Smoking and Alcohol Addiction during Pregnancy

     Cigarette smoking affects a pregnant women's health and the health of an unborn child. Tobacco smoking has been shown to have a carcinogenic effect on various organs. Maternal smoking and alcohol consumption during pregnancy is detrimental to both the mother and fetus, increasing the risk of intrauterine growth retardation, obstetric complications and adverse health effects. Maternal smoking during pregnancy affects foetal growth and birth weight causes spontaneous abortion, abnormal bleeding during pregnancy, premature detachment of the placenta, premature rupture of the membranes and perinatal mortality. Smoking in the second and third trimesters of the pregnancy seems to cause these complications. Babies born to smoking pregnant women are on average 200 grams lighter than babies born to non-smoking mothers because of the reduction of placental blood flow that results in a reduction in the nutrient level reaching the foetus. Reduced birth weight increases the risks of diseases and infant death. Foetal miscarriage has been found to be higher in such smoking women. Maternal smoking also induces preterm births. Breastfeeding women who smoke have been found to have lower levels of prolactin, which is essential for the breastfeeding and thus causes reduced breastfeed. Smoking in pregnancy seems to have an adverse on the physical growth and intellectual development of the child associated with a reduced height and intellectual attainments. Women who consume alcohol during pregnancy are at a high risk of having babies with fetal alcohol syndrome, which results in fetal growth deficiencies, problem in the nervous system, comparatively lowered intelligence, and facial abnormalities in the babies. It is also popularly called fetal alcohol spectrum disorder. Pregnant women who drink 10 to 15 units of alcohol a week have been found to have underweight babies. Consuming alcohol during pregnancy also affects foetal development affecting the baby at birth increasing disease susceptibility and cognitive abilities. Pregnant women who consume more than six units of alcohol per day have been shown to be at risk of having babies with foetal alcohol syndrome (FAS).  

Smoking and Alcohol Addiction during Pregnancy

     Cigarette smoking affects a pregnant women's health and the health of an unborn child. Tobacco smoking has been shown to have a carcinogenic effect on various organs. Maternal smoking and alcohol consumption during pregnancy is detrimental to both the mother and fetus, increasing the risk of intrauterine growth retardation, obstetric complications and adverse health effects. Maternal smoking during pregnancy affects foetal growth and birth weight causes spontaneous abortion, abnormal bleeding during pregnancy, premature detachment of the placenta, premature rupture of the membranes and perinatal mortality. Smoking in the second and third trimesters of the pregnancy seems to cause these complications. Babies born to smoking pregnant women are on average 200 grams lighter than babies born to non-smoking mothers because of the reduction of placental blood flow that results in a reduction in the nutrient level reaching the foetus. Reduced birth weight increases the risks of diseases and infant death. Foetal miscarriage has been found to be higher in such smoking women. Maternal smoking also induces preterm births. Breastfeeding women who smoke have been found to have lower levels of prolactin, which is essential for the breastfeeding and thus causes reduced breastfeed. Smoking in pregnancy seems to have an adverse on the physical growth and intellectual development of the child associated with a reduced height and intellectual attainments. Women who consume alcohol during pregnancy are at a high risk of having babies with fetal alcohol syndrome, which results in fetal growth deficiencies, problem in the nervous system, comparatively lowered intelligence, and facial abnormalities in the babies. It is also popularly called fetal alcohol spectrum disorder. Pregnant women who drink 10 to 15 units of alcohol a week have been found to have underweight babies. Consuming alcohol during pregnancy also affects foetal development affecting the baby at birth increasing disease susceptibility and cognitive abilities. Pregnant women who consume more than six units of alcohol per day have been shown to be at risk of having babies with foetal alcohol syndrome (FAS).  

