Aktif ve pasif sigara içiciliğinin gebelik ve fetus üzerine etkileri

Sigara içme alışkanlığı dünyadaki hastalıklar ve erken ölümlerin en önemli önlenebilir sebebidir. Gebelik sırasında annenin sigara içmesi yalnız perinatal yan etkilere değil, önemli doğum sonu problemlere de sebep olur. Gestasyonel dönemde annenin sigara içmesi fetusün mortalite riskini artırmasına ilaveten, muhtemelen plasenta gelişimindeki yetersizliğe bağlı olduğu düşünülen fetal büyümede gerilik, çocukluk çağında solunum yolu hastalıkları, sinir sistemi ve bilişsel anormallikler dahil olmak üzere pek çok gelişimsel problemlerle de ilişkilidir. Sigara metaller, nikotin ve polisiklik aromatik hidrokarbonlar (PAH) dahil fetal gelişimi etkileyen karışık kimyasallar kompleksi ihtiva eder. Sigara içmeye devam eden gebe kadın sıklıkla erken doğum yapar, bebeklerin gestasyonal yaşları genellikle küçüktür ve bunlarda pek çok perinatal problemler görülür. Aktif sigara içiciliğine ilaveten çevresel sigara dumanı (ÇSD) maruziyeti de çocuklar için büyük bir risk faktörüdür. Gebelikte ve hayatın birinci yılında çevresel sigara dumanına maruz kalma sadece intrauterin gelişim, ani bebek ölümü, davranış ve bilişsel fonksiyonlar üzerine değil, sürekli hırıltı, öksürük, bronşit, RSV bronşioliti, orta kulak iltihabı ve astım dahil olmak üzere solunum sistemi üzerine de etki eder.

Anahtar Kelimeler:

Gebe kadınlar, Gebelik, Prenatal maruziyetin geç etkileri, Risk faktörleri, Sigara içme, Sigara dumanı kirliliği, Maternal maruziyet

The effects of active and passive smoking upon pregnancy and fetus

Cigarette smoking is the most important avoidable cause of morbidity and premature death in the world. Maternal smoking during pregnancy is related not only to perinatal adverse events but also to important postnatal problems. Gestational maternal smoking is also associated with many developmental problems, including impaired fetal growth, which is largely assumed to be due to poor placental development, childhood respiratory ill-health, and abnormalities of the nervous system and cognition, as well as possible increased mortality risk for fetuses. Cigarette contains a complex mix of chemicals which can affect fetal development, including metals, nicotine and polycyclic aromatic hydrocarbons (PAH). Pregnant women who continue their smoking often give birth prematurely, the infants are often small for their gestational age, and they have more perinatal incidents. In addition to active smoking, to exposure the environmental tobacco smoke (ETS) is a major risk factor for respiratory disease in children. ETS exposure during pregnancy and the first years of life has been consistently found to have an impact on the respiratory system including symptoms such as wheezing, cough, bronchitis, RSV bronchiolitis, otitis media and asthma, but also on intrauterine growth, sudden infant death, behaviour and cognitive functioning.

Keywords:

Pregnant Women, Pregnancy, Prenatal Exposure Delayed Effects, Risk Factors, Smoking, Tobacco Smoke Pollution, Maternal Exposure,

