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Does maternal smoking during pregnancy affect fetal weight gain before gestational age 32 weeks?

Presented at the Neonatal Society 2011 Spring Meeting.

Kayemba-Kay’s S1,2,6, Antoine Burguet A2,3,4, Menget A5, Gouyon J-B3,4, Hindmarsh P6

1 Paediatrics Dept, Hôpital de l’Enfance, Lausanne University Teaching Hospital, Switzerland
2 Poitou-Charentes Perinatal Network, Poitiers, France
3 Burgundy Perinatal Network, Dijon, France
4 Neonatal Intensive Care Unit, Dijon University Teaching Hospital, France
5 Neonatal intensive Care Unit, Besancon University Teaching Hospital, France
6 Developmental Endocrinology Research Group, Institute of Child Health, UCL, London, UK

Background: Purpose: effects of active maternal smoking during pregnancy on fetal growth are known since the first report by Simpson. Several parameters seem to modulate tobacco impact: maternal and fetal pharmacogenomics, number of cigarette smoked and male gender. Reports have been, however, unable to clearly demonstrate the impact of smoking in preterm infants.Study Objective: Evaluate, in regional population, the impact of active maternal smoking in live born preterm infants with GA 24 -32 weeks, by comparing them to live born term infants.

Methods: 1025 singleton live born preterm infants with GA 24 to 32 weeks+6 days, without malformations, born to mothers without hypertension, delivered in one of 47 participating maternities of three regional prenatal networks, from 2005 to 2009, and 914 live born singleton term born infants. Prospective data collection, maternal tobacco consumption based on self-reporting. Analysis of effect of smoking on fetal BW, performed with two multiple linear regression in preterm and term infants taking into account maternal smoking status (yes/no), fetal gender, GA, parity, maternal BMI. Coefficient of regression and 95 % CI were determined. Cohorts of preterm infants and control group (term infants) calculated for a difference in BW of 5% in exposed fetuses, alpha risk 5% and beta risk 93% (preterm infants) and 98% (controls).

Results: In preterm infants group, maternal smoking is not associated with significant reduction in BW (BW reduction equal to 20 g [CI 95% – 66 to + 22g]). In term born infants, maternal smoking induces significant reduction in BW of 141 g [CI 95% – 220 to -74 g], this effect is similar in boys and girls.

Conclusion: Our study suggests that effects of active maternal smoking occur later in pregnancy. We hypothesize that late occurrence of BW reduction may be secondary to the fact that cigarette smoke components exert their inhibiting effects on fetal leptin synthesis after the second trimester of pregnancy. Our results also support the need for global and well organized care of smoking parturient even in mid-pregnancy. Preventive measures in smoking mothers should aim at saving children from metabolic complications.

Corresponding author: kabangu.kayemba-kays@chuv.ch

References
1. Simpson WJ: Am J Obstet Gyecol, 1957
2. Aagaard-Tillery K: Obstet Gynecol 2010
3. Zaren B: Paediatr Perinat Epidemiol, 2000
4. Kayemba-Kay’s S. Swiss Medical Weekly, in press
5. Bersjo P, Acta Obstet Gynecol Scand 2007
6. Bernstein IM , Am J Obstet Gynecol 2000
7. Fitzgerald K, Am J Perinatol 2007
8. Jaddoe VW, Paediatr Perinat Epidemiol 2008
9. Kayemba-Kay’s S, Eur J Endocrinol, 2008
10.. Helland IB, Acta Paediatr, 2001
11.Piasek M, J Appl Toxicol, 2010

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