Effects of tobacco and alcohol in

pregnancy
Agus Rusdhy Hamid
Tobacco use in pregnancy
Itis well known by now that tobacco consumption is
hazardous to health.
The following health hazards have been
enumerated :
◦ Increased incidence of spontaneous abortion
◦ Increased perinatal mortality
◦ Greater incidence of abruptio placentae
◦ Low birth weight babies
◦ Preterm deliveries
◦ Congenital malformations
◦ Larger placentae
◦ Long term effect on growthg and development.
Mechanism of action of tobacco use in
pregnancy
 Tobacco smoke contains thousands of compounds
that may have adverse effects.
 The major compounds suspected of causing harm
to the developing fetus are nicotine and carbon
monoxide.
 Nicotine crosses the placenta and can be detected
in the fetal circulation at levels that exceed
maternal concentrations by 15%, while amniotic
fluid concentrations of nicotine are 88% higher
than maternal plasma.
 The actions of nicotine include vasoconstriction
and decreased uterine artery blood flow.
 Carbon monoxide also crosses the placenta rapidly and is
detectable in the fetal circulation at levels that are 15%
higher than maternal.
 It has a higher affinity for hemoglobin than oxygen to
form the compound carboxyhemoglobin that shifts the
oxygen dissociation curve to the left.
 Consequently, the availability of oxygen to fetal tissues is
decreased.
 Levels of cyanide in the circulation are higher in smokers,
a substance which is toxic to rapidly dividing cells.
 In addition, smokers frequently have other clinical
characteristics that may account for some adverse
pregnancy outcomes, e.g. poor nutrition, alcohol or drug
abuse.
◦ When tobacco is chewed/applied to gums-
tobacco specific nitrosamines are released and
these may be absorbed and hence stimulate
effects as the compounds in smoke.
◦ The adverse effect of tobacco use in pregnancy is
dose related and not related to the duration of
tobacco habit in pregnant women.
◦ The deleterious effects of tobacco use in
pregnancy are so mixed with the other
confounding factors like age, parity, education,
socioeconomic levels, antenatal care,
environment-rural, urban.
Smoking has a direct dose-response on
fetal growth. Infants of mothers who
smoke are on average 200g lighter than
those of nonsmoker.
Women who discontinue smoking even as
late as 30 weeks of gestation have infants
with higher birthweight than those who
continue smoking.
Alcohol abuse during pregnancy
Alcohol addiction is a chronic, relapsing
disease.
Women have higher blood ethanol
concentrations than men to an equivalent
dose of ethanol.
Total body water measures as much as 8
liters during pregnancy and this provides
a substantially increased volume within
which alcohol can be distributed.
Serum proteins relevant to alcohol
binding undergo considerable changes in
concentration
Ethanol with a rate of elimination that
depends on the activity of liver enzymes
shows a large fall in serum concentration
during pregnancy.
Alcohol transfer across the placenta is
greater during late gestation as :
◦ Increased unbound ethanol available for transport
◦ Increased uteroplacental blood flow
◦ Increased placental surface area
◦ Decreased thickness of the semi permeable lipid
membrane between the placental capillaries
◦ Greater physical disruption of placental
membranes
◦ More acidic fetal circulation
◦ Ethanol has a small molecular weight and is
weakly polar
Pathophysiology
◦ Fetus is exposed to higher levels of ethanol for
longer periods due to the later maturition in the
fetus of enzymes responsible for ethanol
metabolism.
◦ It has been found that alcohol and its breakdown
products, mainly acetaldehyde prevent transfer
of zinc or essential amino acids via placenta to
fetus (these substances are important for fetal
growth and development and prevent fetal
malformations)
Fetal alcohol syndrome is one of the most
frequent recognizable causes of mental
retardation.
Variations in the risk of developing fetal
alcohol syndrome may relate to the metabolism
of acetaldehyde, the first oxidation product of
ethanol.
The blood level of acetaldehyde in mothers
giving birth to a child with fetal alcohol
syndrome was about 40 umol/l after drink
alcohol.
Features of fetal alcohol syndrome
◦ Craniofacial abnormalities-microcephaly, short
palpebral fissures, ptosis, strabismus, epicanthic
folds, midfacial hypoplasia, thin upper lip
◦ Pre and post-natal growth retardation
◦ Central nervous system disorder-hypotonia,
irritability, retardation, poor coordination,
hyperkinesis
◦ Associated findings-abnormalities of eyes, ears,
mouth, cardiovascular system, skeleton,
hemangiomas and hernias.