The short-term effect of smoking on fetal ECG

Background: The number of women who smoke during pregnancy is significant even today. The harmful effects of smoking during pregnancy are well known but there are no data on the effects of smoking on fetal electrocardiography (ECG). The lack of data is in connection with the difficulties of recording fetal ECG through the maternal abdomen.

Method: Third trimester pregnant women who were not able to give up the harmful passion of smoking despite repeated attempts of persuasion were recruited in the study on voluntary basis. The fetal ECG was recorded non-invasively through the maternal abdomen before, during and after smoking, then the data were processed offline. The electrophysiological measurements were performed by a self developed ECG device, which allowed the examination of the morphological differences in “true-to-form” fetal ECG in addition to studying the variability of fetal heart rate. The study involved nine pregnant women. The observed changes are presented through case studies of those pregnant women who showed the most significant anomalies.

Results: Compared with the resting state fetal heart rate was increased during smoking. The short-term variability of fetal heart rate was narrowed, while the mother’s heart rate did not change significantly – which was an indication of direct fetal stress. No explicit ischemic signs were detected in fetal ECG during smoking, however, in the increasing period of the fetal heart rate, the T wave morphology changed slightly, then it returned to normal.

Conclusions: Demonstrable by the electrophysiological methods, smoking has a direct effect on fetal cardiac function. The fetal heart rate variability shows a pattern during smoking which is a typical sign of stress conditions among adults. The results may have educational consequences as well. Understanding those, hopefully will help pregnant women give up this harmful addiction.     

Effect of cigarette smoking on levels of seminal oxidative stress in infertile men: a prospective study

OBJECTIVE: To investigate levels of seminal oxidative stress (OS) and sperm quality in a group of infertile men with a history of cigarette smoking.DESIGN: A prospective clinical study.SETTING: Male infertility clinic, Urological Institute, the Cleveland Clinic Foundation, Cleveland, Ohio.PATIENT(S): Infertile men who smoked cigarettes (n = 20), infertile men who were nonsmokers (n = 32), and healthy nonsmoking donors (n = 13).INTERVENTION(S): Genital examination, standard semen analysis, sperm DNA damage.MAIN OUTCOME MEASURE(S): Levels of seminal reactive oxygen species (ROS) and total antioxidant capacity (TAC) measured by a chemiluminescence assay and seminal OS assessed by calculating a ROS-TAC score. Sperm DNA damage was measured by sperm chromatin structure assay.RESULT(S): Smoking was associated with a 48% increase in seminal leukocyte concentrations (P<.0001), a 107% increase in ROS levels (P=.001), and a 10-point decrease in ROS-TAC scores (P=.003). Differences in standard sperm variables and DNA damage indices between the infertile smokers and infertile nonsmokers were not statistically significant.CONCLUSION(S): Infertile men who smoke cigarettes have higher levels of seminal OS than infertile nonsmokers. Given the potential adverse effects of seminal OS on fertility, physicians should advise infertile men who smoke cigarettes to quit.     

The effect of cigarette smoking during pregnancy on mode of delivery in uncomplicated term singleton pregnancies

Abstract

Objective: To examine the influence of cigarette smoking during pregnancy on mode of delivery.

Methods: A retrospective analysis of 6105 uncomplicated term singleton pregnancies for mode of delivery was performed with respect to smoking status.

Results: Of all, 680 (84.0%) smokers and 4588 (86.7%) non-smokers had a spontaneous vaginal delivery, 65 (8.0%) smokers and 393 (7.4%) non-smokers had an instrumental delivery and 65 (8.0%) smokers and 314 (5.9%) non-smokers had a cesarean delivery (p?=?0.051). Smoking during pregnancy increased the risk of any operative or instrumental intervention by OR 1.240, 95% CI 1.012–1.523. Non-reassuring fetal heart rate pattern that warranted either cesarean or instrumental intervention was present in 99 (12.2%) out of 810 smokers and in 392 out of 5295 (7.4%) non-smokers, p?<?0.001). Smoking during pregnancy increased the risk of non-reassuring fetal heart rate pattern that warranted either cesarean or instrumental intervention by OR 1.650 (95% CI 1.341–2.022).

Conclusion: Women with uncomplicated term singleton pregnancies who smoke during pregnancy are at an increased risk of fetal compromise during labor (as judged by non-reassuring fetal heart rate pattern), leading to increased rates of operative delivery (cesarean either instrumental).     

