Smoking in pregnancy 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 concentrations 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 populations.  Later, effects on hippocampal, cerebellar, and sensory cortex 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 problem  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 delivery  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