Gebelikte Kullanılan Sigara Dozunun Maternal ve Fetal Sonuçlar ile İlişkisi

Öz

Amaç: Sigaranın maternal, fetal ve neonatal olumsuz etkileri bilinmektedir. Biz bu çalışmada sigaranın günlük kullanım miktarı ile maternal ve perinatal sonuçlar arasındaki ilişkiyi araştırmayı amaçladık.

Yöntem ve Gereçler: Bu çalışma 2015 – 2017 yılları arasında Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniğinde yapılmıştır. Çalışmaya 1029 sigara içmeyen ve 261 sigara içen gebe dahil edildi. Hastalar gebelik boyunca içtikleri sigara adedine göre hafif, orta ve ağır içici olmak üzere sub-gruplara (≤5 adet /gün, 5-15 adet/gün, >15 adet/gün) ayrıldı. Hastaların demografik özellikleri kaydedildi. Tüm gebelerde maternal ve perinatal sonuçlar değerlendirildi.

Bulgular: Sigara içen gebelerin %28.4’ ü günde ≤5 adet sigara, %62.5’i 5-15 adet sigara ve %9.2’si >15 adet sigara içmekte idi. Yenidoğanın doğum haftası, doğum ağırlığı, boyu, 1. Dakika apgar skoru ve 5. Dakika apgar skoru sigara içen gebeler lehine istatistiksel olarak anlamlı oranda düşük bulundu. Sigara içen gebelerin yenidoğanlarının doğum ağırlığı sigara içmeyen gebelere göre 162 gram daha düşük bulundu (p<0.0001). Gebelerin doğum şekli ve bebeklerin cinsiyetleri açısından gruplar arasında anlamlı fark bulunmadı. Sigara içen gebelerde preeklampsi, erken membran rüptürü (EMR), preterm prematür membran ruptürü (PPROM), fetal gelişme kısıtlılığı (FGR), intrauterin fetal kayıp ve yenidoğan yoğum bakım ünitesine yatış oranları sigara içmeyen gebelere göre istatistiksel anlamda daha fazla saptandı. Subgruplar kendi arasında karşılaştırıldığında ise >15 adet/gün sigara kullanan gebelerde diğerlerine göre istatistiksel anlamda daha düşük doğum ağırlığı ve daha yüksek yenidoğan yoğun bakım ünitesine yatış oranı görülmüştür.

Sonuç: Çalışmamız, gebelikte maternal sigara kullanımının doza bağlı bir şekilde düşük doğum ağırlığı ve yenidoğan yoğun bakım ünitesine yatış riskini artırdığını göstermiştir. 

Anahtar Kelimeler

• Gebelik,Sigara,Maternal prognoz

Relationship Between Smoking Doses and Maternal and Fetal Outcomes of Pregnancy

Abstract

Introduction: We aimed to investigate the relationship between daily smoking doses and maternal and perinatal outcomes.

Methods: This study was conducted between 2015 and 2017 in Zeynep Kamil Women's and Children's Hospital Education and Research Hospital. 1029 pregnancies who did not smoke and 261 pregnancies who smoked were included in the study. Patients were divided into subgroups (≤5 pcs / day, 5-15 pcs / day,> 15 pcs / day), which were mild, moderate and heavy smokers. Demographic characteristics of the patients were recorded. All maternal and perinatal outcomes were evaluated.

Results:  28.4% of the smokers were using ≤5 cigarettes per day, 62.5% of the smokers were using 5-15 cigarettes and 9.2% of the smokers were using> 15 cigarettes. Birth weight, gestational week of birth, birth height, 1st minute apgar scores and 5th minute apgar scores were statistically significantly lower in pregnancies who smoked. The birth weight of smokers was 162 grams lower than pregnancies who did not smoke (p <0.0001). There was no significant difference between the groups regards to type of delivery and the sex of the infants. Rates of preeclampsia, premature rupture of membranes (PPROM), fetal growth restriction (IUGR), intrauterine fetal demise and neonatal care unit admission were statistically significantly higher in pregnancies who smoked. When subgroups were compared, pregnancies who smoked > 15 cigarettes per day were found to have statistically significantly lower birth weight and higher rates of neonatal intensive care unit admission.

Conclusion: Our study revealed that the risk of low birth weight and risk of admission to the neonatal intensive care unit increased with increasing cigarette usage during pregnancy. 