Research Evidence
      
A recent study to examine if smoking during pregnancy has an influence on the symptoms of attention deficit hyperactivity disorder (ADHD) assessed with questionnaires for a population-based sample of twins found that maternal smoking during pregnancy has an environmentally mediated association with offspring ADHD symptoms (Anita Thapar et.al, 2003). The effect of maternal smoking on neonatal lung function has been demonstrated in a study and has shown that maternal smoking has been associated with increased wheeze in early life and in schoolchildren. The study has concluded that these adverse health effects on the lungs are on account of detrimental changes before birth (Le Sou?f, 2006).A study conducted to demonstrate the association between smoking during pregnancy and sudden infant death syndrome (SIDS) using prospectively collected data has shown that children of smokers had more than three times the risk of SIDS compared with children of non-smokers (OR = 3.5; 95% CI 1.4-8.7), and the risk of SIDS increased with the number of cigarettes smoked per day (p < 0.05) during pregnancy (Kirsten Wisborg et.al, 2000). Recently there have been suggestions to study the genotoxic effect of maternal smoking at the chromosomal level for possible mutagenesis and chromosomal aberrations. Foetal amniotic cells have been marked as potential sites of expression of nicotine induced mutations (Rosa Ana de la Chica, 2005). A recent research work has already implicated smoking in pregnancy in mutagenic effects on the fetus (DeMarini DM et.al, 2005). Results have shown an approximately 3.5 fold increase in the incidence of structural chromosomal abnormalities as deletions and translocations in the fetal cells from smokers compared with those from non-smokers. There are evidences to show that smoking interferes with a woman's hormonal balance during pregnancy and has long-term consequences on the reproductive organs of her children (Golding, 1994). Infants born of smoking mothers suffer from serious respiratory infections than the children of non-smokers. Smoking during pregnancy can also increase the risk of asthma in young children (Gilliland, 2001) due to changes in biological receptors in the baby?s immune system that are responsible for recognising and fighting infections and bacteria (Noakes S et al. 2006). Cleft palate abnormalities due to maternal smoking have also been elucidated (Chung, K.C. et al, 2000). The teratogenic effects of alcohol following exposure during pregnancy, and its influence on the chromosome constitution of the pre-ovulatory egg have been well documented (Kaufman MH. 1997). The study has proved that alcohol and its primary metabolite, acetaldehyde, are teratogenic and exposure of the fetus during pregnancy leads to fetal alcohol syndrome (FAS). These infants although survive, are mentally retarded and found to display a characteristic range of clinical features, principally craniofacial abnormalities and neurological damage. A study to evaluate a twelve year follow up of children exposed to in-utero to alcohol has shown that longer the intrauterine alcohol exposure and the more severe was the diagnosis related to prenatal alcohol exposure. These children were in need of special education and had behavioral problems (Ilona autti-r?m?, 2000). The effect of maternal ethanol consumption during pregnancy on the phospholipid molecular species composition of fetal brain, liver and plasma has been documented as well (Burdge et.al, 1995). The study on the effect of maternal ethanol consumption during pregnancy upon accumulation of docosahexaenoic acid (22:6 (n - 3)) into developing brain phospholipids has shown that Liver from ethanol-exposed fetuses contained significantly lower concentrations of both phosphatidylcholine  (PC) and phosphatidylethanolamine (PE) 22:6(n - 3)-containing molecular species and reduced accumulation of 22:6(n - 3) into phospholipids may be one important mechanism for ethanol-induced brain damage (Keeley-Joanne, et.al, 2006). A study to assess the expression, activity and localization of enzymes Uridine diphosphate glucuronosyltransferase (UGT), ?-glucuronidase, cytochrome P450 1A (CYP1A) and cytochrome P450 2E1 (CYP2E1) in the first trimester human placenta and to measure the effects of maternal variables on placental metabolism has shown that UGT and CYP1A activities were significantly elevated in smokers placentas  (P < 0.05 and P < 0.001 respectively) and were greatest in women who both smoked and consumed alcohol (P < 0.05 and P < 0.01 respectively).This proves that the metabolism of human placenta in the  first trimester may be affected by maternal intake of alcohol altering the constitutive enzyme system of the placenta (Abby C. Collier et.al,2002).An extended analysis of data obtained in a study on the possible association between maternal consumption of alcohol during pregnancy and fetal defects has also shown women who smoked and consumed alcohol in the first trimester gave birth to children with significant birth abnormalities (Moira l. plant et.al,1988).

