Umbilical arteries of babies born to cigarette smokers generate less prostacyclin and contain less arginine and citrulline compared with those of babies born to control subjects

Smoking for two- effects of tobacco consumption on placenta

Tobacco smoking is an important public health issue recognized by the world health organization as one of the most serious, preventable risk factors for developing a series of pregnancy pathologies. Maternal smoking is positively associated with intrauterine growth restriction (IUGR) and gestational diabetes (GDM), but negatively associated with preeclampsia (PE). In this review, we examine epidemiological, clinical and laboratory studies of smoking effects on immunoregulation during pregnancy, trophoblast function, and placental vasculature development and metabolism. We aim to identify effects of tobacco smoke components on specific placental compartments or cells, which may contribute to the understanding of the influences of maternal smoking on placenta function in normal and pathological pregnancies. Data corroborates that in any trimester, smoking is unsafe for pregnancy and that its detrimental effects outweigh questionable benefits. The effects of maternal smoking on the maternal immune regulation throughout pregnancy and the impact of different tobacco products on fetal growth have not yet been fully understood. Smoking cessation rather than treatment with replacement therapies is recommended for future mothers because also single components of tobacco and its smoke may have detrimental effects on placental function.

Influence of Active Exposure to Tobacco Smoke on Nitric Oxide Status of Pregnant Women

Smoking tobacco can impair proper vascular endothelial functioning. This is exhibited through reduced nitric oxide synthesis as well as activity due to accompanying oxidative stress. We examined the relationship between nitric oxide and markers of oxidative stress/antioxidant defense in serum of smoking and non-smoking pregnant women. Subjects included 99 healthy pregnant women, who were tested for nitric oxide (NO), endothelial (eNOS) and inducible (iNOS) nitric oxide synthase, total oxidant capacity (TOC), and total antioxidant capacity (TAC). NO, eNOS, and TAC serum concentrations were significantly lower (p < 0.005), but iNOS (p < 0.05) and TOC (p < 0.001) were higher in smokers than in non-smokers. Multivariate regression analysis showed associations between NO concentration and eNOS, TAC, and smoking status in the whole group of patients. In the model estimated separately for smokers, the highest impact of eNOS (β = 0.375; p = 0.021) and cotinine (β = −0.323; p = 0.037) was indicated for NO concentration. In the model of non-smokers, eNOS (β = 0.291, p = 0.030) and TAC (β = 0.350; p = 0.015) were important for NO level. Smoking during pregnancy could exacerbate oxidative stress, impair the action of nitric oxide synthases, and adversely affect the balance of oxygen and nitrogen metabolism. Relationships between NO concentrations and TAC in the studied women’s blood can confirm the antioxidant nature of nitric oxide.

Maternal smoking during pregnancy, fetal arterial resistance adaptations and cardiovascular function in childhood

OBJECTIVE

To unravel the mechanisms underlying the previously demonstrated associations between low birthweight and cardiovascular disease in adulthood, we examined whether maternal smoking during pregnancy leads to fetal arterial resistance adaptations, and subsequently to fetal growth retardation and changes in postnatal blood pressure and cardiac development.

DESIGN

Prospective cohort study from early fetal life onwards.

SETTING

Academic hospital.

POPULATION

Analyses were based on 1120 children aged 2 years.

METHODS

Maternal smoking during pregnancy [non-smoking, first trimester smoking, continued smoking (< 5 and ≥ 5 cigarettes/day)] was assessed by questionnaire.

MAIN OUTCOME MEASURES

Third trimester placental and fetal arterial resistance indices and fetal growth were assessed by ultrasound and Doppler measurements. Postnatal blood pressure and cardiac structures (aortic root diameter, left atrial diameter, left ventricular mass) were measured at 2 years of age.

