Smoking and risk of preeclampsia: a systematic review

Division of Reproductive Health, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, GA, USA.
Frontiers in Bioscience (Impact Factor: 4.25). 02/2007; 12:2471-83. DOI: 10.2741/2248
Source: PubMed

ABSTRACT Cigarette smoking adversely affects every organ system. Paradoxically, smoking during pregnancy has been associated with a reduced risk of preeclampsia. We reviewed previous epidemiologic and clinical studies on the association between smoking and preeclampsia from 1959 to March, 2006. A total of 48 epidemiologic studies were identified. Overall, smoking during pregnancy reduces the risk of preeclampsia by up to 50% with a dose-response pattern. A protective effect was consistently found in both nulliparas and multiparas, singleton and multifetal pregnancies, and for mild and severe preeclampsia. Evidence on whether quitting smoking before or in early pregnancy reduces the risk remains inconclusive. To understand possible biologic mechanism(s) of the protective effect, we reviewed literature on potential pathophysiology of smoking and its effects on placenta, cardiovascular and immune systems. Although current literature does not lend clear evidence to support a particular mechanism for the protective effect of smoking, smoking might have effects on angiogenic factors, endothelial function and the immune system which act to lower risk of preeclampsia. More epidemiologic studies with biochemically confirmed smoking status and laboratory studies with a focus on promising pathways are warranted to further clarify this puzzling relationship. Understanding the underlying mechanisms through which smoking reduces preeclampsia risk may enhance our understanding of the pathogenesis of this disorder and contribute to the development of prevention strategies.

Download full-text


Available from: Lucinda England, Mar 11, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Nicotine has remarkably diverse effects on the brain. Being the main active compound in tobacco, nicotine can aversively affect brain development. However, it has the ability to act positively by restoring attentional capabilities in smokers. Here, we focus on nicotine exposure during the prenatal and adolescent developmental periods and specifically, we will review the long-lasting effects of nicotine on attention, both in humans and animal models. We discuss the reciprocal relation of the beneficial effects of nicotine, improving attention in smokers and in patients with neuropsychiatric diseases, such as schizophrenia and attention deficit/hyperactivity disorder, vs. nicotine-related attention deficits already caused during adolescence. Given the need for research on the mechanisms of nicotine's cognitive actions, we discuss some of the recent work performed in animals.
    Frontiers in Pharmacology 10/2012; 3:180. DOI:10.3389/fphar.2012.00180
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The pathophysiological mechanisms underlying preeclampsia, a serious complication of pregnancy, are largely unknown. Since, on the other hand, the various risk factors are known, primary and secondary prevention with pre- and inter-pregnancy counseling should be undertaken, and a follow-up should be conducted to evaluate any long-term organic complications. There is evidence in the literature that women with preeclampsia are particularly predisposed to developing cardiovascular diseases, especially ischemia, and it is justifiably believed that preeclampsia and atherosclerosis share the same risk factors. However, further understanding is required concerning the risk of long-term dysfunctions in other organs also involved in the course of preeclampsia: the kidneys, liver and brain. Preeclampsia is, moreover, a complex multispecialist entity, and the internist and/or the intensivist can be important allies along with the obstetrician in the management of this condition.
    Journal of nephrology 21(5):663-72. · 2.00 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIF: évaluer un modèle prédictif de prééclampsie associant des marqueurs cliniques, biologiques (Inhibine A, PP-13, hCG, ADAM12, PAPP-A et PlGF) et du Doppler des artères utérines (DAU) au 1er trimestre de la grossesse. METHODE : étude prospective de cohorte de 893 nullipares chez qui DAU et prélèvement sanguin étaient réalisés à 11-14 semaines. RESULTATS : 40 grossesses se sont compliquées de prééclampsie (4,5%) dont 9 de prééclampsie précoce (1,0%) et 16 de prééclampsie sévère (1,8%). Le meilleur modèle prédictif de la prééclampsie sévère associait les marqueurs cliniques, PAPP-A et PlGF (taux de détection 87,5% pour 10% de faux positif). Le DAU étant corrélé à la concentration de PAPP-A (r=-0,117 ; p<0,001), il n’améliorait pas la modélisation. CONCLUSION : la combinaison de marqueurs cliniques et biologiques (PlGF et PAPP-A) au 1er trimestre permet un dépistage performant de la prééclampsie sévère. Le DAU n’est pas un instrument efficace de dépistage au 1er trimestre dans cette population. OBJECTIVE: To determine the value of combined screening for pregnancy hypertensive disorders by maternal characteristics, first trimester uterine artery Doppler (UAD) and serum biomarkers (Inhibine A, PP-13, hCG, ADAM12, PAPP-A et PlGF). STUDY DESIGN: In this prospective cohort study, 893 nulliparous women had UAD evaluation and collection of serum sample at 11-14 weeks. RESULTS: 40 women developed preeclampsia (4.5%) of which 9 early-onset preeclampsia (1.0%), and 16 severe preeclampsia (1.8%). The best model to predict preeclampsia associated maternal charateristics, PAPP-A and PlGF (detection rate 87.5% for 10% of false positive). UAD was correlated to PAPP-A concentration (r=-0.117 ; p<0.001), and so did not add to predictive accuracy. CONCLUSION: Combination of maternal characteristics and first trimester PlGF and PAPP-A provides a useful screening for severe preeclampsia. First trimester UAD was not an efficient screening tool in this population.