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Geburtshilfe Frauenheilkd 2008; 68(2): 141-146
DOI: 10.1055/s-2008-1038371
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Rauchen in der Schwangerschaft

Smoking During PregnancyI. Hösli1 , R. Zanetti-Daellenbach1 , W. Holzgreve1 , O. Lapaire1
  • 1Frauenklinik, Universitätsspital Basel, Schweiz
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Publication History

eingereicht 9.10.2007

akzeptiert 24.10.2007

Publication Date:
26 February 2008 (online)

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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

Literatur

  • 1 Luck W, Nau H, Hansen R, Steldinger R. Extent of nicotine and cotinine transfer to the fetus, placenta and amniotic fluid of smoking mothers.  Dev Pharmacol Ther. 1985;  8 384-395
    PubMedGoogle Scholar
  • 2 Simpson W J. A preliminary report on cigarette smoking and the incidence of prematurity.  Am J Obstet Gynecol. 1957;  73 808-815
    PubMedGoogle Scholar
  • 3 U. S. Department of Health and Human Services .The Health Benefits of Smoking Cessation: U. S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 1990
    Google Scholar
  • 4 Voigt M, Fusch C, Olbertz D, Carstensen M, Brüning A, Hartmann K, Hesse V. 10. Mitteilung: Zum Anstieg der SGA-Neugeborenenrate durch das Rauchen der Mütter in der Schwangerschaft und Risikostruktur von „starken Raucherinnen“.  Geburtsh Frauenheilk. 2006;  66 270-276
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Centers for Disease Control and Prevention (CDC) . Smoking during pregnancy-United States, 1990 - 2002.  MMWR Morb Mortal Wkly Rep. 2004;  53 911-915
    PubMedGoogle Scholar
  • 6 http://www.socialstyrelsen.se/Publicerat/2005/8997/2005-125-14.htm
  • 7 Chiolero A, Bovet P, Paccaud F. Association between maternal smoking and low birth weight in Switzerland: the EDEN study.  Swiss Med Wkly. 2005;  135 525-530
    PubMedGoogle Scholar
  • 8 Australian Institute of Health and Welfare .2001 National Drug Strategy Household Survey. Canberra; AIHW, Catalogue No. PHE‐35, Series 11 2002
    Google Scholar
  • 9 Wisborg K, Henriksen T B, Hedegaard M, Secher N J. Smoking habits among Danish pregnant women from 1989 to 1996 in relation to sociodemographic and lifestyle factors.  Acta Obstet Gynecol Scand. 1998;  77 836-840
    CrossrefPubMedGoogle Scholar
  • 10 Blondel B, Norton J, du Mazaubrun C, Bréart G. Development of the main indicators of perinatal health in metropolitan France between 1995 and 1998. Results of the national perinatal survey.  J Gynecol Obstet Biol Reprod (Paris). 2001;  30 552-564
    PubMedGoogle Scholar
  • 11 Ward C, Lewis S, Coleman T. Prevalence of maternal smoking and environmental tobacco smoke exposure during pregnancy and impact on birth weight: retrospective study using Millennium Cohort.  BMC Public Health. 2007;  7 81
    CrossrefPubMedGoogle Scholar
  • 12 Castles A, Adams E K, Melvin C L, Kelsch C, Boulton M L. Effects of smoking during pregnancy. Five meta-analyses.  Am J Prev Med. 1999;  16 208-215
    CrossrefPubMedGoogle Scholar
  • 13 Conde-Agudelo A, Althabe F, Belizan J M, Kafury-Goeta A C. Cigarette smoking during pregnancy and risk of preeclampsia: a systematic review.  Am J Obstet Gynecol. 1999;  181 1026-1035
    CrossrefPubMedGoogle Scholar
  • 14 DiFranza J R, Lew R. Morbidity and mortality in children associated with the use of tobacco products by other people.  Pediatrics. 1996;  97 560-568
    PubMedGoogle Scholar
