Smoking and pregnancy
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National and Kapodistrian University of Athens, Medical Faculty. Hellenic Cancer Society, Research Centre for Smoking and Lung Cancer, sponsorship from George D. Behrakis
Adjunct Associate Professor of Physiology, Department of Environmental Health, School of Public Health, Harvard University
Andriani Loukopoulou   

V. Othonos 65, Kifisia, 14561 Attiki
Pneumon 2010;23(2):160–167
Maternal smoking during pregnancy is considered to be one of the most significant causes of complications in pregnancy and is associated with an unfavourable outcome in childbirth compared with pregnancy in non-smokers. Specifically, smoking during pregnancy increases the likelihood of placenta praevia, abruptio placentae, ectopic gestation and premature rupture of the membranes (PRM). In addition, research has established that smoking during pregnancy increases the rates of low birth weight (LBW), perinatal mortality, premature birth and sudden infant death syndrome (SIDS). As these children grow up they present a variety of health problems, including respiratory illness, behaviour disturbances, attention deficit hyperactivity disorder (ADHD) and high arterial blood pressure. LBW is also associated with an increased incidence of health problems in the neonatal period. Effects have been documented of maternal smoking during pregnancy on the future fertility of male infants and the occurrence of congenital abnormalities, and a connection has been reported between daily maternal smoking in early pregnancy and infantile autism.
Οrganization for Economic Co-Operation and Development. Health at a Glance 2007: OECD Indicators, 2007.
European Network for smoking Prevention, Annual Report. Bruxelles; 2007.
Schuz J, Kaatsch P, Kaletsch U, et al. Association of childhood cancer with factors related to pregnancy and birth. Int J Epidemiol 1999;28:631–9.
Chatenoud L, Chiaffarino F, Parazzini F, et al. Prevalence of smoking among pregnant women is lower in Italy than England.BMJ1999; 318:1012.
DeFarias AragaoVM, Barbieri MA, MouraDaSilva AA, et al. Risk factors for intrauterine growth restriction: a comparison between two Brazilian cities. Pediatr Res 2005;57:674–9.
Grange G, Vayssiere C, Borgne A, et al. Description of tobacco addiction in pregnant women. Eur J Obstet Gynecol Reprod Biol 2005;120:146–51.
Viljoen JE, Odendaal HJ. Smoking in pregnancy—what does my patient know? S.Afr Med J 2005;95: 308–10.
Hoyert DL, Mathews TJ, Menacker F, et al. Annual summary of vital statistics: 2004. Pediatrics 2006;117:168–83.
Pichini S, Garcia-Algar O. In utero exposure to smoking and newborn neurobehavior: how to assess neonatal withdrawal syndrome? Ther Drug Monit 2006;28:288–90.
Cnattingius S, Haglund B. Decreasing smoking prevalence during pregnancy in Sweden: the effect on small-for-gestational-age births. Am J Public Health 1997;87:410-413.
Pitsiou GG, Argyropoulou-Pataka P. Woman and smoking Pneumon 2007;20:1:27-42.
Luck W, Nau H, Hanesen R, et al. Extent of nicotine and cotinine transfer to the human fetus, placenta and amniotic fluid of smoking mothers. Dev Pharmacol Ther1985;8:384–395.
Lambers D, Clark K. The maternal and fetal physiologic effects of nicotine. Semin Perinatol 1996;20:115–126.
Hill E, Hill J, Power G, et al. Carbon monoxide exchanges between the human fetus and mother: a mathematical model. Am J Physiol 1977;232:H311–323.
Benowitz N. Nicotine replacement therapy during pregnancy. JAMA 1991;266:3174–3177.
Perry CL, Silvis GL. Smoking Prevention: Behavioural prescriptions for the pediatrician. Pediatrics 1987;79:790-99.
Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bulletin of the World Health Organisation 1987;65:663-737.
Kleinman J, Pierre MJ, Madans J, et al. The effects of maternal smoking on fetal and infantmortality. Am J Epidemiol 1988;127:274–282.
Ventura SJ, Martin JA, Taffel SM, et al. Advance report of final natality statistics, 1993. Monthly Vital Stat Rep 1995;44 (suppl):1-88.
Creatsas G. Modern obstetrics and gynecology. Obstetrics. Paschalidis PH, Αthens, 1998, pp. 162,280.
Chasman AH. The effect of tobacco and coffee in the placenta ultrasound depiction. PhD Thesis. Department of Medicine, University of Patras, 1990.
