임신 중 흡연 smoking in pregnancy
TRANSCRIPT
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Smoking in pregnancy
2015. 10 전임의 최은정
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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
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In cigarette smoke Carbon monoxide Nicotine Cotinine Cyanide Arsenic Lead Propylene glycol Thiocyanate More than 4,000 chemicals
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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
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Acetylcholine (ACh) on embryo Initiation of axons and dendrites, migration of nerve cells,
synaps function and localization of specific nerve cell popula-tions.
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
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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)
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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
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Placenta previa, placenta abruption and preterm de-livery
Spontaneous abortion Sudden infant death syndrome (SIDS)
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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
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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)
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Reproduction Male
Erectile function impair by compromising arterial flow to pe-nis
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
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