RESULTS

First trimester smoking was not associated with third trimester placental and fetal blood flow adaptations. Continued smoking of ≥ 5 cigarettes/day was associated with an increased resistance in uterine, umbilical and middle cerebral arteries, and with a decreased flow and diameter of the ascending aorta. Among mothers who continued to smoke, the third trimester estimated fetal weights and birthweights were most affected in children with the highest umbilical artery resistance. Fetal arterial resistance indices were also associated with aortic root diameter and left atrial diameter.

CONCLUSIONS

Fetal arterial resistance adaptations may be involved in the pathways leading from maternal smoking during pregnancy to low birthweight and cardiovascular developmental changes in childhood in the offspring.

Nitric oxide-mediated blood flow regulation as affected by smoking and nicotine

Cigarette smoking is a major risk factor for atherosclerosis, cerebral and coronary vascular diseases, hypertension, and diabetes mellitus. Chronic smoking impairs endothelial function by decreasing the formation of nitric oxide and increasing the degradation of nitric oxide via generation of oxygen free radicals. Nitric oxide liberated from efferent nitrergic nerves is also involved in vasodilatation, increased regional blood flow, and hypotension that are impaired through nitric oxide sequestering by smoking-induced factors. Influence of smoking on nitric oxide-induced blood flow regulation is not necessarily the same in all organs and tissues. However, human studies are limited mainly to the forearm blood flow measurement that assesses endothelial function under basal and stimulated conditions and also determination of penile tumescence and erection in response to endothelial and neuronal nitric oxide. Therefore, information about blood flow regulation in other organs, such as the brain and placenta, has been provided mainly from studies on experimental animals. Nicotine, a major constituent of cigarette smoke, acutely dilates cerebral arteries and arterioles through nitric oxide liberated from nitrergic neurons, but chronically interferes with endothelial function in various vasculatures, both being noted in studies on experimental animals. Cigarette smoke constituents other than nicotine also have some vascular actions. Not only active but also passive smoking is undoubtedly harmful for both the smokers themselves and their neighbors, who should bear in mind that they can face serious diseases in the future, which may result in lengthy hospitalization, and a shortened lifespan.

Effects of prenatal tobacco exposure on gene expression profiling in umbilical cord tissue

Maternal smoking doubles the risk of delivering a low birth weight infant. The purpose of this study was to analyze differential gene expression in umbilical cord tissue as a function of maternal smoking, with an emphasis on growth-related genes. We recruited 15 pregnant smokers and 15 women who never smoked during pregnancy to participate. RNA was isolated from umbilical cord tissue collected and snap frozen at the time of delivery. Microarray analysis was performed using the Affymetrix GeneChip Scanner 3000. Six hundred seventy-eight probes corresponding to 545 genes were differentially expressed (i.e. had an intensity ratio > +/- 1.3 and a corrected significance value p < 0.005) in tissue obtained from smokers versus nonsmokers. Genes important for fetal growth, angiogenesis, or development of connective tissue matrix were upregulated among smokers. The most highly upregulated gene was CSH1, a somatomammotropin gene. Two other somatomammotropin genes (CSH2 and CSH-L1) were also upregulated. The most highly downregulated gene was APOBEC3A; other downregulated genes included those that may be important in immune and barrier protection. Validation of the three somatomammotropin genes showed a high correlation between qPCR and microarray expression. We conclude that maternal smoking may be associated with altered gene expression in the offspring.

The influence of maternal cigarette smoking on placental pathology in pregnancies complicated by abruption

OBJECTIVE

The purpose of this study was to evaluate the effect of maternal cigarette smoking on placental histology in women with abruption.

STUDY DESIGN

Data were derived from the New Jersey-Placental Abruption Study (NJ-PAS)--an ongoing, case-control study, conducted since August 2002 in 2 large hospitals in NJ. Abruption cases were identified based on a clinical diagnosis. Histologic evaluations were performed by 2 perinatal pathologists who were blinded to the abruption status. Maternal smoking during pregnancy was determined based on patient's self-report. Among abruption cases, histologic findings were compared between smokers and nonsmokers, and the association expressed as odds ratio (OR) with 95% confidence interval (CI). All analyses were adjusted for potential confounders.

