|
Newsletter
February 2006
Volume 1, No 3
Complications
To The Fetus Of Smoking During Pregnancy
Smoking While Pregnant Causes Finger,
Toe Deformities
Largest Study
of Its Kind Proves Just Half a Pack per Day Harms Unborn Child
January 10, 2006
Women have yet another
reason to stop smoking while pregnant.
In the largest study of its kind, plastic surgeons found smoking
during pregnancy
significantly elevates the risk of having a child with excess,
webbed or missing fingers and toes, according to the January issue
of Plastic and Reconstructive Surgery, the official
medical journal of the American Society of Plastic Surgeons (ASPS).
In fact, the study found
that smoking just half a pack per day increases the risk of having a
child born with
a toe or finger defect by 29 percent.
Reconstructive surgery to repair limb, toe and finger
abnormalities in children
represents a large portion of my practice — it is the most common
issue I treat," said
Benjamin Chang, M.D., ASPS member and study author.
"Parents would ask why
this happened to their child, but I didn't have an answer.
This study shows that even minimal smoking during pregnancy can
significantly
increase the risk of having a child with various toe and finger
defects."
Researchers examined the records of more than 6.8 million live
births in the United States
during 2001 and 2002, finding 5,171 children born with a digital
anomaly where the
mother smoked during pregnancy but did not suffer from other medical
complications,
such as heart disease, diabetes or high blood pressure.
The study authors discovered pregnant women who smoked one to
10 cigarettes
per day increased the risk of having a child with a toe or finger
deformity by 29 percent.
The more a woman smoked, the higher the risk became. Women who
smoked
11 to 20 cigarettes a day raised the risk 38 percent, and women who
smoked 21
or more cigarettes per day raised the risk 78 percent.
Known as polydactyly, syndactyly and adactyly, these deformities
are the most
common congenital limb abnormalities. Polydactyly is the presence of
more
than five digits on the hands or feet. Syndactyly is having fused
or webbed fingers
or toes. Adactyly is the absence of fingers or toes.
Webbed fingers or toes occur one in every 2,000 to 2,500 live
births and excess
fingers or toes occur one in every 600 live births. Webbed fingers
or toes occur
twice as often in boys and are more common in Caucasians than
African Americans.
Excess digits, however, are 10 times more common in African
Americans and are
only slightly prevalent in boys. Nevertheless, the majority of these
defects occur
without any family history and most causes are unknown which has
lead researchers
to investigate environmental causes, such as smoking, for these
anomalies.
The results of this study were interesting. We suspected that
smoking was a
cause of digital anomalies but didn't expect the results to be so
dramatic,"
said Dr. Chang. "Smoking is so addictive that pregnant women often
can't stop
the habit, no matter what the consequences. Our hope is this study
will show
expectant mothers another danger of lighting up."
Source: American Society of Plastic Surgeons
http://www.plasticsurgery.org/news_room/press_releases/maternal-smoking.cfm
XXXXXXX XXXXXXX
XXXXXXX
"Smoking cigarettes is associated with adverse pregnancy outcomes
including low birth weight, premature birth, and perinatal (of,
relating to, or being the period around childbirth, especially
the five months before and one month after birth care)
death. Smoking by both the pregnant woman and members of the
household should be avoided during pregnancy and,
preferably, not resumed
postpartum. The relative risk of intrauterine growth
restriction (IUGR) among pregnant smokers has been calculated at 2.2
to 4.2 Because of the morbidity associated with smoking,
various methods to assist women to quit smoking
should be encouraged
prior to pregnancy. Use of the transdermal nicotine patch in
pregnancy is thought to be preferable to smoking. One benefit
of using a nicotine patch
is the elimination of exposure to other
toxins such as carbon monoxid4e inhaled in cigarette smoke.
Its theoretical risk is that it creates a constant blood level of
nicotine, as opposed to the vacillations that occur with smoking.
Similarly, all illicit drugs have the potential of harming the
pregnancy."
Source:
Danforth, David N., et al.
Danforth's Obstetrics and Gynecology
(9th Edition). Philadelphia: Lippincott Williams and
Wilkins, 2003.
