“Smoking may worsen outcome

of pregnancy complication”
July 28, 2010, 3:40pm

NEW YORK (Reuters Health) – A new study suggests that smokers who develop preeclampsia
during pregnancy are at particular risk of suffering the complications associated with the disorder
-- including preterm delivery, low birth weight and stillbirth.

The findings may not sound surprising. But they actually present something of a paradox, as past
studies have linked smoking to a reduced risk of developing preeclampsia in the first place.

Preeclampsia is a syndrome marked by a sudden increase in blood pressure after the 20th week
of pregnancy and a buildup of protein in the urine due to stress on the kidneys. Most women with
preeclampsia deliver a healthy baby, but the condition can develop into a life-threatening
condition called eclampsia, which can cause seizures or coma.

Preeclampsia can also slow the growth of the fetus and increase the risks of preterm birth,
placental abruption -- where the placenta separates from the uterine wall before delivery of the
newborn, potentially leading to heavy bleeding that can be life-threatening to mother and child.

A number of studies have found that pregnant smokers are less likely than non-smokers to
develop preeclampsia, for reasons that are not yet clear.

But these latest findings, reported in the American Journal of Obstetrics & Gynecology, suggest
that once preeclampsia develops, smoking exacerbates the risk of complications, according to
Elizabeth Miller and colleagues at the Ottawa Hospital in Canada.

Using a database with information on more than 300,000 births between 2004 and 2006, the
researchers found that women who smoked during pregnancy had a slightly lower rate of
preeclampsia -- 1.2 percent, versus 1.5 percent among non-smokers.

But among women with preeclampsia, smokers were more likely to have serious complications.

For example, 9 percent of smokers had a baby who was small for gestational age -- smaller than
the norm for the baby's sex and the week of pregnancy during which he or she was born. That
compared with 5 percent of non-smokers who had preeclampsia.

Similarly, just over 3 percent of smokers with preeclampsia suffered placental abruption, versus
0.7 percent of non-smokers with the condition. The rates of stillbirth were 1.8 percent and 0.9
percent, respectively.

When Miller's team factored in variables like the mother's age and how many pregnancies she'd
had (preeclampsia is more common in first-time mothers), smokers with preeclampsia were three
to six times more likely to have a stillbirth, preterm delivery, placental abruption or undersized
newborn than non-smokers without preeclampsia.

Non-smokers with preeclampsia also had elevated risks, but not of the magnitude seen among
smokers.

Despite the fact that smoking is linked to a relatively lower risk of developing preeclampsia,
experts have always stressed that the risks of smoking during pregnancy -- including miscarriage,
poor fetal growth and preterm delivery -- far outweigh the potential benefit.

The current findings reinforce the importance of quitting smoking during, or preferably before,
pregnancy, according to Miller's team.

They also indicate that smokers with preeclampsia should have their pregnancies closely
monitored, and be offered particularly intensive smoking-cessation counseling.

It is hard to explain why smoking might protect against preeclampsia development yet worsen its
outcome, according to the researchers.

But, they note, cigarettes do contain substances that inhibit blood vessels from constricting,
which may help protect against preeclampsia. On the other hand, smoking also reduces levels of
hormone-like substances called prostacyclins, which help dilate blood vessels. In women who
have preeclampsia, Miller's team speculates, smoking may exacerbate any reduction in oxygen
getting to the fetus.

http://www.mb.com.ph/articles/269328/smoking-may-worsen-outcome-pregnancy-complication