Impact of Prenatal Tobacco Smoke Exposure, as Measured by Midgestation Serum Cotinine Levels, on Fetal Biometry and Umbilical Flow Velocity Waveforms

ABSTRACT

The aim of this prospective cohort study was to evaluate the impact of tobacco smoke exposure, measured by maternal serum concentration of cotinine, on fetal midgestation biometric parameters and umbilical artery (UA) qualitative blood flow indices. The study population consisted of 114 healthy women in 20 to 24 weeks gestation who were recruited from the patients of two antenatal care units in Lodz, Poland. Significant negative correlation was found between fetal biparietal diameter (BPD) and serum cotinine concentration. Serum cotinine positively correlated with all blood flow indices under study (systolic/diastolic index [S/D], resistance index, and pulsatility index) after controlling for gestational age, gender, and femur length. The midgestation UA S/D ratio > 3 was found to be a significant risk factor for decreased birthweight. Tobacco smoke exposure is a significant factor inducing increased resistance of umbilical blood flow as measured in 20 to 24 weeks gestation. This could be one of the main mechanisms leading to decreased birthweight observed among infants with prenatal exposure to tobacco smoke.

KEYWORDS

Environmental tobacco smoke exposure - cotinine - uteroplacental circulation

REFERENCES

• 1 Eskenazi B, Prehn A W, Christianson R E. Passive and active maternal smoking as measured by serum cotinine: the effect on birthweight.  Am J Public Health. 1995;  85 395-398
• 2 Kyrklund-Blomberg N B, Cnattingius S. Preterm birth and maternal smoking: risk related to gestational age and onset of delivery.  Am J Obstet Gynecol. 1998;  179 1051-1055
• 3 Windham G C, Hopkins B, Fenster L, Swan S H. Prenatal active or passive tobacco smoke exposure and the risk of preterm delivery or low birth weight.  Epidemiology. 2000;  11 427-433
• 4 Adams J D, O'Mara-Adams K J, Hoffmann D. Toxic and carcinogenic agents in undiluted mainstream smoke and sidestream smoke of different types of cigarettes.  Carcinogenesis. 1987;  8 729-731
• 5 Iwase A, Aiba M, Kira S. Respiratory nicotine absorption in non-smoking females during passive smoking.  Int Arch Occup Environ Health. 1991;  63 139-143
• 6 Remmer H. Passively inhaled tobacco smoke: a challenge to toxicology and preventive medicine.  Arch Toxicol. 1987;  61 89-104
• 7 U.S Department of Health, Education, and Welfare .Smoking and health: a report of the Surgeon General. Washington, DC; US GPO 1979
• 8 US Environmental Protection Agency (EPA), Department of Health and Human Services .Respiratory health effects of passive smoking: lung cancer and other disorders. NIH publication: Smoking and tobacco control monograph 4. Washington, DC; EPA, Department of Health and Human Services 1993 NIH Pub. No. 93-3605, 199
• 9 Andersen B D. Cotinine in amniotic fluids from passive smokers.  Lancet. 1982;  1 791-792
• 10 Jordanov J S. Cotinine concentrations in amniotic fluid and urine of smoking, passive smoking and non-smoking pregnant women at term and in the urine of their neonates on 1st day of life.  Eur J Pediatr. 1990;  149 734-737
• 11 Ahlborg G, Bodin L. Tobacco smoke exposure and pregnancy outcome among working women.  Am J Epidemiol. 1991;  133 338-347
• 12 Dejin-Karlsson E, Hanson B S, Ostergren P O, Sjoberg N O, Marsal K. Does passive smoking in early pregnancy increase the risk of small-for-gestational-age infants?.  Am J Public Health. 1998;  88 1523-1527
