Abnormal Development - Smoking
|Embryology - 20 Aug 2017 Expand to Translate|
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|Educational Use Only - Embryology is an educational resource for learning concepts in embryological development, no clinical information is provided and content should not be used for any other purpose.|
There is an association between physical defects among newborns and maternal smoking tobacco during pregnancy.
Spontaneous abortion, ectopic implantation, pre-term births, low-weight full-term babies, and fetal and infant deaths all occur more frequently among mothers who smoke during pregnancy than among those who do not. These developmental abnormalities are therefore environmental (maternal) in origin and not congenital (though there are probably genetics involved with a tendency to smoke).
The possible relationship to preterm birth generates one major clinical problem, as preterm birth results in 47% of all neonatal deaths (UK data).
Also of great concern is that smoking is a suggested causative factor for low infant birth weight (LBW) (2.500kg and below). LBW is in turn related to future (postnatal) health by the fetal origins hypothesis.
Some Recent Findings
Early Hum Dev. 2013 Jul;89(7):497-501. doi: 10.1016/j.earlhumdev.2013.03.007. Epub 2013 Apr 8.
|More recent papers|
This table shows an automated computer PubMed search using the listed sub-heading term.
References listed on the rest of the content page and the associated discussion page (listed under the publication year sub-headings) do include some editorial selection based upon both relevance and availability.
Kevin Marquez, Kalyan Chakravarthy Potu, Chad Laurich, Randall Lamfers Pulmonary Embolism Caused by Popliteal Vein Aneurysm: A Case Report. S D Med: 2017, 70(3);123-125 PubMed 28813774
Jesper Fleischer, Esben Laugesen, Simon Lebech Cichosz, Pernille Hoeyem, Thomas Fremming Dejgaard, Per Loegstrup Poulsen, Lise Tarnow, Troels Krarup Hansen Continuous glucose monitoring adds information beyond HbA1c in well-controlled diabetes patients with early cardiovascular autonomic neuropathy. J. Diabetes Complicat.: 2017; PubMed 28728915
Angela Zhang, Robert Marshall, Gary Kelsberg Clinical Inquiry: What effects--if any--does marijuana use during pregnancy have on the fetus or child? J Fam Pract: 2017, 66(7);462-466 PubMed 28700762
Nicole G Barra, Maria Lisyansky, Taylor A Vanduzer, Sandeep Raha, Alison C Holloway, Daniel B Hardy Maternal nicotine exposure leads to decreased cardiac protein disulfide isomerase and impaired mitochondrial function in male rat offspring. J Appl Toxicol: 2017; PubMed 28681937
Yu Lili, Ma Jian, Gao Junpeng, Zhai Kun, Zhu Jinfang, Huang Yongqing [Association between non-syndromic cleft lip with or without cleft palate and environmental factors in Ningxia]. Hua Xi Kou Qiang Yi Xue Za Zhi: 2017, 35(3);291-295 PubMed 28675015
Search term: Pregnancy Smoking
Sanne D van Otterdijk, Alexandra M Binder, Karin B Michels Locus-specific DNA methylation in the placenta is associated with levels of pro-inflammatory proteins in cord blood and they are both independently affected by maternal smoking during pregnancy. Epigenetics: 2017; PubMed 28820654
Emmanuel Angulo-Castro, Luis F Acosta-Alfaro, Alma M Guadron-Llanos, Adrian Canizalez-Román, Fernando Gonzalez-Ibarra, Ignacio Osuna-Ramírez, Joel Murillo-Llanes Maternal Risk Factors Associated with the Development of Cleft Lip and Cleft Palate in Mexico: A Case-Control Study. Iran J Otorhinolaryngol: 2017, 29(93);189-195 PubMed 28819616
Sulistyo E Dwi Putra, Christoph Reichetzeder, Martin Meixner, Karsten Liere, Torsten Slowinski, Berthold Hocher DNA methylation of the glucocorticoid receptor gene promoter in the placenta is associated with blood pressure regulation in human pregnancy. J. Hypertens.: 2017; PubMed 28817493
Jacob K Kresovich, Yinan Zheng, Andres Cardenas, Brian T Joyce, Sheryl L Rifas-Shiman, Emily Oken, Matthew W Gillman, Marie-France Hivert, Andrea A Baccarelli, Lifang Hou Cord blood DNA methylation and adiposity measures in early and mid-childhood. Clin Epigenetics: 2017, 9;86 PubMed 28814982
Alice Panchaud, Sonia Hernandez-Diaz, Marlene P Freeman, Adele C Viguera, Sarah C MacDonald, Alexandra Z Sosinsky, Lee S Cohen Use of atypical antipsychotics in pregnancy and maternal gestational diabetes. J Psychiatr Res: 2017, 95;84-90 PubMed 28810177
Nicotine is a natural ingredient in tobacco leaves, where as an alkaloid it provides some protection for the plant being eaten by insects by acting as a botanical insecticide.