Bush PG, Mayhew TM, Abramovich DR, et al. A quantative study on the effects of maternal smoking on placental morphology and cadmium concentration. Placenta 2000;21:247-56.
Genbacev O, McMaster MT, Zdravkovic T, et al. Disruption of oxygen-regulated responses underlies pathological changes in the placentas of women who smoke or who are passively exposed to smoke during pregnancy Reproductive Toxicology 2003;17:509–518.
Creatsas G. Modern obstetrics and gynecology. Gynecology. Paschalidis PH, Αthens, 1998, p.313.
Handler A, Davis F, Ferre C, et al. The Relationship of Smoking and Ectopic Pregnancy AJPH September 1989;79:1239-1242.
Saraiya M, Berg C, Kendrick J, et al. Cigarette smoking as a risk factor for ectopic pregnancy. Am J Obstet Gynecol 1998;178: 493-498.
Salamalekis Ε. Special Topics in Fetal Medicine. Publications of the 3rdDepartment of Obstetrics and Gynaecology. General University Hospital ‘ATTIKON’, Athens, 2003 p. 107.
Meyer M, Tonascia J. Perinatal events associated with maternal smoking during pregnancy. Am J Epidemiol 1976; 1103:464–476.
Castles A, Adams K, Melvin CL, et al. Effects of smoking during Pregnancy: five meta-analyses. Am J Prev Med 1999;16;3:208- 215.
Avanth CV, Cnattigious S. Influence of maternal smoking on placental abruption in successive pregnancies: A population –based prospective cohort study in Sweden. Am J Epidemiol 2007:1-7.
Monica G, Lilja C. Placenta previa, maternal smoking and recurrence risk. Acta Obstet Gynecol Scand 1995;74:341–345.
Ananth CV, Demissie K, Smulian JC, et al. Placenta previa in singleton and twin births in the United States,1989 through 1998:A comparison of risk factor profiles and associated conditions. Am J Obstet Gynecol 2003;188:275-281.
Williams M, Mittendorf A, Stubblefield P, et al. Cigarettes, coffee and preterm premature rupture of the membranes. Am J Epidemiol 1992;135;8:895-903.
Hadley C, Main D, Gabbe, S. Risk factors for preterm premature rupture of the fetal membranes. Am J Perinatol 1990;7: 374–379.
United Nations. Framework Convention on Tobacco Control of World Health organisation, New York, 2003.
Simpson WJ. A preliminary report on cigarette smoking and the incidence of prematurity. Am J Obstet Gynecol 1957;73: 4: 808.
Hofhuis W, de Jongste JC, Merkus PJF. Adverse health effects of prenatal and postnatal tobacco smoke exposure on children. Arch Dis Child 2003;88:1086-1090.
United Nations. Convention of United Nations on the Rights of Child, New York, 1989.
Barker D, Osmond C, Simmonds SJ, et al. The relation of head size and thinness at birth to death from cardiovascular disease in adult life. BMJ 1993;306:422-426.
U.S. Department of Health and Human Services. Women and Smoking: A Report of the Surgeon General. Rockville; 2001.
Labropoulos L. Smoking and Pregnancy. Medicine 1992;62: 237-241.
Yu S, Park C, Schwalberg R. Factors associated with smoking cessation among U.S. pregnant women. Matern Child Health J 2002;6:89–97.
Stein R, Siegel MJ, Bauman LJ. Are Children of Moderately Low Birth Weight at Increased Risk for Poor Health? A New Look at an Old Question Pediatrics 2006;118;1:217-223.
Fergusson DM, Horwood LJ. Parental smoking and respiratory illness during early childhood: A six-year longitudinal study. Pediatr Pulmonol1985;1:99–106.
Panagoulias D. Arterial Pressure of children of mothers who are smokers at the neonatal age and the first year of life. PhD Thesis. Department of Medicine, University of Patras;1999.
Willinger M, James LS, Catz C. Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by the National Institute of Child Health and Human Development. Paediatr Path 1991;11:677-84.
Gavin NI, Wiesen C, Layton C. Review and Meta-Analysis of the Evidence On The Impact of Smoking on Perinatal Conditions Bull into SAMMECII, Final Report to the national centre for the chronic Disease Prevention and health promotion, Research Triangle Institute (RTI) RTI Project NO 7171-010, Sept 2001.
