Semir KÖSE, Gökhan TOSUN, Banu İŞBILEN BAŞOK, Sabahattin ALTUNYURT

Sigara kullanan gebelerde obstetrik sonuçlara ilk üçay tarama döneminden bakış

GİRİŞ ve AMAÇ: Gebelikte sigara kullanımına bağlı obstetrik komplikasyon gelişimi ve fetal büyümenin etkilenimi bireysel farklılıklar göstermektedir. Temel hipotezimiz sigaraya bağlı kötü obstetrik sonuçların plasental disfonksiyon dolayımlı olduğu ve ilk üçay tarama döneminde biyokimyasal (PAPPA ve fβhCG ) ve biyofiziksel (uterin arter pulsatilite indeksi (UtAPI)) belirteçlerle bu etkilenimin saptanabileceği üzerine kuruludur. YÖNTEM ve GEREÇLER: Retrospektif kohort tasarımlı çalışmada 1 Ağustos 2016-1 Ocak 2018 tarihleri arasında Buca Doğumevi’ne ilk üçay kombine tarama testi için başvuran gebelere ait obstetrik sonuçlar derlenmiştir. Sigara kullanımı bilgilerine göre olgular; gebelikte kullanıyor, ilk haftalarda bırakmış ve hiç kullanmamış olarak üç kategoride ele alınmıştır. BULGULAR: Toplam 3837 olguya ait obstetrik sonuçlar çalışılmıştır. Doğum ağırlıkları sigara içen (3149±531), gebelikte bırakmış (3273±517) ve hiç kullanmamış (3319±505) gruplar arasında anlamlı farklılık gösterdi (p

A look at the obstetric outcomes in smoking pregnants through the first trimester screening window

INTRODUCTION: The adverse effects of smoking on incidence of obstetric complications and fetal growth are highly variable between individuals. The deletorius effects of smoking should be due to placental dysfunction and this impaired function could be clinically demonstrated via biochemical (PAPPA and fβhCG) and biophysical (uterine artery pulsatility index (UtAPI)) markers. METHODS: In our retrospective cohort study, we assessed the obstetric outcomes of pregnant women attended for the first trimester combined test (FTCT) to Buca Maternity Hospital between 1 August 2016 and 1 January 2018. According to the self-reports the studied sample categorized as; smoking during pregnancy, smoking cessation during first weeks of gestation and never smoked. RESULTS: Median birth weights were significantly different among the groups; smoking (3149±531), smoking-stopped (3273±517) and never smoked (3319±505), (p