RESULTS

A total of 189 abruption cases were available for analysis, of which 10.6% (n = 20) were smokers. Intervillous thrombus was more common in women who smoked (20%) than in nonsmokers (3.0%) (OR, 17.5; 95% CI, 3.1-99.4). However, placental infarcts were seen less frequently among smokers than nonsmokers (10.0% vs 32.5%; OR, 0.2; 95% CI, 0.1-0.8).

CONCLUSION

These findings suggest that different pathologic mechanisms may be responsible for the histologic findings between smokers and nonsmokers diagnosed with placental abruption.

Biomarkers to assess the utility of potential reduced exposure tobacco products

To date, we have no valid biomarkers that serve as proxies for tobacco-related disease to test potential reduced exposure products. This paper represents the deliberations of four workgroups that focused on four tobacco-related heath outcomes: Cancer, nonmalignant pulmonary disease, cardiovascular disease, and fetal toxicity. The goal of these workgroups was to identify biomarkers that offer some promise as measures of exposure or toxicity and ultimately may serve as indicators for future disease risk. Recommendations were based on the relationship of the biomarker to what is known about mechanisms of tobacco-related pathogenesis, the extent to which the biomarker differs among smokers and nonsmokers, and the sensitivity of the biomarker to changes in smoking status. Other promising biomarkers were discussed. No existing biomarkers have been demonstrated to be predictive of tobacco-related disease, which highlights the importance and urgency of conducting research in this area.

Biomarkers to assess the utility of potential reduced exposure tobacco products

To date, we have no valid biomarkers that serve as proxies for tobacco-related disease to test potential reduced exposure products. This paper represents the deliberations of four workgroups that focused on four tobacco-related heath outcomes: Cancer, nonmalignant pulmonary disease, cardiovascular disease, and fetal toxicity. The goal of these workgroups was to identify biomarkers that offer some promise as measures of exposure or toxicity and ultimately may serve as indicators for future disease risk. Recommendations were based on the relationship of the biomarker to what is known about mechanisms of tobacco-related pathogenesis, the extent to which the biomarker differs among smokers and nonsmokers, and the sensitivity of the biomarker to changes in smoking status. Other promising biomarkers were discussed. No existing biomarkers have been demonstrated to be predictive of tobacco-related disease, which highlights the importance and urgency of conducting research in this area.

Arginine deficiency in preterm infants: biochemical mechanisms and nutritional implications

Arginine, an amino acid that is nutritionally essential for the fetus and neonate, is crucial for ammonia detoxification and the synthesis of molecules with enormous importance (including creatine, nitric oxide, and polyamines). A significant nutritional problem in preterm infants is a severe deficiency of arginine (hypoargininemia), which results in hyperammonemia, as well as cardiovascular, pulmonary, neurological, and intestinal dysfunction. Arginine deficiency may contribute to the high rate of infant morbidity and mortality associated with premature births. Although hypoargininemia in preterm infants has been recognized for more than 30 years, it continues to occur in neonatal intensive care units in the United States and worldwide. On the basis of recent findings, we propose that intestinal citrulline and arginine synthesis (the major endogenous source of arginine) is limited in preterm neonates owing to the limited expression of the genes for key enzymes (e.g., pyrroline-5-carboxylate synthase, argininosuccinate synthase and lyase), thereby contributing to hypoargininemia. Because premature births in humans occur before the normal perinatal surge of cortisol (an inducer of the expression of key arginine-synthetic enzymes), its administration may be a useful tool to advance the maturation of intestinal arginine synthesis in preterm neonates. Additional benefits of cortisol treatment may include the following: 1) allowing early introduction of enteral feeding to preterm infants, which is critical for intestinal synthesis of citrulline, arginine, and polyamines as well as for intestinal motility, integrity, and growth; and 2) shortening the expensive stay of preterm infants in hospitals as a result of accelerated organ maturation and the restoration of full enteral feeding. Further studies of fetal and neonatal arginine metabolism will continue to advance our understanding of the mechanisms responsible for the survival and growth of preterm infants. This new knowledge will be beneficial for designing the next generation of enteral and parenteral amino acid solutions to optimize nutrition and health in this compromised population.