  • 15 Wysznski D, Duffy D, Beaty T. Maternal cigarette smoking and oral cleft: a meta-analysis.  Cleft Palate Craneofac J. 1997;  34 206-209
    PubMedGoogle Scholar
  • 16 Chelmow D, Andrew D E, Baker E R. Maternal cigarette smoking and placenta previa.  Obstet Gynecol. 1996;  87 703-706
    CrossrefPubMedGoogle Scholar
  • 17 Ananth C V, Savitz D A, Luther E R. Maternal cigarette smoking as a risk factor for placental abruption, placenta previa, and uterine bleeding in pregnancy.  Am J Epidemiol. 1996;  144 881-889
    PubMedGoogle Scholar
  • 18 Raymond E G, Cnattingius S, Kiely J L. Effects of maternal age, parity, and smoking on the risk of stillbirth.  Br J Obstet Gynaecol. 1994;  101 301-306
    PubMedGoogle Scholar
  • 19 Nabet C, Ancel P Y, Burguet A, Kaminski M. Smoking during pregnancy and preterm birth according to obstetric history: French national perinatal surveys.  Paediatric and perinatal epidemiology. 2005;  19 88-96
    PubMedGoogle Scholar
  • 20 Nanath C V, Smulian J C, Vintzileos A M. Incidence of placental abruption in relation to cigarette smoking and hypertensive disorders during pregnancy: a metaanalysis of observational studies.  Obstet Gynecol. 1999;  93 622-628
    CrossrefPubMedGoogle Scholar
  • 21 Ananth C V, Cnattingius S. Influence of maternal smoking on placental abruption in successive pregnancies: a population-based prospective cohort study in Sweden.  A J Epidemiology. 2007;  166 289-295
    PubMedGoogle Scholar
  • 22 Horta B L, Victora C G, Menezes A M, Barros F C. Environmental tobacco smoke and breastfeeding duration.  Am J Epidemiol. 1997;  146 128-133
    PubMedGoogle Scholar
  • 23 Seidman D S, Ever-Hadani P, Gale R. Effect of maternal smoking and age on congenital anomalies.  Obstet Gynecol. 1990;  76 1046-1050
    PubMedGoogle Scholar
  • 24 Haddow J E, Palomaki G E, Holman M S. Young maternal age and smoking during pregnancy as risk factors for gastroschisis.  Teratology. 1993;  47 225-228
    CrossrefPubMedGoogle Scholar
  • 25 Man L X, Chang B. Maternal cigarette smoking during pregnancy increases the risk of having a child with a congenital digital anomaly.  Plast Reconstr Surg. 2006;  117 301-308
    CrossrefPubMedGoogle Scholar
  • 26 Shaw G M, Wasserman C R, Lammer E J, O'Malley C D, Murray J C, Basart A M, Tolarova M M. Orofacial clefts, parental cigarette smoking, and transforming growth factor-alpha gene variants.  Am J Hum Genet. 1996;  58 551-561
    PubMedGoogle Scholar
  • 27 Morales-Suárez-Varela M M, Bille C, Christensen K, Olsen J. Smoking habits, nicotine use, and congenital malformations.  Obstet Gynecol. 2006;  107 51-57
    CrossrefPubMedGoogle Scholar
  • 28 De la Chica R A, Ribas I, Giraldo J, Egozcue J, Fuster C. Chromosomal instability in amniocytes from fetuses of mothers who smoke.  JAMA. 2005;  293 1212-1222
    CrossrefPubMedGoogle Scholar
  • 29 Spencer K, Bindra R, Cacho A M, Nicolaides K H. The impact of correcting for smoking status when screening for chromosomal anomalies using maternal serum biochemistry and fetal nuchal translucency thickness in the first trimester of pregnancy.  Prenat Diagn. 2004;  24 169-173
    CrossrefPubMedGoogle Scholar
  • 30 Burton G J, Palmer M E, Dalton K J. Morphometric differences between the placental vasculature of non-smokers, smokers and ex-smokers.  Br J Obstet Gynecol. 1989;  96 907-915
    CrossrefPubMedGoogle Scholar
  • 31 Cnattingius S, Nordstrom M L. Maternal smoking and feto-infant mortality: biological pathways and public health significance.  Acta Paediatr. 1996;  85 1400-1402