Impact of inherited thrombophilias on first and second trimester maternal serum markers for aneuploidy

Objective: To evaluate first and second-trimester maternal serum markers in pregnancies complicated with inherited thrombophilias. Methods: A case-control study was conducted in 50 pregnancies complicated with hereditary thrombophilia and 100 control pregnancies. Results: Each woman with inherited thrombophilia received low molecular weight heparin (LMWH) throughout her pregnancy. Gravidity, parity, number of first-trimester and second-trimester abortions, and rate of adverse pregnancy outcomes (APO) were significantly higher in the thrombophilia group compared to the control group (P < 0.001 for all). Among the thrombophilia group median values of pregnancy associated placental protein-A (PAPP-A) (0.6 vs. 0.9; P < 0.001) and free β-human chorionic gonadotropin (β-hCG) (0.9 vs. 1.1; P = 0.001) in the first trimester; median values of α-fetoprotein (AFP) (0.7 vs. 1.1; P = 0.027), unconjugated estriol 3 (uE3) (0.9 vs. 1.1; P < 0.001), and hCG (0.7 vs. 1.2; P < 0.001) in the second trimester were significantly lower with respect to control pregnancies. Multivariate analysis revealed that low uE3 and hCG levels were independently associated with APO. Conclusion: Pregnant women with hereditary thrombophilias, all of whom were treated with LMWH, had decreased levels of all first and second trimester serum markers. In addition, levels of hCG and uE3 in the second trimester could independently predict placenta-related disorders and adverse outcomes in these patients.     

The effect of infertility and assisted reproduction on first-trimester placental and fetal development

Our investigation of differences in first-trimester placentation and/or fetal biometry in pregnancies conceived spontaneously compared with those conceived through fertility treatment, and comparing less invasive fertility treatment with in vitro fertilization found no statistically significant difference in first-trimester abnormal placentation or fetal growth between pregnancies conceived spontaneously and those conceived through fertility treatment, or between the in vivo and in vitro subgroups.     

The effect of cigarette smoking on cell proliferation in normal uterine cervix epithelium

Background  

The aim of this study was to evaluate the effect of smoking on cell proliferation in normal cervical epithelium.     

The effect of maternal prenatal smoking and alcohol consumption on the placenta-to-birth weight ratio

Background

Maternal influence on fetal growth is mediated through the placenta and this influence may have an implication for the offspring's long-term health. The placenta-to-birth weight ratio has been regarded as an indicator of placental function. However, few studies have examined the effect of maternal lifestyle exposures on the placenta-to-birth weight ratio. This study aims to examine the associations of maternal prenatal smoking and alcohol consumption with the placenta-to-birth weight ratio.

Methods

Data for 7945 term singletons, gestation≥37 weeks, were selected from the Tasmanian Infant Health Survey; a 1988–1995 Australian cohort study. Placenta and birth weight were extracted from birth notification records.

Results

Maternal smoking during pregnancy was strongly associated with a 6.77 g/kg higher (95% CI 4.83–8.71) placenta-to-birth weight ratio when compared to non-smoking mothers. Maternal prenatal smoking was associated with lower placental (β = −15.37 g; 95% CI −23.43 to −7.31) and birth weights (β = −205.49 g; 95% CI −232.91 to −178.08). Mothers who consumed alcohol during pregnancy had a lower placenta–to-birth weight ratio (β = −2.07 g/kg; 95% CI −4.01 to −0.12) than mothers who did not consume alcohol. The associations of maternal alcohol consumption during pregnancy with placental and birth weight did not reach statistical significance.

Discussion

Maternal prenatal smoking and alcohol consumption may influence fetal growth by either directly or indirectly altering the function of the placenta.

Conclusions

The alteration of the in utero environment induced by smoking and alcohol consumption appears to affect placental and fetal growth in differing ways. Further studies are needed to elucidate the mechanism.     

Chronic effects of maternal smoking on pulse waves in the fetal aorta

Objective.?In order to evaluate the impact of maternal smoking on arterial stiffness in utero, pulse wave characteristics in the fetal aorta were investigated. A prospective clinical study was made of 34 smoking and 34 non-smoking healthy volunteers with uncomplicated pregnancies at 31–40 weeks of gestation.

Methods.?The mechanical properties of the fetal thoracic aorta were assessed by an ultrasonic phase-locking echo-tracking system. For each fetus with a smoking mother, a non-smoking control matched for gestational and maternal age was monitored. Women with later appearing pregnancy complications were excluded. Pulse wave velocity (PWV), maximum diameter in systole (Ds), end-diastolic diameter (Dd), pulse amplitude (ΔD), and maximum incremental velocity (MIV) in the fetal aorta were measured and analyzed in relation to maternal smoking and gestational age.

Results.?Results were computed on fetuses of 32 smokers and 30 non-smokers. PWV increased with gestational age in smokers (corr. coeff. 0.49, p < 0.006) but not in non-smokers (corr. coeff. ?0.12). MIV did not change in smokers (corr. coeff. ?0.15) but increased in non-smokers (corr. coeff. 0.40, p < 0.03). Differences in regression lines between the groups regarding PWV and MIV were significant (p < 0.02 for both).

Conclusions.?Maternal smoking seems to promote the stiffening of the fetal aorta during gestation.     

