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: 3.52). 02/2007; 12(7):2471-83. DOI: 10.2741/2248
Source: PubMed


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.

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    • "A 33% reduced incidence in the development of PE has been associated with smoking cigarettes in pregnancy [13], [14] and in a dose dependent manner [15]. The same is not true of smokeless tobacco [15], [16], which led us to hypothesize that carbon monoxide (CO) a combustible product in cigarettes, was the agent conferring the reduction of PE [17]. "
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    ABSTRACT: Preeclampsia (PE) remains a leading cause of maternal and neonatal morbidity and mortality worldwide. Smoking cigarettes is associated with a decreased incidence of PE. Based on this observation and previous work, we hypothesize that women who smoke have a lower risk of developing PE because of elevated levels of carbon monoxide (CO) in their blood. The objective of this study was to determine if low-dose CO in ambient air could attenuate the late pregnancy hypertension (HTN) and proteinuria in the Adenovirus (Ad) sFlt-1 PE-like mouse model. Continuous low-dose CO treatment (250 ppm) was started on E10.5 and maintained until E17.5. Compared to control and Ad empty vector, AdsFlt-1 mice displayed late- gestation HTN (E14.5-17.5) (P<0.05), proteinuria (P<0.05) and reduced Bowman's space which were all prevented with CO treatment. Use of the Ad (with/without sFlt-1) or CO had no effect (p>0.05) on litter size, fetal resorption numbers and fetal or placental weights. This study shows that treatment with CO can prevent HTN and proteinuria in a mouse model of PE. It provides a possible mechanism for the reduced incidence of PE in smoking women, and supports the possibility of using CO as a future treatment for PE.
    Full-text · Article · Sep 2014 · PLoS ONE
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    • "Paradoxically, Studies have shown that smoking during pregnancy has been associated with a reduced risk of preeclampsia [16]. For example, smoking during pregnancy reduces the risk of preeclampsia by up to 50% with a dose-response pattern [17]. Numerous studies have shown that twin pregnancy is an important risk factor for HDP. "
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    ABSTRACT: Hypertensive disorders of pregnancy (HDP) are a group of medical complications in pregnancy and also a risk factor for severe pregnancy outcomes, but it lacks a large-scale epidemiological investigation in recent years. This survey represents a multicenter cross-sectional retrospective study to estimate the prevalence and analyze the risk factors for HDP among the pregnant women who had referred for delivery between January 1st 2011 and December 31st 2011 in China Mainland. A total of 112,386 pregnant women were investigated from 38 secondary and tertiary specialized or general hospitals randomly selected across the country, of which 5,869 had HDP, accounting for 5.22% of all pregnancies. There were significant differences in the prevalence of HDP between geographical regions, in which the North China showed the highest (7.44%) and Central China showed the lowest (1.23%). Of six subtypes of HDP, severe preeclampsia accounted for 39.96%, gestational hypertension for 31.40%, mild preeclampsia for 15.13%, chronic hypertension in pregnancy for 6.00%, preeclampsia superimposed on chronic hypertension for 3.68% and eclampsia for 0.89%. A number of risk factors for HDP were identified, including twin pregnancy, age of >35 years, overweight and obesity, primipara, history of hypertension as well as family history of hypertension and diabetes. The prevalence of pre-term birth, placental abruption and postpartum hemorrhage were significantly higher in women with HDP than those without HDP. The possible risk factors confirmed in this study may be useful for the development of early diagnosis and appropriate treatment of HDP.
    Full-text · Article · Jun 2014 · PLoS ONE
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    • "A well-known more immediate consequence of maternal smoking during pregnancy is the increased risk for sudden infant death syndrome due to nicotine targeting monoamine pathways in brainstem and cardiac sympathetic innervation (Slotkin et al., 1999, 2010), and intra-uterine growth retardation resulting in reduced birth weight (Ernst et al., 2001b). Although it does not outweigh the negative effects of smoking, smoking during (late) pregnancy could protect the mother from hypertension and resulting pre-eclampsia (England and Zhang, 2007; Wikstrom et al., 2010). "
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    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.
    Full-text · Article · Oct 2012 · Frontiers in Pharmacology
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