    PubMedGoogle Scholar
  • 32 Lockwood C J. The diagnosis of preterm labor and the prediction of preterm delivery.  Clin Obstet Gynecol. 1995;  38 675-687
    CrossrefPubMedGoogle Scholar
  • 33 Lieberman E, Torday J, Barbieri R, Cohen A, Van Vunakis H, Weiss S T. Association of intrauterine cigarette smoke exposure with indices of fetal lung maturation.  Obstet Gynecol. 1992;  79 564-570
    PubMedGoogle Scholar
  • 34 Andrews W W, Hauth J C, Goldenberg R L. Infection and preterm birth.  Am J Perinatol. 2000;  17 357-365
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Mc Allister-Sistilli C G, Caggiula A R, Knopf S, Rose C A, Miller A L, Donny E C. The effect of nicotine on the immune system.  Psychoneuroendocrinology. 1998;  23 175-187
    CrossrefPubMedGoogle Scholar
  • 36 Offenbacher S. Maternal periodontal infections, Prematurity and growth restriction.  Clin Obstet Gynecol. 2004;  47 808-821
    PubMedGoogle Scholar
  • 37 Kyrklund-Blomberg N B, Granath F, Cnattingius S. Maternal smoking and causes of very preterm birth.  Acta Obstet Gynecol Scand. 2005;  84 572-577
    CrossrefPubMedGoogle Scholar
  • 38 Wuenschell C W, Zhao J, Tefft J D, Warburton D. Nicotine stimulates branching and expression of SP‐A and SP‐C mRNAs in embryonic mouse lung culture.  Am J Physiol. 1998;  274 (1 Pt 1) L165-L170
    PubMedGoogle Scholar
  • 39 Burguet A, Kaminski M, Truffert P, Menget A, Marpeau L, Voyer M, Roze J C, Escande B, Cambonie G, Hascoet J M, Grandjean H, Breart G, Larroque B. Epipage Study Group . Does smoking in pregnancy modify the impact of antenatal steroids on neonatal respiratory distress syndrome? Results of the Epipage study.  Arch Dis Child Fetal Neonatal Ed. 2005;  90 F41-F45
    CrossrefPubMedGoogle Scholar
  • 40 Nukui T. et al . Maternal/newborn GSTT1 null genotype contributes to risk of preterm, low birthweight infants.  Pharmacogenetics. 2004;  14 569-576
    CrossrefPubMedGoogle Scholar
  • 41 Meyer M. How does maternal smoking affect birth weight and maternal weight gain?.  Am J Obstet Gynecol. 1978;  131 888-893
    PubMedGoogle Scholar
  • 42 Spira A, Spira N, Goujard J, Schwartz D. Smoking during pregnancy and placental weight. A multivariate analysis on 3759 cases.  J Perinat Med. 1975;  3 237-241
    PubMedGoogle Scholar
  • 43 Anderson G D, Blidner I N, McClemont S, Sinclair J C. Determinants of size at birth in a Canadian population.  Am J Obstet Gynecol. 1984;  150 236-244
    PubMedGoogle Scholar
  • 44 Windsor R A. Smoking, cessation and pregnancy. In: WHO Women and the tobacco epidemic: challenges for the 21st century. 2001 WHO/NMH/TFI/01.1
    Google Scholar
  • 45 Schaffer C H, Bergmann R L, Gravens-Mueller L, Krumholz S, Bergmann K E, Dudenhausen J W. Rauchen während der Schwangerschaft oder niedriger Sozialstatus. Welches ist das größte Risiko für ein geringeres Geburtsgewicht?.  Geburtsh Frauenheilk. 2001;  61 761-765
    Article in Thieme ConnectPubMedGoogle Scholar
  • 46 Ward C, Lewis S, Coleman T. Prevalence of maternal smoking and environmental tobacco smoke exposure during pregnancy and impact on birth weight: retrospective study using Millennium Cohort.  BMC Public Health. 2007;  7 81
    CrossrefPubMedGoogle Scholar
  • 47 Windsor R A, Li C Q, Boyd Jr N R, Hartmann K E. The use of significant reduction rates to evaluate health education methods for pregnant smokers: a new harm reduction behavioral indicator?.  Health Educ Behav. 1999;  26 648-662
