Rauchen in der Schwangerschaft

Zusammenfassung

Ca. 20 - 25 % der Frauen rauchen vor einer Schwangerschaft, nur ein Drittel von ihnen hört spontan zu Beginn der Schwangerschaft auf. Rauchen ist nach wie vor einer der wichtigsten modifizierbaren Risikofaktoren für Schwangerschaftskomplikationen, wie vorzeitigen Blasensprung, vorzeitige Plazentalösung, Placenta praevia, Frühgeburt und Wachstumsretardierung. Nikotin und andere embryotoxische Substanzen werden bei Raucherinnen in höherer Konzentration im Fruchtwasser und im fetalen Kreislauf gemessen als im mütterlichen Serum. Es gibt Hinweise, dass verschiedene maternale und fetale Polymorphismen die Enzymaktivität zur Elimination toxischer Substanzen reduzieren und das Risiko fetaler Malformationen oder fetaler Wachstumsretardierung erhöhen. Spezifische Fehlbildungen einer vaskulären Disruptionssequenz wie Lippen-Kiefer-Gaumenspalte, Gastroschisis, Analatresie und Extremitätendefekte wie Syndaktylie treten gehäuft auf. Prognostisch günstige Faktoren für die Entwöhnung sind Konsum von weniger als 10 Zigaretten vor der Schwangerschaft und Nulliparität, prognostisch ungünstig sind: Mehrgebärende, Depressionen, Gewalterfahrung, Angst vor Gewichtszunahme und allein erziehende Frauen. Als Therapie haben sich Stufenkonzepte zur Rauchentwöhnung bewährt: ein zeitlich auf 5 - 10 min begrenztes gezieltes Counselling, psychosoziale Begleitung und in ausgewählten Situationen eine Nikotinersatztherapie. Die Erfolgsraten zur Rauchentwöhnung liegen bei 50 - 70 %.

Abstract

Approximately 20 - 25 % of all women smoke before pregnancy, and only one third of them quit spontaneously during the first trimester. Smoking is still one of the most important modifiable risk factors of pregnancy-associated complications, such as rupture of membranes, placental abruptio, placenta previa, preterm delivery and intrauterine growth retardation. Nicotine and other embryotoxic substances can be measured in the amniotic fluid and in the fetal circulation in higher concentrations than in maternal serum. There are some indications that various maternal and fetal polymorphisms reduce enzyme activities which are important for the elimination of toxic substances, and that therefore the risk of fetal malformations and of intrauterine growth retardation is elevated. Specific malformations, such as a vascular disruption sequence, leading to cleft lip or palate, gastroschisis, anal atresia or limb defects, are more common in pregnant smokers. Various factors, such as smoking fewer than 10 cigarettes per day and nulliparity have been found to be prognostically favorable to break the habit of smoking, whereas multiparity, depression, domestic violence, no partner and fear of weight gain are disadvantages. Stepwise strategies have been proven to be useful for stopping smoking; these include limited targeted counseling sessions of 5 - 10 minutes, psychosocial monitoring and, in selected cases, a nicotine replacement therapy. With this concept, cessation of smoking is successful in 50 - 70 % of cases.

Schlüsselwörter

Rauchen - Schwangerschaft - Plazentastörungen - Frühgeburt - Rauchentwöhnung

Key words

smoking - pregnancy - placental disorders - preterm birth - cessation of smoking

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