pregnant women continue to smoke and smoking continues to account for an estimated 10% of all fetal mortality (Kleinman et al., 1988~. The percentage of women who smoke during pregnancy declined from 13.6% in 1996 to 12.9% in 1998 with rates being highest for non-Hispanic whites, American Indian, and Hawaiian women and for women of lower socioeconomic and educational levels (CDC, 1998, 1999, 2000~.
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From page 544... ...
, a tobacco smoke toxin (Cooper et al., 1999~. Furthermore, an evaluation of the Women's Health Study found that current and former smokers, after adjusting for age, race, education, marital status, number of sexual partners, frequency of intercourse, history of gonorrhea, and current method of contraception, had a significantly increased risk of pelvic inflammatory disease, possibly related to impairment of immunity and altered tubal
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From page 545... ...
Although recent large prospective study found no consistent evidence of an association between environmental tobacco smoke and spontaneous abortion (Windham et al., 1999) , a few earlier studies have described such a relationship (Ahlborg and Bodin, 1991; Chatenoud et al., 1998; Windham et al., 1992~.
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From page 546... ...
There has been consistent evidence that smoking is an independent risk factor for placenta previa and placental abruption after control for potential confounders including maternal age and parity, hypertension, preeclampsia, and alcohol use. Studies have suggested a dose-dependent association between reported numbers of cigarettes smoked and placental complications, but the data have been inconclusive (Ananth et al., 1996; Handler et al., 1994; reviewed in Andres, 1996~.
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From page 547... ...
found no improvement of gestational age with smoking reduction but did show a significant improvement after smoking cessation. The mechanism of smoke-attributed preterm delivery is not certain but may be related to intrauterine infections secondary to decreased immunity, structural abnormalities especially the loss of integrity of type III collagen, or the increase in production of prostaglandin (PGE2)
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From page 548... ...
A recent Swedish study found an OR of 2.4 for low birthweight infants among nonsmoking mothers exposed to ETS and an OR of 3.6 for smoking mothers exposed to ETS (Dejin-Karlsson et al., 1998~. Paternal smoking has also been shown to have an adverse effect on infant birthweight.
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From page 549... ...
Cyanide in tobacco smoke can decrease stores of vitamin By, a cofactor for fetal growth (Ness et al., 1999~. Additionally, smoking-related maternal and fetal nutritional deficits caused by cigarette smoking have been postulated as mechanisms for fetal growth retardation.
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From page 550... ...
Furthermore, conduct disorder and disruptive behavior have been found to have a weak doserelated association with maternal cigarette smoking after control for confounding social factors (Fergusson et al., 1993~. Postulated mechanisms of cognitive impairment involve effects of cigarette smoking on the fetus including chronic hypoxia, decreased nutrition, and direct toxicity to cortical tissue by toxins such as CO, nicotine, and lead in cigarette smoke.
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From page 551... ...
suggests that the detrimental effects on respiratory function occur before the last trimester and further supports the predominant effects of in utero smoke exposure compared to postnatal ETS exposure. Suggested mechanisms of airway dysfunction caused by cigarette smoke exposure during pregnancy include decreased airway compliance, poor bronchial tree development, and emphysema-like changes of the alveoli (Cunningham et al., 1994; Lodrup Carlsen et al., 1997~.
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From page 552... ...
CONCLUSIONS Exposure to cigarette smoking is a major cause of fetal and infant morbidity and mortality. This is particularly true for the association with low birthweight and it consequences, as well as for preterm delivery and SIDs.
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From page 553... ...
For example, dose may be measured by maternal serum and urine cotinine levels, which have shown reliable correlations with maternal and consequently fetal tobacco smoke exposure. Self-reported smoking data can be unreliable, since pregnant women who have been advised to quit tend to under report tobacco use because of the stigma attached to smoking (Kendrick et al., 1995~.
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From page 554... ...
Should adverse findings become apparent, there may substantial implications for risk of chronic illnesses among nonpregnant adults, and coordinated pathogenic studies might allow conclusions on new tobacco product outcomes in advance of studies exploring longer "incubation periods." Studies on the Component Exposures of PREPs The committee recommends that further basic research be undertaken to elucidate the components of cigarette smoke that are primarily responsible for adverse health outcomes. In order to evaluate the safety of many PREPs, it is important to understand the effect of smoke components, especially nicotine and CO, on the pathogenesis of intrauterine growth retardation, spontaneous abortions and other health outcomes.
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From page 555... ...
1996. Maternal cigarette smoking as a risk factor for placental abruption, placenta previa, and uterine bleeding in pregnancy.
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From page 556... ...
1991. Increased risk of ectopic pregnancy with maternal cigarette smoking.
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1990. Cigarette smoking as a risk factor for pelvic inflammatory disease.
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From page 558... ...
2000. A systematic review and meta-analysis of prospective studies on the association between maternal cigarette smoking and preterm delivery.
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From page 559... ...
2000. Prenatal active or passive tobacco smoke exposure and the risk of preterm delivery or low birth weight.
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