Keywords

• Pregnancy,Cigarette,Maternal prognosis

Kaynakça

1. 1- Committee on Health Care for Underserved Women. Committee opinion number 503: tobacco use and women’s health. Obstet Gynecol.2011;118(3):746–50.
2. 2- Balkaya N.A. Vural G. Eroğlu K. Gebelikte Belirlenen Risk Faktörlerinin Anne ve Bebek Sağlığı Açısından Ortaya Çıkardığı Sorunların İncelenmesi. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 2014;4(1): 6-16.
3. 3- Abel EL. Smoking during pregnancy: a review of effects on growth and development of the offspring. Human Biology 1980;52(4):593-625.
4. 4- Bouyer J, Coste J, Shojaei T, Pouly JL, Fernandez H, Gerbaud L, Job-Spira N. Risk factors of ectopic pregnancy: a comprehensive analysis based on a large case-control population based study in France. Am J Epidemol 2003;157(3):185-94.
5. 5- Walsh RA Effects of maternal smoking on adverse pregnancy outcomes: examination of the criteria of causation. Hum Biol. 1994;66(6):1059-92.
6. 6- Andres RL The association of cigarette smoking with placenta previa and abruptio placentae. Semin Perinatol. 1996;20(2):154-9.
7. 7- Agrawal A, Scherrer JF, Grant JD, Sartor CE, Pergadia ML, Duncan AE, Madden PA, Haber JR, Jacob T, Bucholz KK, Xian H. The effects of maternal smoking during pregnancy on offspring outcomes. Prev Med. 2010;50(1-2):13-8.
8. 8- Högberg L,Cnattingius S. The influence of maternal smoking habits on the risk of subsequent stillbirth: is there a causal relation? BJOG 2007;114(6): 699–704.

9. 9- Sopori M. Effects of cigarette smokes on the immune system. Nat Rev Immunol 2002;2(5):372-377.
10. 10- Hafström O, Milerad J, Sandberg KL, Sundell HW. Cardiorespiratory effects of nicotine exposure during development. Respir Physiol Neurobiol. 2005;149(1-3):325-41.
11. 11- Riedel C, Schönberger K, Yang S, Koshy G, Chen YC, Gopinath B et al. Parental smoking and childhood obesity: higher effect estimates for maternal smoking in pregnancy compared with paternal smoking: a meta-analysis. Int J Epidemiol. 2014;43(5):1593-606.
12. 12- Virtanen HE, Sadov S, Toppari J. Prenatal exposure to smoking and male reproductive health. Curr Opin Endocrinol Diabetes Obes. 2012;19(3):228-32.
13. 13- Huang SH, Weng KP, Huang SM, Liou HH, Wang CC, Ou SF, Lin CC, Chien KJ, Lin CC, Wu MT. The effects of maternal smoking exposure during pregnancy on postnatal outcomes: A cross sectional study. J Chin Med Assoc 2017;80(12):796-802.
14. 14- Berlin I, Golmard JL, Jacob N, Tanguy ML, Heishman SJ. Cigarette Smoking During Pregnancy: Do Complete Abstinence and Low Level Cigarette Smoking Have Similar Impact on Birth Weight? Nicotine Tob Res. 2017;19(5):518-524.
15. 15- Spracklen CN, Ryckman KK, Harland K, Saftlas AF. Effects of smoking and preeclampsia on birth weight for gestational age. J Matern Fetal Neonat Med 2015;28(6):679-684.
16. 16- Newman MG, Lindsay MK, Graves W. Cigarette smoking and pre-eclampsia: their association and effects on clinical outcomes. J Matern Fetal Neonat Med 2001;10(3):166-170.
17. 17- Shobeiri F, Jenabi E. Smoking and placenta previa: a meta-analysis. J Matern Fetal Neonat Med 2017; 30(24):2985-2990.
18. 18- Lambers DS, Clark KE. The maternal and fetal physiologic effects of nicotine. Semin Perinatol 1996;20(2):115-126.
19. 19- Mantzoros CS, Varvarigou A, Kaklamani VG, Beratis NG, Flier JS. Effect of birth weight and maternal smoking on cord blood leptin concentrations of full-term and preterm newborns. J Clin Endocrinol Metab. 1997;82(9):2856-61.
20. 20- Bernstein IM, Mongeon JA, Badger GJ, Solomon L, Heil SH, Higgins ST. Maternal smoking and its association with birth weight. Obstet Gynecol. 2005;106(5 pt.1):986-991.
21. 21- 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. Am J Epidemiol 2001;154(8):694-701.
22. 22- Ko TJ, Tsai LY, Chu LC, Yeh SJ, Leung C, Chen CY, Chou HC, Tsao PN, Chen PC, Hsieh WS. Parental smoking during pregnancy and its association with low birth weight, small for gestational age, and preterm birth offspring: a birth cohort study. Pediatr Neonatol 2014;55(1):20-27.
23. 23- Kramer MS. Determinants of low birthweight: methodological assessment and metaanalysis. Bulletin of the World Health Organization 1987; 65(5):663-737.
24. 24- Berkowitz GS, Papiernik E. Epidemiology of preterm birth. Epidemiologic Reviews 1993;15(2):414-443.
25. 25- 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):465–472.
26. 26- Horta BL, Victora CG, Menezes AM, Halpern R, Barros FC. Low birthweight, preterm births and intrauterine growth retardation in relation to maternal smoking. Paediatr Perinat Epidemiol 1997;11(2):140-151.
27. 27- Chiolero A, Bovet P, Paccaud F. Association between maternal smoking and low birth weight in Switzerland: the EDEN study. Swiss Med Wkly. 2005;135(35-36):525-530.
28. 28- Blatt K, Moore E, Chen A, Van Hook J, DeFranco EA. Association of reported trimester-specific smoking cessation with fetal growth restriction. Obstet Gynecol. 2015;125(6):1452-1459.