Conclusion

    Research has shown that smoking during pregnancy causes health problems for both mothers and babies, such as Pregnancy complications, Premature birth, Low-birth-weight infants, Stillbirth Sudden infant death syndrome (SIDS). Smoking has been found to not only expos??s the fetus to potential toxins in tobacco smoke, but also damaging the placental function. Thus the children born to these women have organs that are smaller, have poorer lung function, are and are ill more frequently. Hence it is important for pregnant women to avoid smoking in the best interests of themselves and the society. Consumption of alcohol during pregnancy is deleterious to the fetus as evidenced by research. Maternal alcohol consumption seems to have a serious teratogenic effect due to altered placental metabolism and induced mutagenesis.

Reference

•Abby C. Collier, Malcolm D. Tingle, James W. Paxton, Murray D. Mitchel and Jeffrey A. Keelan (2002). Metabolizing enzyme localization and activities in the first trimester human placenta: the effect of maternal and gestational age, smoking and alcohol consumption, Human Reproduction.17(10); 2564-2572.

•Anita Thapar, et.al (2003). Maternal Smoking During Pregnancy and Attention Deficit Hyperactivity Disorder Symptoms in Offspring, Am J Psychiatry 160:1985-1989.

•Brookes et.al. (2006), A Common Haplotype of the Dopamine Transporter Gene Associated With Attention-Deficit/Hyperactivity Disorder and Interacting With Maternal Use of Alcohol During Pregnancy, Arch Gen Psychiatry.63:74-81.

•Burdge GC et.al (1995). Effect of maternal ethanol consumption during pregnancy on the phospholipid molecular species composition of fetal guinea-pig brain, liver and plasma. Biochim Biophys Acta .16 (2):197.

•ChristineMacArthur, E. George Knox, Robert J.Lancashire (2001) Effects at age nine of maternal smoking in pregnancy: experimental and observational findings, BJOG: An International Journal of Obstetrics and Gynaecology, 108 (1); 67.

•Chung, K.C. et al. (2000) Maternal cigarette smoking during pregnancy and the risk of having a child with cleft lip/palate. Plast.Reconstr.Surg; 105 (92): 485-491.

•E.J. Waterson1 and Iain M. Murray-Lyon (1990). Preventing fetal alcohol effects; a trial of three methods of giving information in the antenatal clinic, Health Education Research, 5(1): 53-61.

•F. Lazzaroni et.al (1993). Moderate maternal drinking and outcome of pregnancy, European Journal of Epidemiology. 9(6).

•Flynn, Heather A.; Marcus, Sheila M.; Barry, Kristen L.; Blow, Frederic C. (2003). Rates and Correlates of Alcohol Use among Pregnant Women in Obstetrics Clinics. Alcoholism: Clinical & Experimental Research. 27(1):81-87.

•Gilliland, F.D. et al (2001). Effects of maternal smoking during pregnancy and environmental tobacco smoke on asthma and wheezing in children.  Am J Respir Crit Care Med 163(2): 429-436.   

http://www.bma.org.uk/ap.nsf/Content/SmokingReproductiveLife

•Ilona Autti-Rämö (2000) Twelve-year follow-up of children exposed to alcohol in utero. Developmental Medicine & Child Neurology .42: 406-411.

•Kaufman MH. (1997). The teratogenic effects of alcohol following exposure during pregnancy, and its influence on the chromosome constitution of the pre-ovulatory egg. Alcohol Alcohol. 32(2):113-28.

•Kirsten Wisborg, Ulrik Kesmodel, Tine Brink Henriksen, Sjurdur Frodi Olsen, Niels Jørgen Secher (2000) A prospective study of smoking during pregnancy and SIDS, Arch Dis Child.83:203-206.

•Moira l. plant and martin a. plant (1988) Maternal use of alcohol and drugs during pregnancy and birth abnormalities: further results from a prospective study, Alcohol and Alcoholism23(3). 229-233.

•Noakes S et al (2006).  Maternal smoking is associated with impaired neonatal Toll-like receptor (TLR) mediated immune responses.  European Respiratory Journal  doi:10.1183/09031936.06.00050206

•P. N. Le Souëf (2006). Adverse effects of maternal smoking during pregnancy on innate immunity in infants, Eur Respir J. 28:675-677.

•Sondergaard C (2001). Smoking during pregnancy and infantile colic.  Paediatrics 108(2): 342-346.

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