• 13 Dejmek J, Solansky I, Podrazilova K, Sram R J. The exposure of nonsmoking and smoking mothers to environmental tobacco smoke during different gestational phases of fetal growth.  Environ Health Perspect. 2002;  110 601-606
• 14 Fortier I, Marcoux S, Brisson J. Passive smoking during pregnancy and risk of delivering a small-for-gestational-age infant.  Am J Epidemiol. 1994;  139 294-310
• 15 Hanke W, Kalinka J, Florek E, Sobala W. Passive smoking and pregnancy outcome in Central Poland.  Hum Exp Toxicol. 1999;  18 265-271
• 16 Martin T R, Bracken M B. Association of low birth weight with passive smoke exposure in pregnancy.  Am J Epidemiol. 1986;  124 633-642
• 17 Ogawa H, Tominaga S, Hori K, Noguchi K, Kanou I, Matsubara M. Passive smoking by pregnant women and fetal growth.  J Epidemiol Community Health. 1991;  45 164-168
• 18 Jedrychowski W. Effects of Poor Air Quality on the Health of Krakow Children, 1st ed. Kraków, Poland; Jagiellonian University Collegium Medicum 1998
• 19 Klebanoff M A, Levine R J, Clemens J D, DerSimonian R, Wilkins D G. Serum cotinine concentration and self-reported smoking during pregnancy.  Am J Epidemiol. 1998;  148 259-262
• 20 Hayde M, Bernaschek G, Stevenson D K, Knight G J, Haddow J E, Widness J A. Antepartum fetal and maternal carboxyhemoglobin and cotinine levels among cigarette smokers.  Acta Paediatr. 1999;  88 327-331
• 21 Lymperopoulou A, Hainaut F, Crimail P, Durand J L, Locatelli C, Maison C. Tabac et grossesse: recherche d'une correlation cotininemie et Doppler.  J Gynecol Obstet Biol Reprod (Paris). 1996;  25 824-827
• 22 Castro L C, Allen R, Ogunyemi D, Roll K, Platt L D. Cigarette smoking during pregnancy: acute effects on uterine flow velocity waveforms.  Obstet Gynecol. 1993;  81 551-555
• 23 Clark K E, Irion G L. Fetal hemodynamics response to maternal intravenous nicotine administration.  Am J Obstet Gynecol. 1992;  167 1624-1631
• 24 Suzuki K, Minei L J, Johnson E E. Effect of nicotine upon uterine blood flow in the pregnant rhesus monkey.  Am J Obstet Gynecol. 1980;  136 1009-1013
• 25 Newnham J P, Patterson L, James I, Reid S E. Effects of maternal cigarette smoking on ultrasonic measurements of fetal growth and on Doppler flow velocity waveforms.  Early Hum Dev. 1990;  24 23-36
• 26 Benowitz N L. Cotinine as a biomarker of environmental tobacco smoke exposure.  Epidemiol Rev. 1996;  18 188-204
• 27 Cummings S R, Richard R J. Optimum cutoff points for biochemical validation of smoking status.  Am J Public Health. 1988;  78 574-575
• 28 Kimya Y, Cengiz C, Ozan H, Kolsal N. Acute effects of maternal smoking on uterine and umbilical artery blood velocity waveforms.  J Matern Fetal Investig. 1998;  8 79-81
• 29 Morrow R J, Ritchie J W, Bull S B. Maternal cigarette smoking: the effects on umbilical and uterine blood flow velocity.  Am J Obstet Gynecol. 1988;  159 1069-1071
• 30 Salafia C, Schiverick K. Cigarette smoking and pregnancy, II: vascular effects.  Placenta. 1999;  20 273-279
• 31 Jauniaux E, Gulbis B, Acharya G, Thiry P, Rodeck C. Maternal tobacco exposure and cotinine levels in fetal fluids in the first half of pregnancy.  Obstet Gynecol. 1999;  93 25-29
• 32 Steuerer A, Rosenbaum P, Heller W D et al.. Einfluss des Rauchverhaltens und der antioxidativen Vitaminkonzentrationen von Schwangeren auf das Geburtsgewicht von Neugeborenen.  Z Geburtshilfe Neonatol. 1999;  203 110-114