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1. Sabra S, Gratacós E, Gómez Roig MD. Smoking-Induced Changes in the Maternal Immune, Endocrine, and Metabolic Pathways and Their Impact on Fetal Growth: A Topical Review. Fetal Diagn Ther 2017; 41(4): 241-250.
2. Kirkland SA, Dodds LA, Brosky G. The natural history of smoking during pregnancy among women in Nova Scotia. CMAJ 2000; 163(3): 281- 282.
3. Pineles BL, Park E, Samet JM. Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. Am J Epidemiol 2014; 179(7): 807-23.
4. Gardosi J, Madurasinghe V, Williams M, Malik A, Francis A. Maternal and fetal risk factors for stillbirth: population based study. BMJ 2013; 346: f108.
5. Lee T, Silver H. Etiology and epidemiology of preterm premature rupture of the membranes. Clin Perinatol 2001; 28(4): 721-34.
6. Polakowski LL, Akinbami LJ, Mendola P. Prenatal smoking cessation and the risk of delivering preterm and small-for-gestational-age newborns. Obstet Gynecol 2009; 114(2 Pt 1): 318-25.
7. Tikkanen M. Placental abruption: epidemiology, risk factors and consequences. Acta Obstet Gynecol Scand 2011; 90(2): 140-9.
8. Pereira PP, Da Mata FA, Figueiredo AC, de Andrade KR, Pereira MG. Maternal Active Smoking During Pregnancy and Low Birth Weight in the Americas: A Systematic Review and Meta-analysis. Nicotine Tob Res 2017; 19(5): 497-505.
9. Durualp E, Bektaș G, Ergin D, Karaca E, Topçu E. Annelerin Sigara Kullanımı ile Yenidoğanın Doğum Kilosu, Boyu ve Baș Çevresi Arasındaki İlișkinin İncelenmesi. Ankara Üniversitesi Tıp Fakültesi Mecmuası 2011, 64(3): 119-126.
10. Suter MA, Anders AM, Aagaard KM. Maternal smoking as a model for environmental epigenetic changes affecting birthweight and fetal programming. Mol Hum Reprod 2013; 19(1): 1-6.
11. Ganer Herman H, Miremberg H, Nini N, Feit H, Schreiber L, Bar J, et al. The effects of maternal smoking on pregnancy outcome and placental histopathology lesions. Reprod Toxicol 2016; 65: 24-28.
12. Xiao D, Huang X, Yang S, Zhang L. Direct effects of nicotine on contractility of the uterine artery in pregnancy. J Pharmacol Exp Ther 2007; 322(1): 180-5.
13. Wang R, Wang Z. Three different vasoactive responses of rat tail artery to nicotine. Can J Physiol Pharmacol 2000; 78(1): 20-8.
14. Salihu HM, Wilson RE. Epidemiology of prenatal smoking and perinatal outcomes. Early Hum Dev. 2007 Nov;83(11):713-20.
15. Bhide A, Acharya G, Bilardo CM, Brezinka C, Cafici D, Hernandez-Andrade E, et al. ISUOG practice guidelines: use of Doppler ultrasonography in obstetrics. Ultrasound Obstet Gynecol. 2013 Feb;41(2):233-39.
16. Barut A, Gültekin İB, Akkaş Yılmaz E, Sabancı M, Karslı F, Kara OF, ve ark. Geç preterm fetüslerin nörogelişimsel sorunları ve nörolojik morbiditeye etki eden faktörler. Perinatoloji Dergisi 2015; 23 (3): 141-147.
17. Brunnemann KD, Hoffmann D. Analytical studies on tobacco-specific N-nitrosamines in tobacco and tobacco smoke. Crit Rev Toxicol 1991; 21(4): 235-40.
18. Jauniaux E, Burton GJ. Morphological and biological effects of maternal exposure to tobacco smoke on the feto-placental unit. Early Hum Dev 2007; 83(11): 699–706.
19. Wang X, Zuckerman B, Pearson C, Kaufman G, Chen C, Wang G, et al. Maternal cigarette smoking, metabolic gene polymorphism, and infant birth weight. JAMA 2002; 287(2): 195– 202.
20. Fryer AA, Emes RD, Ismail KM, Haworth KE, Mein C, Carroll WD, et al. Quantitative, highresolution epigenetic profiling of CpG loci identifies associations with cord blood plasma homocysteine and birth weight in humans. Epigenetics 2011; 6(1): 86–94.
21. Ferreira JC, Choufani S, Grafodatskaya D, Butcher DT, Zhao C, Chitayat D, et al. WNT2 promoter methylation in human placenta is associated with low birthweight percentile in the neonate. Epigenetics 2011; 6(4): 440–449.
22. Wilhelm M, Ritz B. Local variations in CO and particulate air pollution and adverse birth outcomes in Los Angeles County, California, USA. Environ Health Perspect 2005; 113(9): 1212–1221.
23. Liu S, Krewski D, Shi Y, Chen Y, Burnett RT. Association between maternal exposure to ambient air pollutants during pregnancy and fetal growth restriction. J Expo Sci Environ Epidemiol 2007; 17(5): 426–432.
24. Burton GJ, Palmer ME, Dalton KJ. Morphometric differences between the placental vasculature of non-smokers, smokers and exsmokers. Br J Obstet Gynaecol 1989; 96(8): 907– 915.
25. Larsen LG, Clausen HV, Jønsson L. Stereologic examination of placentas from mothers who smoke during pregnancy. Am J Obstet Gynecol 2002; 186(3): 531–537.
26. Lehtovirta P, Forss M. The acute effect of smoking on intervillous blood flow of the placenta. Br J Obstet Gynaecol 1978; 85(10): 729-31.
27. Barrett SL, Bower C, Hadlow NC. Use of the combined first-trimester screen result and low PAPP-A to predict risk of adverse fetal outcomes. Prenat Diagn 2008; 28(1): 28-35.
28. Dugoff L, Hobbins JC, Malone FD, Porter TF, Luthy D, Comstock CH, et al. First trimester maternal serum PAPP-A and free-beta subunit human gonadotropin concentrations and nuchal translucency are associated with obstetric complications: A population-based screening study (The FASTER trial). Am J Obstet Gynecol 2004; 191(4): 1446–51.
29. Liu DF, Dickerman LH, Redline RW. Pathologic findings in pregnancies with unexplained increases in midtrimester maternal serum human chorionic gonadotropin levels. Am J Clin Path 1999; 111(2): 209–15.
30. Jauniaux E, Suri S, Muttukrishna S. Evaluation of the impact of maternal smoking on ultrasound and endocrinological markers of first trimester placentation. Early Hum Dev 2013; 89(9): 777-80.
31. Burton GJ, Jauniaux E. Placental oxidative stress: from miscarriage to preeclampsia J Soc Gynecol Investig 2004; 11(6): 342–352.
32. Pijnenborg R, Vercruysse L, Hanssens M. The uterine spiral arteries in human pregnancy: facts and controversies. Placenta 2006; 27(9-10): 939– 958.
33. Gagnon A, Wilson RD; Society Of Obstetricians And Gynaecologists Of Canada Genetics Committee. Obstetrical complications associated with abnormal maternal serum markers analytes. J Obstet Gynaecol Can 2008; 30(10): 918- 932.
34. Smith GCS, Stenhouse EJ, Crossley JA, Aitken DA, Cameron AD, Connor JM. Early pregnancy levels of pregnancy-associated plasma protein A and the risk of intrauterine growth restriction, premature birth, preeclampsia and stillbirth. J Clin Endocrinol Metab 2002; 87(4): 1762–7.
35. Rissanen A, Niemimaa M, Suonpää M, Ryynänen M, Heinonen S. Pregnancy-associated plasma protein A, free human chorionic gonadotrophin and nuchal translucency as predictors of miscarriage. Clin Genet 2006; 69(3): 287–9.
36. Nabet C, Ancel PY, Burguet A, Kaminski M. Smoking during pregnancy and preterm birth according to obstetric history: French national perinatal surveys. Paediatr Perinat Epidemiol 2005; 19(2): 88-96.