Feto-Placental Atherosclerotic Lesions in Intrauterine Fetal Demise: Role of Parental Cigarette Smoking

Abstract

The atherogenic effect of cigarette smoking is already recognizable in coronary arteries of fetuses in the last gestational weeks. In this study we analyzed the atherogenic effect of mother’s and father’s smoking habit on coronary arteries and even on adnexa of 30 human fresh fetuses died from 32 to 41 gestational weeks. In 12 cases only the mothers of the victims were cigarette smokers, in 7 cases only the fathers were smokers, whereas in 11 cases nobody smoked.We observed pre-atherosclerotic and initial atherosclerotic lesions of the adnexa in 21 cases, of which 11 cases had only mother smokers and 6 cases only father smokers. The atherogenic effect is statistically significant in both smoker groups, but stronger in maternal one. The atherosclerotic lesions found in umbilical and placental arteries are similar to those described in fetal coronary arteries: thickening of the arterial walls caused by proliferation and migration of the smooth muscle cells of the tunica media with loss of polarity and infiltration of the subendothelial connective tissue.

The First 5-Year-Long Survey on Intrauterine Unexplained Sudden Deaths from the Northeast Italy

“…In particular, exposure to tobacco smoke in utero is the most important preventable risk factor. The smoking, in fact, causes vasoconstriction and reduces the fetal oxygenation and blood flow [34][35][36][37]. In addition, air pollution, which features high rates of both gases (carbon monoxide, nitrogen dioxide, ozone, and sulfur dioxide) and particulate matter (above all PM 10 , with a median diameter of <10 µm), could have an important influence in determining SIUDS [32].…”

Severe intra- and periventricular hemorrhage: role of arteriolosclerosis related to maternal smoke

“…It is important to stress that cerebral arteriolosclerosis is a part of the systemic process of feto-adnexial atherosclerosis [14,16,17]. In fact, atherosclerotic lesions in the arteries of various arterial districts are already recognizable in the fetus in the last weeks of gestation, even in the arteries of adnexa.…”

“…In addition to the direct hemodynamic effects, toxic effects of the gaseous components released during the combustion of nicotine have been shown to damage the arterial wall [15,27]. Therefore, cigarette smoking is an important causal factor of prenatal pathology, also in unexpected and unexplained fetal death [14][15][16][17][28][29][30][31][32][33]. Hence, the strong atherogenic effect of cigarette smoking on human arteries already begins in fetal life, probably in genetically predisposed individuals.…”

“…It is also known that the occurrence of atherosclerotic lesions in fetuses of smoking mothers, especially in the arteries of large and medium caliber [14][15][16][17]. The aim of this work is to describe the atherosclerotic lesions of the cerebral arterioles, as a substrate of their rupture and bleeding, and to evaluate whether prenatal absorption of nicotine could be related to the pathogenesis of IV-PVH.…”

Pathogenesis of coronary artery disease: focus on genetic risk factors and identification of genetic variants

“…Although clinical ischemic cardiovascular events usually appear after the fifth decade of life in men and the sixth decade of life in women, this process starts early in life, even during fetal development. 3 …”