PDF

___

1. Oncken CA, Kranzler HR. Pharmacotherapies to enhance smoking cessation during pregnancy. Drug and Alcohol Review 2003; 22: 191-202.
2. Dempsey DA, Benowitz NL. Risk and benefits of nicotine to aid smoking cessation in pregnancy. Drug Saf. 2001; 24:277-322.
3. Kutlu R. Sigara İçenler Arkadaşınızı Tanıyor musunuz Konya: Selçuk Üniversitesi Vakfı Yayınları. 2002.
4. Andres RL, Day MC. Perinatal complications associated with maternal tobacco use. Semin Neonatal. 2000; 5: 231-241
5. Guindon GE and Boisclair D. Past, Current and Future Trends in Tobacco Use. HNP Discussion paper, Economics of Tobacco Control Paper. 2003; 6
6. Kutlu R. Marakoglu K, Çivi S. Selçuk Üniversitesi Tıp Fakültesi Hemşirelerinde Sigara İçme Durumu ve Etkileyen Faktörler. Cumhuriyet Ü Tıp Fak Dergisi. 2005; 27(1): 29-34.
7 Marakoglu K, Kutlu R, Sahsivar S. The frequency of smoking, quitting and socio-demographic characteristics of physicians of a medical faculty. West Indian Med J. 2006; 55(3): 160-64.
8. Sezer RE. Dünyada ve Türkiye’de sigara tüketiminin eğilimleri. Hipokrat Dergisi. 2002; 11(3): 56-63.
9. Kutlu R, Çivi S. Konya İli Lise Öğretmenlerinin Sigara İçme Sıklığı ve Etkileyen Faktörler. Kor Hek 2007; 6(4): 273-78.
10. Fowler PA, Cassie S, Rhind SM, Brewer MJ, Collinson JM, Lea RG, Baker PJ, Bhattacharya S, O'Shaughnessy PJ. Maternal smoking during pregnancy specifically reduces human fetal Desert hedgehog gene expression during testis development. J Clin Endocrinol Metab. 2007: 13.
11. Mackay J, Eriksen M. The Tobacco Atlas. Geneva. World Health Organization. 2002.
12. PİAR. Sigara alışkanlıkları ve sigarayla mücadele kampanyası kamuoyu araştırması. Ocak 1998.
13. 31 Mayıs “Sigarasız Bir Dünya Günü”nde Toraks Derneği etkinlikleri. http://www.trakya.edu.tr. [Erişim tarihi 10.12.2007].
14. Chatenoud L, Parazzini F, di Cintio E, Zanconato G, Benzi G, Bortolus R, La Vecchia C. Paternal and maternal smoking habits before conception and during the first trimester: relation to spontaneous abortion. Ann Epidemiol. 1998; 8(8):520-6.
15. Horak E, Morass B, Ulmer H. Association between environmental tobacco smoke exposure and wheezing disorders in Austrian preschool children. Swiss Med Wkly. 2007; 3(137): 608-13.
16. Button TM, Maughan B, McGuffin P.The relationship of maternal smoking to psychological problems in the offspring. Early Hum Dev. 2007; 83(11): 727-32.
17. Dowling O, Rochelson B, Way K, Al-Abed Y, Metz CN. Nicotine inhibits cytokine production by placenta cells via NFkappaB: potential role in pregnancy-induced hypertension. Mol Med. 2007; 13: 576-83.
18. Correia S, Nascimento C, Gouveia R, Martins S, Sandes AR, Figueira J, Valente S, Rocha E, Da Silva L. Pregnancy and smoking: an opportunity to change behaviours. Acta Med Port. 2007; 20(3): 201-7.
19. Kaminsky LM, Ananth CV, Prasad V, Nath C, Vintzileos AM; New Jersey Placental Abruption Study Investigators. The influence of maternal cigarette smoking on placental pathology in pregnancies complicated by abruption. Am J Obstet Gynecol. 2007; 197(3): 275.
20. Naeye RL. Abruptio placentae and placenta previa: frequency, perinatal mortality, and cigarette smoking. Obstet Gynecol. 1980; 55(6): 701-4.
21. Alp H, Selimoğlu MA, Yaman S, Energin M, Altınkaynak S, Orbak Z. Gebelikte sigara kullanımının fetüsa etkileri. İst Çocuk Klin Derg. 1995; 30: 80-3.
22. MacGregor SN. Tobacco Smoking In Pregnancy. Medical Therapy In Pregnancy. 1998; 1425-7.
23. Marakoğlu K, Sezer RE. Sivas’ta Gebelikte Sigara Kullanımı. CÜ. Tıp Fakültesi Dergisi 2003; 4: 157-64.
24. Shah NR, Bracken MB. A systematic review and metaanalysis of prospective studies on the association between maternal cigarette smoking and preterm delivery. Am J Obstet Gynecol. 2000; 182(2): 465-72.
25. England LJ, Kendrick JS, Wilson HG, Merritt RK, Gargiullo PM, Zahniser SC. Effects of smoking reduction during pregnancy on the birth weight of term infants. 1: Am J Epidemiol. 2001; 154: 694-70.
26. Hruba D, Kachlik P. Influence of maternal active and passive smoking during pregnancy on birthweight in newborns. Cent Eur J Public Health. 2000; 8: 249-52.