Influence of maternal tobacco smoking during pregnancy on uterine, umbilical and fetal cerebral artery blood flows

BACKGROUND

Cigarette smoking during pregnancy is a major cause of adverse perinatal outcome but effects on critical fetal and maternal circulations remain unclear.

AIMS

To determine (1) the influence of habitual maternal cigarette smoking on blood flow velocities in uterine, umbilical and fetal middle cerebral arteries, and (2) the time-course of changes in these flows after smoking a cigarette.

SUBJECTS AND METHODS

In 74 women who smoked and 69 non-smoking controls we measured Doppler blood flow velocity waveforms in the uterine, umbilical and fetal middle cerebral (MCA) arteries; smokers were divided into light (<10 cigarettes/day, n=28) and heavy smokers (>10 cigarettes/day, n=45).

RESULTS

In the uterine artery there was no significant difference between the systolic/diastolic (S/D) ratio in smoking and non-smoking women; however, in smokers, a diastolic notch was more frequently observed in the uterine artery waveform than in controls (p<0.05), suggestive of a greater resistance in the uterine vasculature. In the umbilical artery, the S/D ratio was significantly greater in smokers than in non-smokers. In the fetal MCA, the S/D ratio was higher in heavy smokers than in light smokers (p<0.05) indicative of greater cerebrovascular resistance. There were no significant correlations between the interval between smoking the last cigarette and making the Doppler measurements and the S/D ratios in any of the vessels.

CONCLUSION

Maternal cigarette smoking is associated with evidence of chronically increased resistances in the uterine, umbilical and fetal middle cerebral arteries.

Reduced endothelial nitric oxide synthase activity and concentration in fetal umbilical veins from maternal cigarette smokers

OBJECTIVE

This study aimed to investigate the effect of maternal cigarette smoking on endothelial nitric oxide synthase (eNOS) activity and concentration in the fetal umbilical vein, and subsequently, to relate the findings to the size of the newborn.

STUDY DESIGN

Forty-four nonsmoking and 30 smoking women were included in the study. Umbilical vein endothelial cells were isolated immediately after delivery. The eNOS activity was determined in the samples by the conversion of (14)C-L-arginine to (14)C-L-citrulline, and the eNOS concentration was determined by a human eNOS immunoassay.

RESULTS

Newborns of smokers had a lower weight (P=.014) and a smaller head circumference (P=.002) than those newborns of nonsmokers. The eNOS activity in fetal umbilical veins exposed to maternal smoking was 40% lower (P=.006), and the eNOS concentration 32% lower (P=.053) in newborns of smokers than in nonsmokers.

CONCLUSION

The findings suggest that maternal smoking reduces nitric oxide production in the fetal circulation. This may contribute to retarded fetal growth caused by the subsequent endothelial dysfunction with reduction of dilatory capacity of the vessels.

Effect of Smoking on Serum Concentrations of Total Homocysteine, Folate, Vitamin B12, and Nitric Oxide in Pregnancy: A Preliminary Study

OBJECTIVE

Nitric oxide (NO) is a potent vasodilator released by endothelial cells that plays an important role in modulating maternal and fetal vascular tone in normal pregnancy. Lower plasma levels of vitamins may result in hyperhomocysteinemia, a known risk factor in pregnancy. The aim of this study was to investigate whether there are alterations in the serum levels of total homocysteine (tHcy), folate, vitamin B12, and total nitrite, as an index of NO, in smoking as compared with age-matched nonsmoking pregnant women.