XXXXXXX XXXXXXX
XXXXXXX
HPRT
Gene Alterations in Umbilical Cord Blood T-Lymphocytes in Newborns
of Mothers Exposed to Tobacco Smoke During
Pregnancy
Prenatal exposure to tobacco smoke has been associated with an
increased risk of pediatric malignancies, yet the transplacental
induction of genetic alterations by tobacco smoke carcinogens
and their implication to childhood diseases remain poorly
understood. We characterized mutations in the HPRT gene
in umbilical cord blood T-lymphocytes of self-reported 103
never- smoking mothers and 104 smoking mothers (54
mothers smoked throughout and 50 mothers quit smoking during
pregnancy).
The results showed the
illegitimate V(D)J recombinase-mediated deletion of HPRT
exons 2–3 was the most prominent alteration occurring in 48.2%
(26/54) of mutants from neonates of the smoking
mothers who smoked during pregnancy, compared with 28.0%
(14/50) from those of smoking
mothers who quit smoking during pregnancy
(p = 0.035, Fisher's exact test), 34.9% (36/103) from
never-smoking
mothers (p = 0.08), or 32.7% (50/153) of
those of neonates born from the latter two groups of mothers
combined (p = 0.043). There was no significant difference
in the frequency of this deletion between neonates of the never-smoking
mothers and the smoking mothers who quit smoking during pregnancy (34.9% versus
28.0%, respectively, p = 0.39). The results show an
increase in illegitimate V(D)J recombinase-mediated deletion of
HPRT exons 2–3 in cord blood T-lymphocytes of newborns of
mothers who smoked during pregnancy, compared with the
group of mothers who did not smoke during pregnancy,
implying an increase in illegitimate V(D)J recombinase-mediated
alteration, a genetic recombination event associated with
childhood malignancies, may be induced in utero during
pregnancy by maternal exposure to tobacco
smoke-derived genotoxicants. Source:
Keohavong, Phouthone et al. Mutation
Research/Fundamental and Molecular
Mechanisms of Mutagenesis, Vol. 572, Issues 1-2, May 2, 2005.
XXXXXXX XXXXXXX
XXXXXXX
Smoking,
Drinking or Cannabis Use During Pregnancy:
Neurobehavioral and Cognitive Functioning in Human Offspring
Teratological investigations have demonstrated that agents that
are relatively harmless to the mother may have significant
negative consequences to the fetus. Among these agents, prenatal
alcohol, nicotine or cannabis (any of the several
mildly euphoriant, intoxicating hallucinogenic drugs, such as
ganja, hashish or marijuana, prepared from various parts
of the cannabis plant) exposure have been related to adverse
offspring outcomes. Although there is a relatively extensive
body of literature that has focused upon birth and behavioral
outcomes in newborns and infants after prenatal exposure to
maternal smoking, drinking and, to a lesser extent,
cannabis use, information on neurobehavioral and cognitive
teratogenic (abnormal in growth or structure)
findings beyond these early ages is still quite limited.
Furthermore, most studies have focused on prenatal exposure to
heavy levels of smoking, drinking or cannabis use. Few
recent studies have paid attention to low or moderate levels of
exposure to these substances. This review endeavors to provide
an overview of such studies, and includes animal findings and
potential mechanisms that may explain the mostly subtle effects
found on neurobehavioral and cognitive outcomes. It is concluded
that prenatal exposure to either maternal smoking,
alcohol or cannabis use is related to some common
neurobehavioral and cognitive outcomes, including symptoms of
ADHD (inattention, impulsivity), increased externalizing
behavior, decreased general cognitive functioning, and deficits
in learning and memory tasks.
Source:
Huizink, Anja C., & Mulder, Eduard J.H., Neuroscience &
Biobehavioral Reviews,
Vol.30, Issue 1, January 2006.
Erasmus Medical Center
Department of Child and Adolescent Psychiatry
P.O. Box 2060,
3000 CB Rotterdam
The Netherlands
XXXXXXX
XXXXXXX XXXXXXX
Attention-Deficit/Hyperactivity
Disorder: A Selective Overview
Advancing the Neuroscience of ADHD
Attention-deficit/hyperactivity disorder (ADHD) is a
multifactorial and clinically heterogeneous disorder that is
associated with tremendous financial burden, stress to families,
and adverse academic and vocational outcomes.