Tobacco also contains other minor alkaloids nornicotine, anatabine and anabasine.
There is a chemical datasheet for nicotine, the pure chemical, note that commercial tobacco products include many additional chemicals.
Neonates have a decreased ability to metabolise nicotine, with a 3-4 times longer half-life in newborns exposed to tobacco smoke compared with adults.
Cytochrome P450, Subfamily IIA, Polypeptide 6 (CYP2A6) is the main enzyme in the liver responsible for metabolism (oxidation) of nicotine. (More? OMIM Entry CYP2A6) and there are known mutations that occur in this gene which would also impact on nicotine metabolism.
See also the recent review paper Metabolism and disposition kinetics of nicotine. Hukkanen J, Jacob P 3rd, Benowitz NL. Pharmacol Rev. 2005 Mar;57(1):79-115. | Dempsey D, Jacob P 3rd, Benowitz NL. Nicotine metabolism and elimination kinetics in newborns. Clin Pharmacol Ther. 2000 May;67(5):458-65. | OMIM Entry CYP2A6
Smoking tobacco is also a source of carbon monoxide (CO), a colourless and odorless gas formed mainly as a by-product of incomplete combustion of hydrocarbons and can cause cytotoxicity by tissue hypoxia.
A recent study has identified in a newborn mouse model, effects on neurodevelopment of even sub-clinical levels of carbon monoxide.
- enters circulation though the respiratory system
- binding to haemoglobin to form carboxy-haemoglobin (COHb)
- haemoglobin affinity is 240 times greater than for oxygen
- fetal haemoglobin binds with even greater affinity
- tissue hypoxia occurs when COHb levels are greater than 70%
Australian National Drug Strategy Household Survey 1995
Below are excerpted statistics from the 1995 household survey.
Smoking is higher among young women than young men, although males tend to smoke more heavily. Among 14-19 year olds: 13% are current regular smokers, 5% are occasional smokers, while 49% have never smoked.
For more information please email CEIDA Information Centre
Exposure of non-smokers to environmental tobacco smoke, "passive smoking", has been associated with a substantial increased disease risk (coronary heart disease, cancer) a recent study now adds diabetes to the possible deletirious effects. Houston TK, Kiefe CI, Person SD, Pletcher MJ, Liu K, Iribarren C. Active and passive smoking and development of glucose intolerance among young adults in a prospective cohort: CARDIA study. BMJ. 2006 May 6;332(7549):1064-9. "These findings support a role of both active and passive smoking in the development of glucose intolerance in young adulthood."
Smoking and Pregnancy
Smoking doubles the risk of having a low-birthweight baby and significantly increases the rate of perinatal mortality and several other adverse pregnancy outcomes. The mean reduction in birthweight for babies of smoking mothers is 200 g. High quality interventions to help pregnant women quit smoking produce an absolute difference of 8.1% in validated late-pregnancy quit rates. If abstinence is not achievable, it is likely that a 50% reduction in smoking would be the minimum necessary to benefit the health of mother and baby. Healthcare providers perform poorly in antenatal interventions to stop women smoking. Midwives deliver interventions at a higher rate than doctors. The efficacy of nicotine replacement therapy has not been established in pregnancy. Currently, its use should only be considered in women smoking more than 10 cigarettes per day who have made a recent, unsuccessful attempt to quit and who are motivated to quit. Relapse prevention programs have shown little success in the postpartum period. Data from: Quitting smoking in pregnancy Raoul A Walsh, John B Lowe, Peter J Hopkins (MJA 2001; 175: 320-323)
A review of three placental markers showed "maternal smoking impairs human placental development by changing the balance between cytotrophoblast (CTB) proliferation and differentiation"
Data in this graph from AIHW 2014 Report, Birthweight of babies born to Indigenous mothers.