METHODS

Thirty-three women (19 smoking and 14 nonsmoking) between 16 and 22 weeks of their gestation were included in this study. The serum tHcy levels were analyzed by using an enzyme-linked immunosorbent assay kit. Vitamin B12 and folate values were measured by means of DPC kits. Total nitrite was measured by Griess reaction as an index of endogenous NO production.

RESULTS

The serum tHcy concentrations were significantly increased in smoking as compared with nonsmoking pregnant women (p<0.001). The folate and vitamin B12 concentrations were lower in smoking than in nonsmoking pregnant women, but only the differences in folate concentrations were statistically significant (p<0.001). The tHcy concentrations showed a significant negative correlation with folate in the smoking pregnant women. The serum total nitrite concentrations were lower in smoking than in nonsmoking pregnant women (p<0.05). In addition, the serum nitrite levels in smoking pregnant women had significant negative correlations with tHcy and positive correlations with folate and vitamin B12 levels.

CONCLUSIONS

In the light of our findings, we propose that smoking might enhance the vasoconstrictor capacity in pregnant women by increased tHcy concentrations and by a simultaneous decrease in the production of NO which is a vasodilator compound.

Risks and benefits of nicotine to aid smoking cessation in pregnancy

Cigarette smoking during pregnancy is the single largest modifiable risk for pregnancy-related morbidity and mortality in the US. Addiction to nicotine prevents many pregnant women who wish to quit smoking from doing so. The safety and efficacy of nicotine replacement therapy (NRT) for smoking cessation during pregnancy have not been well studied. Nicotine is classified by the US Food and Drug Administration as a Pregnancy Category D drug. Animal studies indicate that nicotine adversely affects the developing fetal CNS, and nicotine effects on the brain may be involved in the pathophysiology of sudden infant death syndrome (SIDS). It has been assumed that the cardiovascular effects of nicotine resulting in reduced blood flow to the placenta (uteroplacental insufficiency) is the predominant mechanism of the reproductive toxicity of cigarette smoking during pregnancy. Short term high doses of nicotine in pregnant animals do adversely affect the maternal and fetal cardiovascular systems. However, studies of the acute effects of NRT in pregnant humans indicate that nicotine alone has minimal effects upon the maternal and fetal cardiovascular systems. Cigarette smoking delivers thousands of chemicals, some of which are well documented reproductive toxins (e.g. carbon monoxide and lead). A myriad of cellular and molecular biological abnormalities have been documented in placentas, fetuses, and newborns of pregnant women who smoke. The cumulative abnormalities produced by the various toxins in cigarette smoke are probably responsible for the numerous adverse reproductive outcomes associated with smoking. It is doubtful that the reproductive toxicity of cigarette smoking is primarily related to nicotine. We recommend the following. Efficacy trials of NRT as adjunctive therapy for smoking cessation during pregnancy should be conducted. The initial dose of nicotine in NRT should be similar to the dose of nicotine that the pregnant woman received from smoking. Intermittent-use formulations of NRT (gum, spray, inhaler) are preferred because the total dose of nicotine delivered to the fetus will be less than with continuous-use formulations (transdermal patch). A national registry for NRT use during pregnancy should be created to prospectively collect obstetrical outcome data from NRT efficacy trials and from individual use. The goal of this registry would be to determine the safety of NRT use during pregnancy, especially with respect to uncommon outcomes such as placental abruption. Finally, our review of the data indicate that minimal amounts of nicotine are excreted into breast milk and that NRT can be safely used by breast-feeding mothers.

