Abnormal Development - Smoking

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Introduction

No smoking sign

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.


Environmental Links: Introduction | Low Folic Acid | Iodine Deficiency | Nutrition | Drugs | Australian Drug Categories | USA Drug Categories | thalidomide | herbal drugs | Illegal Drugs | smoking | Fetal Alcohol Syndrome | TORCH | viral infection | bacterial infection | Zoonotic Infection | Toxoplasmosis | Malaria | Maternal Diabetes | Maternal Hypertension | maternal hyperthermia | Maternal Inflammation | Maternal Obesity | Hypoxia | Biological Toxins | Chemicals | heavy metals | radiation | Prenatal Diagnosis | Neonatal Diagnosis | International Classification of Diseases | Fetal Origins Hypothesis

Some Recent Findings

  • Impact on birth weight of maternal smoking throughout pregnancy mediated by DNA methylation[1] "Cigarette smoking has severe adverse health consequences in adults and in the offspring of mothers who smoke during pregnancy. One of the most widely reported effects of smoking during pregnancy is reduced birth weight which is in turn associated with chronic disease in adulthood. Epigenome-wide association studies have revealed that smokers show a characteristic "smoking methylation pattern", and recent authors have proposed that DNA methylation mediates the impact of maternal smoking on birth weight. The birthweigt of newborns whose mothers had smoked throughout pregnancy was reduced by >200g. After correction for multiple testing, 30 CpGs showed differential methylation in the maternal smoking subgroup including top "smoking methylation pattern" genes AHRR, MYO1G, GFI1, CYP1A1, and CNTNAP2. The effect of maternal smoking on birth weight was partly mediated by the methylation of cg25325512 (PIM1); cg25949550 (CNTNAP2); and cg08699196 (ITGB7). Sex-specific analyses revealed a mediating effect for cg25949550 (CNTNAP2) in male newborns." epigenetics
  • The effects of electronic cigarette emissions on systemic cotinine levels, weight and postnatal lung growth in neonatal mice[2] "Electronic cigarette (E-cigarettes) emissions present a potentially new hazard to neonates through inhalation, dermal and oral contact. Exposure to nicotine containing E-cigarettes may cause significant systemic absorption in neonates due to the potential for multi-route exposure. Systemic absorption of nicotine and constituents of E-cigarette emissions may adversely impact weight and lung development in the neonate. ...These studies indicate that exposure to E-cigarette emissions during the neonatal period can adversely impact weight gain. In addition exposure to nicotine containing E-cigarettes can cause detectable levels of systemic cotinine, diminished alveolar cell proliferation and a modest impairment in postnatal lung growth." Respiratory System Development
  • Helping pregnant smokers to quit[3] "Although most smokers manage to quit during pregnancy, a proportion does not. In England, 26% of women smoke in the year before their pregnancy and 12% smoke through to delivery.1 The rate is similar in other high income countries, whereas in low and middle income countries, smoking rates are more variable and seem to be increasing among young women.2 In addition to the countless negative consequences for the smoker’s own mental and physical health, smoking in pregnancy is linked to a wide range of poor health outcomes for the child.3 Thus there is an urgent need to help pregnant smokers who find it difficult to quit."
  • Smoking overrules many other risk factors for small for gestational age birth in less educated mothers.[4] "In this study fully completed data were available for 3793 pregnant women of Dutch origin from a population-based cohort (ABCD study). Path-analysis was conducted to examine the role of explanatory factors in the relation of maternal education to SGA. ...Among a large array of potential factors, the elevated risk of SGA birth among low-educated women appeared largely attributable to maternal smoking and to a lesser extent to maternal height. To reduce educational inequalities more effort is required to include low-educated women especially in prenatal intervention programs such as smoking cessation programs instead of effort into reducing other SGA-risk factors, though these factors might still be relevant at the individual level."
More recent papers  
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This table shows an automated computer PubMed search using the listed sub-heading term.

  • Therefore the list of references do not reflect any editorial selection of material based on content or relevance.
  • References appear in this list based upon the date of the actual page viewing.

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.

