EFFECTS OF TOBACCO ON PREGNANCY MiniLecture 2 Module

EFFECTS OF TOBACCO ON PREGNANCY Mini-Lecture 2 Module: Tobacco and the Reproductive System

Objectives of the Mini Lecture GOAL OF MINI LECTURE: Increase student’s knowledge of the potential problems related to tobacco use during pregnancy. LEARNING OBJECTIVES: Students will be able to: • Understand the effects of smoking on poor pregnancy outcomes. • Understand that smoking causes IUGR. • Understand the benefits of cessation and reduction on third trimester fetal growth and birth weight outcomes.

Contents Core Slides 1. Tobacco Use among Women: India 2. Smoking and Pregnant Women 3. Poor Early Pregnancy Outcomes 4. Smoking and Placental Disorders 5. In-utero Tobacco Smoke Exposure 6. Smoking and Birth Weight 7. Maternal Smoking and Birth Outcomes 8. Maternal Chewing and Birth Outcomes 9. Why Tobacco Cessation? Optional Slides 1. Smoking And Intrauterine Growth Retardation (IUGR): Mechanism 2. Smoking and Preeclampsia

CORE SLIDES Effects of Tobacco on Pregnancy Mini Lecture 2 Module: Tobacco and the Reproductive System

India Tobacco Use among Women: India • India (25 -49 yrs): 1 • Smoking: 2. 3% • Chewing: 11. 3% • Kerala: 2 • Smoking: 0. 4% • Chewing: 10. 1% http: //www. trekearth. com/gallery/Asia/India/photo 849034. htm 1. Parasuraman et al. 2009; 2. Rani et al. 2003

Smoking and Pregnant Women • Increased risk of premature delivery 1 • Increased risk of ectopic pregnancy 2 • Increased risk of IUGR 1 • Increased risk of perinatal and neonatal mortality 1 http: //www. womenshealthdata. ca/images/bodypic /maternal-smoking-b. jpg 1. Danish Environmental Protection Agency 2001; 2. American Society for Reproductive Medicine 2003

Poor Early Pregnancy Outcomes 1 • Increased risk of spontaneous abortion 1 • Frequency of abortion directly proportional to the number of cigarettes smoked 1 • Increased risk of congenital malformations 2 1. American Society for Reproductive Medicine 2003; 2. Danish Environmental Protection Agency 2001

Smoking and Placental Disorders • Increased risk of placental complications 1 • Increased risk of placenta previa 2 • Increased risk of placental abruption 2 http: //z. about. com/d/create/1/0/U/o/-/-/0151. jpg 1. England Zhang 2007; 2. Danish Environmental Protection Agency 2001

In-utero Tobacco Smoke Exposure • Reduced lung function at birth, perinatal period, childhood and adolescence 1 • Poor performance at birth and infancy (head turning, sucking, visual alertness, etc. )2 http: //medicineworld. org/images/blogs/4 -2008/fetus-452290. jpg 1. Gilliland et al. 2000; 2. Danish Environmental Protection Agency 2001

Smoking and Birth Weight • Low birth weight primarily due to intrauterine growth retardation (IUGR)1 • Low birth weight risk doubled among maternal smokers 2 • Risk is dose dependent 2 http: //cdn-write. demandstudios. com/upload//9000/30/5/29335. jpg 1. Danish Environmental Protection Agency 2001; 2. Werler 1997

Maternal Smoking and Birth Outcomes 1 • Pre-term birth • Low birth weight • Small head circumference • Low APGAR score at 5 min • Stillbirths and neonatal deaths 1. Kallen 2001

Maternal Chewing and Birth Outcomes • Decreased gestational age at birth: average reduction of 6. 2 days • Decreased birth weight: average reduction of 105 g http: //www. marketmanila. com/archives/a-nicotine-high Gupta and Sreevidya 2004

Why Tobacco Cessation? 1 • Ideal time for smoking intervention 1 • There is no increase in low birth weight risk if smoking cessation is done in early pregnancy 2 • Increasing use of smokeless tobacco: requires attention as part of routine prenatal care 3 1. Cnattingius 2004; 2. Werler 1997; 3. Gupta 2004

OPTIONAL SLIDES Effects of Tobacco on Pregnancy Mini Lecture 2 Module: Tobacco and the Reproductive System

Smoking and Intrauterine Growth Retardation (IUGR): Mechanism 1, 2 Nicotine and carbon monoxide: • Trigger fetal carboxyhaemoglobin • Reduce fluidity of blood • Slow oxygenation of fetus • Lead to low birth weight http: //pregnancy. more 4 kids. info/uploads/Image/Nov 2007/fetal-image. jpg 8 1. Danish Environmental Protection Agency 2001; 2. Fourn et al. 1999

Smoking and Pre-eclampsia 1 • Pre-eclampsia risk decreased in smokers but incidence is increased 1. 58 times in snuff users compared with non-users. England Zhang 2007

Stop smoking for the health of your family!