The effect of cigarette smoking on the long term success rates of aortofemoral and femoropopliteal reconstructions

Cigarette smoking is a recognized causative factor in the genesis of arterial insufficiency, but the precise effect of nonsmoking on the success of the operation is not well documented. Three hundred and twenty-six patients who underwent aortobifemoral bypass (209) or femoropopliteal bypass (117) between 1969 and 1978 were observed to determine whether or not the discontinuation of cigarette smoking affected the long term results of these grafts. Patients were divided into three groups: group 1 smoked preoperatively and postoperatively; group 2 smoked preoperatively but not postoperatively, and group 3 did not smoke at all. The five year cumulative success rates for aortobifemoral bypass in the groups were: 42 per cent for group 1 (130 patients); 77 per cent for group 2 (67 patients), and 71 per cent for group 3 (12 patients) (p less than 0.001). In the femoropopliteal group, the variation with regard to the known patency rates of autogenous and prosthetic grafts made the results more difficult to assess. For all grafts the five year cumulative success rates were: 38 per cent of group 1 (57 patients); 33 per cent for group 2 (40 patients), and 70 per cent for group 3 (20 patients) (p less than 0.001). Subdivision of groups 1 and 2 into autogenous and synthetic grafts gave identical success rates of 54 per cent for long saphenous vein grafts (66). Prosthetic grafts were successful at five years in 19 per cent of the patients in group 1 (16 patients) and 43 per cent in group 2 (15 patients). These results were not significant. These results clearly favor the postoperative nonsmoker over the smoker in the aortofemoral group but the distinction in the femoropopliteal group is less clear, although there is a similar trend.     

The effect of tobacco smoking during pregnancy on plasma oxidant and antioxidant status in mother and newborn

Objective

The aim of the study was to estimate the effect of tobacco smoking during pregnancy on oxidative damage and antioxidant defence in matched samples of maternal blood and cord blood.

Study design

Healthy, pregnant women (n = 140) were divided into non-smoking and smoking groups according to the concentration of cotinine in serum and urine. Oxidative damage was measured through levels of malondialdehyde (MDA) and plasma antioxidant status was evaluated by measuring concentrations of total radical trapping parameters (TRAP) and selected antioxidants (β-carotene, vitamin A, vitamin E, uric acid). Statistical analysis was done using the SAS System for Windows (SAS Institute, Cary, NC).

Results

In the course of pregnancy the concentration of MDA increased, but to higher values in smoking women than in non-smoking ones. It was accompanied by significantly lower TRAP in the smoking group than in the controls (p < 0.05). Plasma concentration of uric acid (p < 0.05) and antioxidant vitamins E (p < 0.01), A and β-carotene (p < 0.0001) were all reduced in smokers as compared with non-smoking pregnant women especially in the third trimester. Concentration of MDA in plasma of cord blood of newborns of smoking mothers was significantly higher (p < 0.01) but the antioxidant defence was lower (p < 0.0001) than in non-smoking ones. It was particularly pronounced for β-carotene (32%; p < 0.0001) and vitamin A (28%; p < 0.001). A significant negative correlation was found between MDA and TRAP levels of maternal plasma (non-smoking and smoking: r = −0.50, p < 0.0001) and cord plasma (non-smoking: r = −0.54, p = 0.0057; smoking: r = −0.71, p = 0.0004) in all the study subjects. Total antioxidant status positively correlated with concentrations of uric acid and vitamin E in non-smoking and smoking mothers as well as their newborns.

Conclusion

Tobacco smoke enhances lipid peroxidation and depletes antioxidant potential in the plasma of pregnant women and umbilical cord blood. Therefore smoking during pregnancy may stimulate free radical damage in the mother and the growing fetus.     

The effect of chart speed on fetal monitor interpretation

Objective: Electronic fetal heart monitor chart speeds vary between countries, and it is unclear whether differing chart speeds affect physician tracing interpretation.

Methods: Twenty-minute segments of 19 tracings were displayed on both 1 and 3?cm/min strips and interpreted by 14 physicians at the particular speed they were accustomed to reading. Interpretations of tracing characteristics were compared between groups using free margin kappa, a measure of interobserver agreement.

Results: Compared to 3?cm/min tracings, 1?cm/min tracings were significantly more often identified as having absent than minimal variability, and minimal than moderate variability. Accelerations were significantly more often identified in 1 versus 3?cm/min strips. There were no significant differences between groups with respect to baseline fetal heart rate, prolonged or repetitive decelerations, or American College of Obstetricians and Gynecologists tracing category. Neither chart speed had substantial interobserver agreement in tracing variables; however, agreement was consistently higher in 3 versus 1?cm/min tracings (all p?<?0.05).

Conclusions: Tracing interpretation is significantly affected by fetal monitor chart speed with regards to variability, acceleration and deceleration. Further studies are required to determine if differences in chart speed interpretation affect clinical management.