Links: References | Discussion Page | Pubmed Most Recent | Journal Searches


Search term: Abnormal Development Smoking

Zakaria Hindi, Yousef Hindi, Rami Batarseh A Rare Case of Complete Heart Block in a Young Patient. Case Rep Cardiol: 2018, 2018;1493121 PubMed 29984004

Lawrence F Borges, Vikrant Jagadeesan, Hilary Goldberg, Sravanya Gavini, Wai-Kit Lo, Robert Burakoff, Natan Feldman, Walter W Chan Abnormal Bolus Reflux Is Associated With Poor Pulmonary Outcome in Patients With Idiopathic Pulmonary Fibrosis. J Neurogastroenterol Motil: 2018, 24(3);395-402 PubMed 29969857

Monira Pervin, Keiko Unno, Tomokazu Ohishi, Hiroki Tanabe, Noriyuki Miyoshi, Yoriyuki Nakamura Beneficial Effects of Green Tea Catechins on Neurodegenerative Diseases. Molecules: 2018, 23(6); PubMed 29843466

J S Wang, A H Yan [A study on P16 and HPV16 in sinonasal squamous cell carcinoma]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi: 2017, 31(24);1904-1909 PubMed 29798313

Sally Sabra, Ebba Malmqvist, Laura Almeida, Eduard Gratacos, Maria Dolores Gomez Roig Differential correlations between maternal hair levels of tobacco and alcohol with fetal growth restriction clinical subtypes. Alcohol: 2018, 70;43-49 PubMed 29778069

Search term: Pregnancy Smoking

Clare L Taylor, Matthew Broadbent, Mizanur Khondoker, Robert J Stewart, Louise M Howard Predictors of severe relapse in pregnant women with psychotic or bipolar disorders. J Psychiatr Res: 2018, 104;100-107 PubMed 30015264

Raymond Li, Jade Lodge, Christopher Flatley, Sailesh Kumar The burden of adverse obstetric and perinatal outcomes from maternal smoking in an Australian cohort. Aust N Z J Obstet Gynaecol: 2018; PubMed 30014485

Xia Xiao, Yan Li, Xiaoxiao Song, Qinghua Xu, Siwei Yang, Jie Wu, Edmund Seto Discrepancy between Self-Reported and Urine Cotinine-Verified Environmental Tobacco Smoke Exposure among Rural Pregnant Women in China. Int J Environ Res Public Health: 2018, 15(7); PubMed 30012986

Ildiko Tombor, Emma Beard, Jamie Brown, Lion Shahab, Susan Michie, Robert West Randomized factorial experiment of components of the SmokeFree Baby smartphone application to aid smoking cessation in pregnancy. Transl Behav Med: 2018; PubMed 30011020

Stella Y Lee, Chrystelle M Sirieix, Eugene Nattie, Aihua Li Pre- and early postnatal nicotine exposure exacerbates autoresuscitation failure in serotonin-deficient rat neonates. J. Physiol. (Lond.): 2018; PubMed 30008184

Older papers  
  • Influence of Smoking and Alcohol during Pregnancy on Outcome of VLBW Infants[5] "Nicotine and alcohol consumption have been associated with premature delivery and adverse neonatal outcome. We wanted to analyze the influence of self-reported nicotine and alcohol consumption on outcome of VLBW infants.In an ongoing multicenter study 2 475 parents of former very low birth weight (VLBW) infants born between January 2009 and December 2011 answered questionnaires about maternal smoking habits and alcohol consumption during pregnancy. ...Smoking during pregnancy results in a high rate of growth restricted VLBW infants. Prenatal exposition to nicotine seems to increase postnatal complications such as BPD und ROP."
  • Maternal smoking during pregnancy and kidney volume in the offspring: the Generation R Study[6] "An adverse fetal environment leads to smaller kidneys, with fewer nephrons, which might predispose an individual to the development of kidney disease and hypertension in adult life. ... Among mothers who continued smoking, we observed dose-dependent associations between the number of cigarettes smoked during pregnancy and kidney volume in fetal life. Smoking less than five cigarettes per day was associated with larger fetal combined kidney volume, while smoking more than ten cigarettes per day tended to be associated with smaller fetal combined kidney volume (p for trend: 0.002). This pattern was not significant for kidney volume at the age of 2 years. Our results suggest that smoking during pregnancy might affect kidney development in fetal life with a dose-dependent relationship."
  • Quantitative effects of tobacco smoking exposure on the maternal-fetal circulation[7] "In pregnant women who smoke, higher arterial resistance indices and lower birth weights were observed, and these findings were associated with increasing levels of tobacco smoking exposure. The values were significantly different when compared to those found in non-smoking pregnant women. This study contributes to the findings that smoking damage during pregnancy is dose-dependent, as demonstrated by the objective methods for measuring tobacco smoking exposure."

