Abnormal Development - Smoking
|Embryology - 25 May 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.
Andrew J Skabelund, Frederic A Rawlins, Edward T McCann, Joshua A Lospinoso, Lorraine Burroughs, Roger A Gallup, Michael J Morris Pulmonary Function and Respiratory Health of Military Personnel Before Southwest Asia Deployment. Respir Care: 2017; PubMed 28465382
I V Koning, J Dudink, I A L Groenenberg, S P Willemsen, I K M Reiss, R P M Steegers-Theunissen Prenatal cerebellar growth trajectories and the impact of periconceptional maternal and fetal factors. Hum. Reprod.: 2017;1-8 PubMed 28453631
Nikolaos Garmpis, Christos Damaskos, Nikolaos Patelis, Dimitrios Dimitroulis, Eleftherios Spartalis, Ioannis Tomos, Anna Garmpi, Michael Spartalis, Efstathios A Antoniou, Konstantinos Kontzoglou, Periklis Tomos Large thoracic tumor without superior vena cava syndrome. Folia Morphol. (Warsz): 2017; PubMed 28394008
Daniel D Droukas, Stephen C Machnicki A 28-Year-Old Woman With Branching Opacity and Chest Pain. Chest: 2017, 151(4);e85-e89 PubMed 28390642
Shannon Kispert, Susan Crawford, Grant Kolar, Jane McHowat In Vivo Effects of Long-Term Cigarette Smoke Exposure on Mammary Tissue in Mice. Am. J. Pathol.: 2017; PubMed 28388394
Search term: Pregnancy Smoking
A H Al-Ani, J S Antoun, W M Thomson, T R Merriman, M Farella Maternal Smoking during Pregnancy Is Associated with Offspring Hypodontia. J. Dent. Res.: 2017;22034517711156 PubMed 28535361
M P Velez, T E Arbuckle, P Monnier, W D Fraser Is maternal periconceptional smoking associated with 2D:4D digit ratio in their children? J Dev Orig Health Dis: 2017;1-7 PubMed 28532524
Ivori Zvorsky, Joan M Skelly, Stephen T Higgins Effects of Financial Incentives for Smoking Cessation on Mood and Anxiety Symptoms Among Pregnant and Newly Postpartum Women. Nicotine Tob. Res.: 2017; PubMed 28531302
Yi-Chang, Chang-Chin Yeh, Peng-Hui Wang Voluntary and involuntary smoking during pregnancy. J Chin Med Assoc: 2017; PubMed 28529024
Constantin M Durnea, Ali S Khashan, Louise C Kenny, Uliana A Durnea, James C Dornan, Suzanne M O'Sullivan, Barry A O'Reilly What is to blame for postnatal pelvic floor dysfunction in primiparous women-Pre-pregnancy or intrapartum risk factors? Eur. J. Obstet. Gynecol. Reprod. Biol.: 2017, 214;36-43 PubMed 28525825
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 May 25, 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