American Academy of Pediatrics. Task Force on Sudden Infant Death Syndrome. The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts; Controversies Regarding the Sleeping Environment; and New Variables to Consider in Reducing Risk. Pediatrics 2005;116:1245-1255.
U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, 2006; Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
Stick SM, Burton PR, Gurrin L, et al. Effects of maternal smoking during pregnancy and a family history of asthma on respiratory function in newborn infants. Lancet 1996;348:1060-1064.
Dezateux C, Stocks J. Lung development and early origins of childhood respiratory illness. Brit Med Bul 1997;53:40–57.
Hoo A, Henschen M, Dezateux C, et al. Respiratory Function Among Preterm Infants Whose Mothers Smoked During Pregnancy. Am. J. Respir. Crit. Care Med 1998;158;3:700-705.
Alati R, Al Mamun A, O’Callaghan M, et al. In utero and postnatal maternal smoking and asthma in adolescence. Epidemiology 2006;17:138-44.
Jaakkola JJ, Kosheleva AA, Katsnelson BA, et al. Prenatal and postnatal tobacco smoke exposure and respiratory health in Russian children. Respir Res 2006;7:48.
Bisgaard H, Dalgaard P, Nyboe J. Risk factors for wheezing during infancy. Acta Paediatr Scand 1987;76:719-726.
Xepapadaki P, Manios Y, Liarigkovinos T, et al. Association of passive exposure of pregnant women to environmental tobacco smoke with asthma symptoms in children. Pediatr Allergy Immunol 2009;20:423–429.
Skorge TD, Eagan TM, Eide GE, et al. The adult incidence of asthma and respiratory symptoms by passive smoking in uterus or in childhood. Am J Respir Crit Care Med 2005;172:61–6.
Narang I, Rosenthal M, Cremonesini D, et al. Longitudinal Evaluation of Airway Function 21 Years after Preterm Birth. Am J Respir Crit Care Med 2008;178:74-80.
Browne CA, Colditz PB, Dunster KR. Infant autonomic function is altered by maternal smoking during pregnancy. Early Hum Dev 2000;59:209–218.
Dombrowski SC, Martin RP, Huttunen MO. Gestational exposure to cigarette smoke imperils the long-term physical and mental health of offspring. Birth Defects Res A Clin Mol Teratol 2005;73:170–176.
Olds D. Tobacco exposure and impaired development: A review of the evidence. Ment Retard Dev Disabil Res Rev 1997; 3:257–269.
Brennan P, Grekin E, Mednick S. Maternal smoking during pregnancy and adult male criminal outcomes. Arch Gen Psychiatry 1999;56:215–219.
Lambe M, Hultman C, Torrång A, et al. Maternal Smoking During Pregnancy and School Performance at Age 15. Epidemiology. 2006;17;5:524-530.
Fergusson D, Lloyd M. Smoking during pregnancy and its effects on child cognitive ability from the ages of 8 to 12 years. Paediatr Perinat Epidemiol 1991;5:189 –200.
Baghurst P, Tong S, Woodward A, et al. Effects of maternal smoking upon neuropsychological development in early childhood: importance of taking account of social and environmental factors. Paediatr Perinat Epidemiol 1992; 6:403– 415.
Larroque B. Prenatal exposure to tobacco smoke and cognitive development: epidemiology studies. Journal de Gynιcologie Obstιtrique et Biologie de la Reproduction. (Paris). 2003;32: IS23–29.
Gillberg C, Wing L. Autism: not an extremely rare disorder Acta Psychiatr Scand 1999;99:399–406.
Hultman CM, Sparén P, Cnattingius S. Perinatal Risk Factors for Infantile Autism. Epidemiology 2002;13;4:417-423.
Ramlau-Hansen CH, Thulstrup AM, Storgaard L, et al. Is prenatal exposure to tobacco smoking a cause of pure semen quality? A follow-up study. Am J Epidemiol 2007;165;12:13372-9.
Himmelberger DU, Brown BW, Cohen EN. Cigarette smoking during pregnancy and the occurrence of spontaneous abortion and congenital abnormality. Am J Epidemiol 1978;108; 6:470-479.
Man LX, Chang B. Maternal Cigarette Smoking during Pregnancy increases the Risk of Having a Child with a Congenital Digital Anomaly. Plast Rreconstr Surg 2006;117;1:301-308.
Wisborg K, Henriksen TB, Obel C, et al. Smoking during pregnancy and hospitalization of the child. Pediatrics 1999;104:4: e46.