Nicotine

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


Carbon Monoxide

Mouse carbon monoxide exposure

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.[8]


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%

Epigenetics

A recent study has looked at the effect on birth weight of maternal smoking throughout pregnancy and associated epigenetic effects.[1]

"Cigarette smoking has severe adverse health consequences in adults and in the offspring of mothers who smoke during pregnancy. One of the most widely reported effects of smoking during pregnancy is reduced birth weight which is in turn associated with chronic disease in adulthood. Epigenome-wide association studies have revealed that smokers show a characteristic "smoking methylation pattern", and recent authors have proposed that DNA methylation mediates the impact of maternal smoking on birth weight. The birthweigt of newborns whose mothers had smoked throughout pregnancy was reduced by >200g. After correction for multiple testing, 30 CpGs showed differential methylation in the maternal smoking subgroup including top "smoking methylation pattern" genes AHRR, MYO1G, GFI1, CYP1A1, and CNTNAP2. The effect of maternal smoking on birth weight was partly mediated by the methylation of cg25325512 (PIM1); cg25949550 (CNTNAP2); and cg08699196 (ITGB7). Sex-specific analyses revealed a mediating effect for cg25949550 (CNTNAP2) in male newborns."


Links: epigenetics

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

Passive Smoking

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)

Placental Function

A review[9] of three placental markers showed "maternal smoking impairs human placental development by changing the balance between cytotrophoblast (CTB) proliferation and differentiation"

Australia

Australian Indigenous birthweight graph 42.jpg

Data in this graph from AIHW 2014 Report, Birthweight of babies born to Indigenous mothers.[10]


Links: Birth Weight

References

  1. 1.0 1.1 Witt SH, Frank J, Gilles M, Lang M, Treutlein J, Streit F, Wolf IAC, Peus V, Scharnholz B, Send TS, Heilmann-Heimbach S, Sivalingam S, Dukal H, Strohmaier J, Sütterlin M, Arloth J, Laucht M, Nöthen MM, Deuschle M & Rietschel M. (2018). Impact on birth weight of maternal smoking throughout pregnancy mediated by DNA methylation. BMC Genomics , 19, 290. PMID: 29695247 DOI.
  2. McGrath-Morrow SA, Hayashi M, Aherrera A, Lopez A, Malinina A, Collaco JM, Neptune E, Klein JD, Winickoff JP, Breysse P, Lazarus P & Chen G. (2015). The effects of electronic cigarette emissions on systemic cotinine levels, weight and postnatal lung growth in neonatal mice. PLoS ONE , 10, e0118344. PMID: 25706869 DOI.
  3. Brose LS. (2014). Helping pregnant smokers to quit. BMJ , 348, g1808. PMID: 24620362
  4. van den Berg G, van Eijsden M, Galindo-Garre F, Vrijkotte TG & Gemke RJ. (2013). Smoking overrules many other risk factors for small for gestational age birth in less educated mothers. Early Hum. Dev. , 89, 497-501. PMID: 23578734 DOI.
  5. Spiegler J, Jensen R, Segerer H, Ehlers S, Kühn T, Jenke A, Gebauer C, Möller J, Orlikowsky T, Heitmann F, Boeckenholt K, Herting E & Göpel W. (2013). Influence of smoking and alcohol during pregnancy on outcome of VLBW infants. Z Geburtshilfe Neonatol , 217, 215-9. PMID: 24363249 DOI.
  6. Taal HR, Geelhoed JJ, Steegers EA, Hofman A, Moll HA, Lequin M, van der Heijden AJ & Jaddoe VW. (2011). Maternal smoking during pregnancy and kidney volume in the offspring: the Generation R Study. Pediatr. Nephrol. , 26, 1275-83. PMID: 21617916 DOI.
  7. Machado Jde B, Plínio Filho VM, Petersen GO & Chatkin JM. (2011). Quantitative effects of tobacco smoking exposure on the maternal-fetal circulation. BMC Pregnancy Childbirth , 11, 24. PMID: 21453488 DOI.
  8. 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
  9. Zdravkovic T, Genbacev O, McMaster MT & Fisher SJ. (2005). The adverse effects of maternal smoking on the human placenta: a review. Placenta , 26 Suppl A, S81-6. PMID: 15837073 DOI.
  10. 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

Reviews

Jauniaux E & Burton GJ. (2007). Morphological and biological effects of maternal exposure to tobacco smoke on the feto-placental unit. Early Hum. Dev. , 83, 699-706. PMID: 17900829 DOI.


Articles

Venditti CC, Casselman R & Smith GN. (2011). Effects of chronic carbon monoxide exposure on fetal growth and development in mice. BMC Pregnancy Childbirth , 11, 101. PMID: 22168775 DOI.

Genbacev O, McMaster MT, Zdravkovic T & Fisher SJ. (2003). 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. , 17, 509-18. PMID: 14555188

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Cite this page: Hill, M.A. (2018, July 18) Embryology Abnormal Development - Smoking. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Abnormal_Development_-_Smoking

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