    CrossrefPubMedGoogle Scholar
  • 48 Ahlsten G, Cnattingius S, Lindmark G. Cessation of smoking during pregnancy improves foetal growth and reduces infant morbidity in the neonatal period. A population-based prospective study.  Acta Paediatr. 1993;  82 177-181
    PubMedGoogle Scholar
  • 49 Dadak G, Leithner C, Sinzinger H, Silberbauer K. Diminished prostacyclin formation in umbilical arteries of babies born to women who smoke.  Lancet. 1981;  1 94
    PubMedGoogle Scholar
  • 50 Eriksen P S, Marsal K. Acute effects of maternal smoking on fetal blood flow.  Acta Obstet Gynecol Scand. 1984;  63 391-397
    PubMedGoogle Scholar
  • 51 Bottoms S F, Kunnert B R, Kuhnert P M, Reese A L. Maternal passive smoking and fetal thiocynate levels.  Am J Obstet Gynecol. 1982;  69 371-373
    PubMedGoogle Scholar
  • 52 Tobacco Advisory Group .Nicotine addiction in Britain. London; RCP 2000
    Google Scholar
  • 53 Röske K, Hannöver W, Thyrian J R, John U, Hannich H J. Welchen Umgang mit dem Thema Rauchen wünschen sich schwangere Frauen in der medizinischen Versorgung?.  Geburtsh Frauenheilk. 2007;  67 974-977
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 Melvin C L, Dolan-Mullen P, Windsor R A, Whiteside Jr H P, Goldenberg R L. Recommended cessation counselling for pregnant women who smoke: a review of the evidence.  Tob Control. 2000;  9 III 80-84
    PubMedGoogle Scholar
  • 55 Morris M, Maconochie N, Doyle P. Does gravidity influence smoking behaviour in pregnancy? A comparison of multigravid and primigravid women.  Paediatr Perinat Epidemiol. 2007;  21 201
    CrossrefPubMedGoogle Scholar
  • 56 Giglia R C, Binns C W, Alfonso H S. Which women stop smoking during pregnancy and the effect on breastfeeding duration.  BMC Public Health. 2006;  6 195
    CrossrefPubMedGoogle Scholar
  • 57 O'Campo P, Faden R R, Brown H, Glien A C. The impact of of pregnancy on women's prenatal and postpartum smoking behaviour.  Am J Prev Med. 1992;  8 8-13
    PubMedGoogle Scholar
  • 58 Windsor R A, Woodby L L, Miller T M, Hardin J M, Crawford M A, Di Clemente C C. Effectiveness of agency for health care policy and research clinical practice guideline and patient education methods for pregnant smokers in medicaid maternity care.  Am J Obstet Gynecol. 2000;  182 (1 Pt 1) 68-75
    CrossrefPubMedGoogle Scholar
  • 59 Wisborg K, Henriksen T B, Jespersen L B, Secher N J. Nicotine patches for pregnant smokers: a randomized controlled study.  Obstet Gynecol. 2000;  96 967-971
    CrossrefPubMedGoogle Scholar
  • 60 Fagerstrom K O, Schneider N G. Measuring nicotine dependence: a review of the Fagerstrom tolerance questionnaire.  J Behav med. 1989;  12 159-182
    CrossrefPubMedGoogle Scholar
  • 61 Lumley J, Oliver S S, Chamberlain C, Oakley L. Interventions for promoting smoking cessation during pregnancy.  Cochrane Database Syst Rev. 2004;  (4) CD001055-Review 2004, Issue 4
    PubMedGoogle Scholar
  • 62 National Institute for clinical excellence NICE. .echnology appraisal guidance-No. 39: NICE Guidance on the use of nicotine replacement therapy (NRT) and bupropion for smoking cessation. March/2002
    Google Scholar
  • 63 Fiore M C, Hatsukami D K, Baker T B. Effective tobacco dependence treatment.  JAMA. 2002;  288 1768-1771
    CrossrefPubMedGoogle Scholar

PD Dr. med. I. Hösli

Abteilungsleiterin
Geburtshilfe und Schwangerschaftsmedizin
Frauenklinik
Universitätsspital Basel

Spitalstrasse 21

CH-4031 Basel

Email: ihoesli@uhbs.ch