- Links: Birth Weight
- Sharon A McGrath-Morrow, Madoka Hayashi, Angela Aherrera, Armando Lopez, Alla Malinina, Joseph M Collaco, Enid Neptune, Jonathan D Klein, Jonathan P Winickoff, Patrick Breysse, Philip Lazarus, Gang Chen The Effects of Electronic Cigarette Emissions on Systemic Cotinine Levels, Weight and Postnatal Lung Growth in Neonatal Mice. PLoS ONE: 2015, 10(2);e0118344 PubMed 25706869 | PLoS One.
- Leonie S Brose Helping pregnant smokers to quit. BMJ: 2014, 348;g1808 PubMed 24620362
- Gerrit van den Berg, Manon van Eijsden, Francisca Galindo-Garre, Tanja G M Vrijkotte, Reinoud J B J Gemke Smoking overrules many other risk factors for small for gestational age birth in less educated mothers. Early Hum. Dev.: 2013, 89(7);497-501 PubMed 23578734
- J Spiegler, R Jensen, H Segerer, S Ehlers, T Kühn, A Jenke, C Gebauer, J Möller, T Orlikowsky, F Heitmann, K Boeckenholt, E Herting, W Göpel Influence of smoking and alcohol during pregnancy on outcome of VLBW infants. Z Geburtshilfe Neonatol: 2013, 217(6);215-9 PubMed 24363249
- H Rob Taal, J J Miranda Geelhoed, Eric A P Steegers, Albert Hofman, Henriette A Moll, Maarten Lequin, Albert J van der Heijden, Vincent W V Jaddoe Maternal smoking during pregnancy and kidney volume in the offspring: the Generation R Study. Pediatr. Nephrol.: 2011, 26(8);1275-83 PubMed 21617916
- Julia de B Machado, V M Plínio Filho, Guilherme O Petersen, José M Chatkin Quantitative effects of tobacco smoking exposure on the maternal-fetal circulation. BMC Pregnancy Childbirth: 2011, 11;24 PubMed 21453488
- Cheng Y, Thomas A, Mardini F, Bianchi SL, Tang JX, et al. (2012) Neurodevelopmental Consequences of Sub-Clinical Carbon Monoxide Exposure in Newborn Mice. PLoS ONE 7(2): e32029. PLoS One
- T Zdravkovic, O Genbacev, M T McMaster, S J Fisher The adverse effects of maternal smoking on the human placenta: a review. Placenta: 2005, 26 Suppl A;S81-6 PubMed 15837073
- AIHW 2014. Birthweight of babies born to Indigenous mothers. Cat. no. IHW 138. Canberra: AIHW. Viewed 5 August 2014 http://www.aihw.gov.au/publication-detail/?id=60129548202
Eric Jauniaux, Graham J Burton Morphological and biological effects of maternal exposure to tobacco smoke on the feto-placental unit. Early Hum. Dev.: 2007, 83(11);699-706 PubMed 17900829
Carolina C Venditti, Richard Casselman, Graeme N Smith Effects of chronic carbon monoxide exposure on fetal growth and development in mice. BMC Pregnancy Childbirth: 2011, 11;101 PubMed 22168775
Olga Genbacev, Michael T McMaster, Tamara Zdravkovic, Susan J Fisher Disruption of oxygen-regulated responses underlies pathological changes in the placentas of women who smoke or who are passively exposed to smoke during pregnancy. Reprod. Toxicol.: 2003, 17(5);509-18 PubMed 14555188
Search Pubmed: smoking and pregnancy
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Cite this page: Hill, M.A. 2017 Embryology Abnormal Development - Smoking. Retrieved August 20, 2017, from https://embryology.med.unsw.edu.au/embryology/index.php/Abnormal_Development_-_Smoking
- © Dr Mark Hill 2017, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G