Maternal cigarette smoking increases F2-isoprostanes and reduces prostacyclin and nitric oxide in umbilical vessels

The objective of this study was to evaluate the influence of smoking on F2-isoprostanes, prostacylin and nitric oxide in human umbilical vessels. Umbilical cords from 13 babies of smoking mothers and from 28 babies of non-smoking mothers were examined for levels of F2-isoprostanes, prostacyclin, L-arginine, and L-citrulline. Forty-one umbilical arteries and eleven umbilical veins were analyzed. Statistical analysis of data was done using modified t-test. Cigarette smoking increased F2-isoprostane levels and reduced the generation of prostacyclin, L-arginine and L-citrulline comparably in umbilical arteries and veins. Notably, in umbilical cords of babies of non-smoking mothers the F2-isoprostane level was significantly higher in arteries. Cigarette smoking correlates with a direct vasoconstrictive effect. We suggest that smoking might enhance the vasoconstrictory capacity in umbilical arteries by increased F2-isoprostanes and by a simultaneous decrease in the production of the vasodilatory compounds, prostacyclin, and nitric oxide.

Geophysical variables and behavior: LXXXV. Sudden infant death, bands of geomagnetic activity, and pc1 (0.2 to 5 HZ) geomagnetic micropulsations

Pc1s (continuous pulsations) within the geomagnetic field, whose durations are about 30 minutes but which can reoccur several times nightly, are observed during periods when global geomagnetic activity is very low (less than 10 nT). The hypothesis that these 0.2 to 5 Hz synchronized micropulsations or hydromagnetic emissions might stimulate physical chemical cascades within the brain that precipitate the sudden death in infants was tested by correlational analysis for a two-year period (1960-1961) for Ontario. Results were consistent with the hypothesis that the monthly incidences of these unexpected deaths, pcl micropulsations and geomagnetic activity less than 10 nT displayed a shared source of variance. Implications are discussed.

Stem villous arteries from the placentas of heavy smokers: functional and mechanical properties

OBJECTIVE

The aim of the study was to compare the mechanical and functional properties of isolated small stem villous arteries from the placentas of women who smoked heavily (>/=15 cigarettes/d) during pregnancy with those from the placentas of nonsmokers.

STUDY DESIGN

Isolated stem villous arteries were mounted in small-vessel myographs. Circumference-tension relationships were established with 124 mmol/L potassium chloride. Concentration-response curves were obtained for endothelin 1, prostaglandin F2alpha, vasoactive intestinal peptide, corticotropin-releasing hormone, sodium nitroprusside, and cadmium chloride. The effect of nitric oxide was examined with N omega-nitro-l -arginine.

RESULTS

Stem villous arteries from the heavy smoking group developed a significantly lower tension than did those from nonsmokers at 6 of 9 steps of the circumference-tension experiment (P <.05). Endothelin 1 evoked a significantly greater maximum vasoconstrictive response in stem villous arteries from heavy smokers than in those from nonsmokers (P <.05).

CONCLUSION

Stem villous arteries of heavy smokers have altered mechanical properties and a greater vasoconstrictive response to endothelin 1 than do those from nonsmokers. These changes may compromise fetal placental blood flow and thereby contribute to the lower birth weights seen among infants born to heavy smokers.

An introduction to reactive oxygen species and their possible roles in substance abuse

There is a growing body of information relating diverse diseases and the consequences of injury to generation and toxicity of reactive oxygen species (ROS). Recently, it has been shown that the fetus and its membranes are also vulnerable to this toxicity, suggesting that a number of obstetric diseases may result from exposure to ROS, which are ubiquitous in aerobic organisms. Endogenous antioxidants, including superoxide dismutase, catalase, and glutathione peroxidase are essential for defense against ROS. It is significant that all antioxidants appear to be down-regulated in the fetus and membranes, suggesting the possibility that any process that further depresses their activities or increases the burden of ROS may compromise fetal development or maternal health. When permitted to accumulate, ROS can damage all classes of macromolecules, including lipids, proteins, and nucleic acids. Toxicity includes mutation, protein degradation, and lipid peroxidation, which can severely disturb membrane permeability and alter intracellular calcium and pH. An understanding of the generation and toxicity of ROS should help to define their potential roles in obstetric disease and lead to innovative preventive and therapeutic approaches.