Medical Care Costs Attributable to Smoking During Pregnancy

it฀is฀questionable฀whether฀the฀indings฀obtained฀can฀be฀transposed฀to฀human฀pregnancy.฀On฀ the฀basis฀of฀at฀least฀the฀experimental฀animal฀studies฀to฀date,฀no฀malformations฀have฀come฀ to฀light.฀The฀regulation฀of฀dopaminergic฀receptors฀is฀altered,฀and฀while฀it฀has฀been฀postu- lated฀that฀cardiopulmonary฀regulation฀is฀disturbed,฀this฀has฀by฀no฀means฀been฀proved. • ฀ Overall,฀almost฀all฀complications฀in฀the฀unborn฀child฀occurring฀during฀pregnancy฀can฀ be฀attributed฀to฀the฀combustion฀products฀of฀tobacco,฀including฀the฀formation฀of฀CO.฀ This฀body฀of฀evidence฀might฀also฀justify฀reconsideration฀of฀the฀use฀of฀smoking฀cessa- tion฀therapy฀with฀nicotine฀products฀in฀pregnant฀women. • ฀ Alongside฀the฀harmful฀effects฀to฀the฀child,฀the฀additional฀economic฀burden฀imposed฀on฀ the฀state฀and฀society฀should฀be฀suficient฀reason฀for฀implementing฀effective฀smoking฀ cessation฀programmes. References ฀ 1.฀Anonym฀ 1994฀ Dokumentation฀ über฀ Mutterschaftsvorsorge฀ und฀ Entbindungen,฀ Tabelle฀ 3.฀ Kassenärztliche฀Bundesvereinigung,฀Köln ฀ 2.฀Voigt฀M,฀Hesse฀V,฀Wermke฀K,฀Friese฀K฀2001฀Rauchen฀in฀der฀Schwangerschaft.฀Risiko฀für฀das฀ Wachstum฀des฀Feten.฀Kinderärztl฀Praxis฀72:26–29 ฀ 3.฀Andres฀RL,฀Day฀MC฀2000฀Perinatal฀complications฀associated฀with฀maternal฀tobacco฀use.฀ Semin฀Neonatol฀53:231–241 ฀ 4.฀Salihu฀HM,฀Aliyu฀MH,฀Pierre-Louis฀BJ,฀Alexander฀GR฀2003฀Levels฀of฀excess฀infant฀deaths฀ attributable฀to฀maternal฀smoking฀during฀pregnancy฀in฀the฀United฀States.฀Matern฀Child฀Health฀J฀ 74:219–227 ฀ 5.฀Ockene฀J,฀Ma฀Y,฀Zapka฀J,฀Pbert฀L,฀Valentine฀GK,฀Stoddard฀A฀2002฀Spontaneous฀cessation฀of฀ smoking฀and฀alcohol฀use฀among฀low-income฀pregnant฀women.฀Am฀J฀Prev฀Med฀233:150–159 ฀ 6.฀Wasserman฀GA,฀Liu฀X,฀Pine฀DS,฀Graziano฀JH฀2001฀Contribution฀of฀maternal฀smoking฀during฀ pregnancy฀and฀lead฀exposure฀to฀early฀child฀behavior฀problems.฀Neurotoxicol฀Teratol฀231:13–21 ฀ 7.฀Lackmann฀GM,฀Angerer฀J,฀Tollner฀U฀2000฀Parental฀smoking฀and฀neonatal฀serum฀levels฀of- polychlorinated฀biphenyls฀and฀hexachlorobenzene.฀Pediatr฀Res฀475:598–601 ฀ 8.฀Ahluwalia฀IB,฀Grummer-Strawn฀L,฀Scanlon฀KS฀1997฀Exposure฀to฀environmental฀tobacco฀ smoke฀and฀birth฀outcome:฀increased฀effects฀on฀pregnant฀women฀aged฀30฀years฀or฀older.฀Am฀ J฀Epidemiol฀1461:42–47 ฀ 9.฀Ananth฀CV,฀Savitz฀DA,฀Luther฀ER฀1996฀Maternal฀cigarette฀smoking฀as฀a฀risk฀factor฀for฀placental฀ abruption,฀placenta฀previa,฀and฀uterine฀bleeding฀in฀pregnancy.฀Am฀J฀Epidemiol฀1449:881–889 10.฀Cnattingius฀S,฀Axelsson฀O,฀Eklund฀G,฀Lindmark฀G฀1985฀Smoking,฀maternal฀age,฀and฀fetal฀ growth.฀Obstet฀Gynecol฀664:449–452 11.฀Wang฀X,฀Tager฀IB,฀Van฀Vunakis฀H,฀Speizer฀FE,฀Hanrahan฀JP฀1997฀Maternal฀smoking฀during฀ pregnancy,฀urine฀cotinine฀concentrations,฀and฀birth฀outcomes.฀A฀prospective฀cohort฀study.฀Int฀ J฀Epidemiol฀265:978–988 12.฀Poppe฀WA,฀Drijkoningen฀M,฀Ide฀PS,฀Lauweryns฀JM,฀Van฀Assche฀FA฀1996฀Langerhans’฀cells฀ and฀L1฀antigen฀expression฀in฀normal฀and฀abnormal฀squamous฀epithelium฀of฀the฀cervical฀trans- formation฀zone.฀Gynecol฀Obstet฀Invest฀413:207–213 13.฀Bernstein฀L,฀Pike฀MC,฀Lobo฀RA,฀Depue฀RH,฀Ross฀RK,฀Henderson฀BE฀1989฀Cigarette฀smok- ing฀in฀pregnancy฀results฀in฀marked฀decrease฀in฀maternal฀hCG฀and฀oestradiol฀levels.฀Br฀J฀Obstet฀ Gynaecol฀961:92–96 14.฀Boyce฀A,฀Schwartz฀D,฀Hubert฀C,฀Cedard฀L,฀Dreyfus฀J฀1975฀Smoking,฀human฀placental฀lac- togen฀and฀birth฀weight.฀Br฀J฀Obstet฀Gynaecol฀8212:964–967