Consequences of Smoking during Pregnancy on Maternal Health

Abstract

Objective: To estimate the incidence of maternal cardiovascular and pulmonary events and the prevalence of other comorbid conditions among pregnant smokers. Methods: We queried the Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ) for pregnancy-related discharge codes for the years 2000-2004. The prevalence of various conditions and the incidence of various complications were compared between smokers and nonsmokers. Results: The majority of smokers were young and white and had public insurance. Smokers were more likely to have experienced deep vein thrombosis (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.1, 1.6), stroke (OR 1.7, 95% CI 1.2, 2.5), pulmonary embolus (OR 2.5, 95% CI 2.1, 3.0), and myocardial infarction (OR 4.6, 95% CI 3.3, 6.4). They were 3 times more likely to have experienced influenza or pneumonia (OR 2.9, 95% CI 2.7, 3.2) and 15 times more likely to have bronchitis (OR 15.2, 95% CI 12.8,18.2). They were more likely to suffer from a number of comorbidities, including asthma (OR 4.0, 95% CI 3.7, 4.2) and gastrointestinal ulcers (OR 3.7, 95% CI 2.6, 5.5). Although they were less likely to have experienced gestational diabetes (OR 0.9, 95% CI 0.9, 1.0), preeclampsia (OR 0.8, 95% CI 0.8, 0.9), or eclampsia (OR 0.7, 95% CI 0.6, 0.9), they were more than 5 times as likely to have experienced an ectopic pregnancy (OR 5.4, 95% CI 4.6, 6.3). Conclusions: Smoking has a negative impact on maternal health. Counseling about the risks of smoking in pregnancy should include not only fetal risks but maternal risks as well.

Folate Metabolism and Preeclampsia

“…Since a study which was published in the New England Journal of Medicine in 1999, indicated that the risk of developing PE was 32% lower in women who smoked than in nonsmokers 68 , other studies have reported similar observations. A systemic review identified 48 epidemiologic studies on the association between smoking and PE from 1959 to 2006.…”

“…The review concluded that smoking during pregnancy reduces the risk of PE by up to 50% with a dose-response pattern. A protective effect was consistely found in both nulliparas and multiparas, singleton and multifetal pregnancies 68 .…”

“…Some investigators have hypothesized that carbon monoxide (CO) produced by cigarette smoking may be the substance that underlies the negative association 68 . However, Engel et al 69 found that smoking is only protective against PE in women without pre-gestational hypertension, and even then principally among younger women.…”

Prevalência do uso de drogas de abuso por gestantes

“…(7)(8)(9)(10) The harmful effects of smoking are very subtle and harder to identify in relation to illicit drugs, and its use can go unnoticed to healthcare professionals, bringing consequences both during pregnancy and breastfeeding. (11,12) Approximately 80% of smoking women continue the habit during pregnancy. In the past few decades, there was a decrease in the number of people who smoke, due to the increase in campaigns and local bans.…”

Cardiovascular Diseases among Women

“…Analytické zpracování výsledků rozsáh-lé studie Healthcare and Utilization Project (HCUP) dokumentovalo zvýšení rizika u těhotných kuřaček ve srovnání s nekuřačkami pro hluboké venózní trombózy (OR 1,3; 95% CI 1,1-1,6), plicní embolii (OR 2,5; 95% CI 2,1-3,0), MM (OR 1,7; 95% CI 1,2-2,5) a IM (OR 4,6; 95% CI 3,3-6,4). Kuřačky měly rovněž signifikantně zvýšenou přítomnost různých komorbidit (zejména zá-nětů průdušek a plic, astmatu, gastrointestinálních vře-dů a atopického ekzému) (46). Z hlediska následných kardiovaskulárních onemocnění je závažný výskyt preeklampsie v průběhu těhoten-ství; je to klinický syndrom spojený s hypertenzí a proteinurií.…”