Attention-deficit/hyperactivity disorder is highly prevalent in
children worldwide, and the prevalence of this disorder in
adults is increasingly recognized. Studies of adults with a
diagnosis of childhood-onset ADHD indicate that clinical
correlates—demographic, psychosocial, psychiatric, and cognitive
features—mirror findings among children with ADHD. Predictors of
persistence of ADHD include family history of the disorder,
psychiatric comorbidity, and psychosocial adversity. Family
studies of ADHD have consistently supported its strong familial
nature. Psychiatric disorders comorbid with childhood ADHD
include oppositional defiant and conduct disorders, whereas mood
and anxiety disorders are comorbid with ADHD in both children
and adults. Pregnancy and delivery complications,
maternal smoking during pregnancy, and adverse family
environment variables are considered important risk factors for
ADHD. The etiology of ADHD has not been clearly identified,
although evidence supports neurobiologic and genetic origins.
Structural and functional imaging studies suggest that
dysfunction in the fronto-subcortical pathways, as well as
imbalances in the dopaminergic and noradrenergic systems,
contribute to the pathophysiology of ADHD. Medication with
dopaminergic and noradrenergic activity seems to reduce ADHD
symptoms by blocking dopamine and norepinephrine reuptake. Such
alterations in dopaminergic and noradrenergic function are
apparently necessary for the clinical efficacy of pharmacologic
treatments of ADHD.
Source:
Biederman, Joseph.
Biological Psychiatry
, Vol. 57, Issue 11, June 1,2005.
Department of Pediatric Psychopharmacology Research
Massachusetts General Hospital, and Department of Psychiatry
Harvard Medical School
Boston, Massachusetts
XXXXXXX XXXXXXX
XXXXXXX
Can Regular Multivitamin/Mineral Supplementation Modify the Relation
Between Maternal Smoking
and Select Adverse Birth Outcomes?
PURPOSE: The purpose of this study was to
examine whether or not regular multivitamin/mineral supplementation
can modify the relation between maternal
smoking and preterm birth (gestational age < 37 weeks),
very-low-birthweight (VLBW)
(< 1500 g), moderately-low-birthweight (MLBW) (< 2499 g), or
small-for-gestational-age
(SGA) (< 10th percentile of birth weight for gestational age).
METHODS: Live birth data from the 1988
National Maternal and Infant Health Survey
(NMIHS) were used for the analysis. Maternal
smoking referred to
self-reported average number of cigarettes smoked after recognition
of pregnancy, while
regular multivitamin/mineral supplementation referred to use of
multivitamin/mineral supplements
for at least three days per week
during the three months
before and/or after recognition
of pregnancy. Sample
sizes included 9402 singleton infants for the analysis of preterm
birth, 9395 for very or moderately low birthweight, and 9363 for
small-for-gestational-age. Odds ratios were derived from logistic
regression analyses after adjusting for a number
of demographic and reproductive variables.
RESULTS: Major results include: 1) increased
risks for the adverse outcomes studied
were observed among smoking
women; 2) no effect of regular multivitamin/mineral supplementation
in the absence of maternal
smoking was revealed; and 3) relative
excess risks due to interaction at different
smoking levels and
overall interactions
between smoking and
supplementation were not observed.
CONCLUSIONS: These results suggest that
regular multivitamin/mineral supplementation does not
minimize the adverse effects associated with maternal
smoking.
Source:
Tiejian
Wu, MD ,
Germaine
Buck, PhD and
Pauline
Mendola, PhD . "Can
Regular
Multivitamin/Mineral Supplementation Modify the Relation Between
Maternal Smoking and
Select Adverse Birth Outcomes?" Annals of Epidemiology,
Vol.8, Issue 3, 175-183,
April 1998.
If Hartsell Medical-Legal
Consulting Services Can Assist You Or If You Would
Like To
See A Particular Subject In The Newsletter, Please
Contact:
Back to Newsletter Index Here
|
|
