Rauchen, Nikotin und Schwangerschaft

Zusammenfassung

Zigarettenrauchen bewirkt während der Schwangerschaft und der Stillperiode erhebliche gesundheitliche Schäden am Feten und in der ersten Wachstumsphase des Säuglings. Die Mütter gehen ein erhebliches Risiko für ihr Kind ein, was nicht nur in einem erhöhten Abortrisiko, vorzeitiger Plazentalösung, reduziertem Geburtsgewicht, sondern auch in Fehlbildungen (Lippen-Kiefer-Gaumen-Spalten, Gliedmaßendefekte, polyzystische Nieren, aortopulmonale Septumdefekte, Gastroschisis, Deformation des Schädels usw.) bestehen kann. Die Entwicklung eines Down-Syndroms wird kontrovers diskutiert. Verursacht werden diese Schäden durch eine beim Rauchen auftretende Hypoxie mit nachfolgender Carboxyhämoglobinämie, wie sie auch bei CO-Vergiftungen beobachtet werden, die ebenfalls Mißbildungen zur Folge haben.

Zahlreiche Säuglinge sterben in den ersten Lebensmonaten an einem plötzlichen Kindstod (SIDS), ausgelöst durch das Rauchen der Mutter und durch Passivrauchen. Die Beteiligung von Nikotin an diesen Schäden ist bisher nicht einheitlich zu beurteilen, zumal dazu nur Tierversuche vorliegen, deren Übertragbarkeit auf den Menschen fraglich ist. Nach bisherigen Studien sind keine Mißbildungen durch Nikotin bekannt geworden. Über Veränderungen der Regulation dopaminerger Rezeptoren wurden kardiopulmonale Regulationsstörungen diskutiert, sie sind aber nicht als pathogenetisches Prinzip anzuerkennen.

Insgesamt können alle während der Schwangerschaft auftretenden kindlichen Komplikationen fast ausschließlich auf die Abbrandprodukte des Tabaks einschließlich des inhalierten CO zurückgeführt werden. Der Übergang von Nikotin in die Muttermilch ist nicht nur bei stillenden Raucherinnen gesichert, sondern es kommt auch durch das Passivrauchen von Mutter und Kind zum Anstieg von Nikotin und Cotinin in der Milch bzw. beim Säugling. Diese Befunde könnten neue Überlegungen auch im Hinblick auf eine Raucherentwöhnung der schwangeren Frau gestatten.

Abstract

Maternal cigarette smoking entails considerable risks for the fetus in utero and for the breastfed neonate. Smoking is associated with increased risks for spontaneous early pregnancy loss, placental abruption, low birth weight, and malformations (e.g., cleft lip and palette, deformations of the extremities, polycystic kidneys, aortopulmonary septum defects, gastroschisis, cranial deformations). Whether smoking increases the risk for trisomy 21 is unclear. Most smoking-related problems are du to hypoxia and subsequent carboxyhemoglobinemia similar to that occurring with carbon monoxide poisoning. During the first months of life the risk of the sudden infant death syndrome (SIDS) is markedly increased with maternal smoking or exposure to passive smoke. However, the etiologic role of nicotine in these conditions is hard to pin down because the results of animal experiments are difficult to apply to humans. Nicotine does not seem to cause malformations. It may cause cardiopulmonary episodes via dopaminergic receptors but the pathogenetic role of these effects is unclear. All smoking-related complications of pregnancy are due to nicotine, its metabolites, other inhaled substances, and inhaled carbon monoxide. Nicotine is present in the breast milk of nursing mothers who smoke actively or passively. Nicotine and cotinine have been found in the plasma and urine of non-breast-fed children of mothers who smoke actively or passively.

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