27. Nusbaum ML, Gordon M, Nusbaum D, McCarthy MA, Vasilakis D. Smoke alarm: a review of the clinical impact of smoking on women. Prim Care Update Ob Gyns. 2000; 7:207-214.
28. Mochizuki M, Maruo T, Masuko K. Mechanism of foetal growth retardation caused by smoking during pregnancy. Acta Physiol Hung. 1985; 65(3): 295-304.
29. Chung KC, Kowalski CP, Kim HM, Buchman SR. Maternal cigarette smoking during pregnancy and the risk of having a child with cleft lip/palate. Plast Reconstr Surg. 2000; 105:485-91.
30. Schulte-Hobein B, Schwartz Bickenbach D, Abt S, et al. Cigarette smoke exposure and developments of infants throughout the first year of life: Influence of passive smoking and nursing on cotinine levels in breast milk and infant’s urine. Acta Pediatr Scand. 1992; 81: 550-57.
31. Bilir N, Aslan D. Dünyada, Türkiye’de ve Hacettepe’de tütün kontrolü çalışmaları. Hacettepe Tıp Dergisi. 2005; 36: 75–79.
32. Aslan D, Bilir N. Tütün ve Tütün Ürünleri ile Mücadele ve Bu Mücadelede Hekimin Rolü. Sted 2006;15: 8-9.
33. U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General—2004. Centers for Disease Control and Prevention. Office on Smoking and Health. Atlanta Georgia. 2004.
34. Habek D, Habek JC, Jugovic D, Salihagic A. Intrauterine hypoxia and sudden infant death syndrome. Acta Med Croatica. 2002; 56: 109-18.
35. Sundell HW: SIDS prevention-good progress, but now we need to focus on avoiding nicotine. Acta Paediatr. 2004; 93:450-2.
36. Soydal T, Ergüder T. Türkiye'de Sigara Sorunu ve Mücadelesi. TC. Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü Yayınları. Ankara. 2002.
37. Karlıkaya C, Öztuna F, Aytemur Solak Z, Özkan M, Örsel O. Tütün Kontrolü. Toraks Dergisi. 2006; 7: 51-64.
38. Bek K, Tomaç N, Delibaş A, Tuna F, Teziç HT, Sungur M. The effect of passive smoking on pulmonary function during childhood. Postgrad Med J. 1999; 75: 339-41.
39. Ralph S. Caraballo, PhD; Gary A. Giovino, PhD; Terry F. Pechacek, PhD; Paul D. Mowery, MS. et al. Racial and Ethnic Differences in Serum Cotinine Levels of Cigarette Smokers. Third National Health and Nutrition Examination Survey. 1988-1991. JAMA. 1998; 280: 135-39.
40. Gürkan F, Kıral A, Dağlı E, Karakoç F. The effect of passive smoking on the development of respiratory syncytial virus bronchiolitis. Am Rev Respir Dis. 1992; 145: 1129-1135.
41. Avol El, Gauderman Wj, Tan Sm, London Sj, Peters Jm. Respiratory Effects of Relocating to Areas of Differing Air Pollution Levels. Am. J. Respir. Crit. Care Med. 2001; 164(11): 2067-2072.
42. Kırımi E, Pençe S. Gebelikte Sigara Kullanımının Fetus ve Plasentanın Gelişimine Etkisi. Van Tıp Dergisi. 1999; 6: 28-30.
43. Jaakkola JJ, Gissler M. Maternal smoking in pregnancy, fetal development and childhood asthma. Am J Public Health. 2004; 94: 136-40.
44. Gray RF, Indurkhya A, McCormick MC. Prevalence, stability, and predictors of clinically significant behavior problems in low birth weight children at 3, 5, and 8 years of age. Pediatrics. 2004; 114: 736-43.
45. Goel P, Radotra A, Singh I, Aggarwal A, Dua D. Effects of passive smoking on outcome in pregnancy. J Postgrad Med. 2004; 50(1): 12-6.
46. Hofhuis W, Merkus PJ, de Jongste JC. Negative effects of passive smoking on the (unborn) child. Ned Tijdschr Geneeskd. 2002; 146(8): 356–9.
47. Prietsch SO, Fischer GB, Cesar JA, Fabris AR, Mehanna H, Ferreira TH, Scheifer LA. Acute disease of the lower airways in children under five years of age: role of domestic environment and maternal cigarette smoking. J Pediatr (Rio J). 2002; 78: 415-22.
48. Armstrong BG, McDonald AD, Sloan M. Cigarette, alcohol, and coffee consumption and spontaneous abortion. Am J Public Health. 1992; 82: 85-7.
49. Petrou S, Hockley C, Mehta Z, Goldacre M. The association between smoking during pregnancy and hospital inpatient costs in childhood. Soc Sci Med. 2005; 60: 1071-85.
50. Drews CD, Murphy CC, Yeargin-Allsopp M, Decoufle P. The relationship between idiopathic mental retardation and maternal smoking during pregnancy. Pediatrics. 1996; 97:547-53.