|
||||||||||||
 |
||||||||||||
THE ADVERSE EFFECTS OF TOBACCO SMOKING ON REPRODUCTION
(BOOKLET) Two factors favoured the rapid spread of tobacco smoking: the simplicity of technique combined with the quick onset of the effects on the central nervous system, which include stimulation, sedation and a combination of both, depending on the dose and the individual's rate of absorption of the nicotine inhaled. [1]. Besides nicotine, the addictive substance of tobacco, the gas and vapour phase of cigarettes contains thousands of other toxic, carcinogenic, mutagenic, growth retardative and immunosuppressive compounds, which include polycyclic aromatic hydrocarbons, cyanide, carbon monoxide, lead and cadmium [2]. Only very recently, the American tobacco industry, under pressure from Congress, released a top-secret list of the further 599 chemicals it adds to cigarettes, which, amongst hundreds of others, also included ammonia and insecticides [3]. All these chemicals have obviously a cumulative deleterious effect on the health of the smoker but are particularly detrimental during the reproductive period, as these toxic substances found in tobacco products are known to affect adversely the reproductive capacity of the individual, as well as have a damaging effect on the offspring [4,5]. THE ADVERSE EFFECTS OF SMOKING ON REPRODUCTION: Reduced length of gestation - Low birth weight Cigarette smoking during pregnancy induces foetal hypoxia through two independent pathways: An acute effect due to nicotine activation of the adrenergic discharge, resulting in vasoconstriction [6] and decrease in placental intervillous blood flow [7], leading to uteroplacental underperfusion [8]. It has been also established that smokers' placentas seem to have an increased frequency of lesions that are indeed characteristic of underperfusion, such as obliterative endarteresis and cytotrophoblastic hyperplasia in villi as well as necrosis of the decidua basalis at the margin of the placenta, all of which are thought to contribute directly to reduced foetal nutrition and hence to foetal growth retardation [8]. Through a delayed but prolonged increase in carboxyhaemoglobin, which causes sustained reduction of foetal oxygenation [6,9-12]. In fact it has been found that the level of carboxyhaemoglobin in the fetus is usually 10-15% higher than that of the mother [2]. The combined effect of continuous nicotine-induced reduction of uteroplacental
blood flow and prolonged increase in the carboxyhaemoglobin on the
fetus has been shown through numerous research studies to contribute
to a reduced length of gestation [13,14], prematurity [15-19], as well
as frequently to a lowered birth weight of the newborn [20-47]. The
average reported weight reduction can fluctuate between 120g to 430g,
or more, depending on the number of cigarettes consumed [4]. The association between maternal smoking and perinatal loss is impressive, ranging from 5-70% depending on the population studied [13,13,18,19,48-61]. Smoking greatly increase the risk of maternal rejection of the fetus at apparently all stages of gestation. It also increases the risk of bleeding, which in most cases can be regarded as a threatened rejection [4]. Antepartum bleeding or abruptio placentae has been liked directly with an excessive cigarette consumption [62]. A report using data from the Ontario Survey [51] concluded that as much as 30-40% of the excess perinatal mortality of smokers' babies was found to be directly attributable to abruptio placentae [56]. A further substantial part of antepartum bleeding, generally about 25%, is associated with placenta praevia [4], which has been increasingly detected among expectant cigarette smoking mothers [63,64]. Placenta praevia in turn has been related to spontaneous abortions and, in some cases, to foetal malformations [4]. Foetal malformations: Experiments on non-human subjects have shown that smoking reduces the cell number without affecting the cell size [65]. Furthermore, smoking reduces the rate of cell replication in all organs, which is associated with a reduced rate of DNA synthesis [66). Tobacco smoking has also been found to reduce the rates of protein synthesis [67]. As maternal smoking reduces both the rate of cell replication and protein synthesis, it is therefore speculated that maternal smoking may cause most of its damage during the first weeks of gestation when the rates of embryonic and fetal cell replication are the most active, leading to various congenital malformations [4,5,57,68,69]. A study among 10,523 health professionals showed a 29% increase in malformations, such as hare lip, cleft palate and various central nervous system abnormalities among infants born to mothers who smoked during pregnancy [57]. Another study found significant over representation of malformations of the central nervous system, digestive system and the heart, among babies born to smoking mothers compared to controls [70]. Maternal nicotine inhalation has also been found to increase significantly the fetal heart rate [6,71,72]. One study reported a large statistically significant increase in the rate of congenital heart defects among infants born to mothers who smoked during pregnancy compared with non-smoking mothers [73]. The mutagenic compounds of tobacco, not only can cause damage during embryonic development but also before conception, by modulating susceptibility to chromosomal aberrations of the sperm [4]. One study on a mouse fetus found that prolonged cumulative exposure to nicotine by the male has a mutagenic action on spermatids and spermatozoa thereby resulting in severe limb deformities in the offspring [74]. This specific report shows clearly how cumulative nicotine exposure by the male can lead to inefficient sperm development, which in turn can cause severe fetal malformations. In addition, research from Sweden, which studied the origins of severe mental subnormality, indicated that 35% of mental subnormalities could be attributable to these chromosomal aberrations [75]. Tobacco smoking in male and female infertility: In females, cigarette smoking has been linked with both an early onset of menopause as well as directly with infertility [4,76-79]. In males it has been linked with decreased sperm density [80,82], a lower proportion of motile sperm [80,82- 85], decreased total sperm count [84,85], reduced testosterone secretion [86] and, as previously shown, an increase in morphologically abnormal spermatids and spermatozoa, which can be a direct cause of various fetal malformations [74,80,87]. In addition, a recent study by Dr Lars Wickmann from the Department of Biomedical Sciences, Tampere University, Finland, found 41.9% of infertility among men who smoked compared to 27.8% among non-smokers [88]. Tobacco smoking and reduced immunocompetence: Studies both on both animal and human subjects have shown that the nicotine as well as the vapour phase of tobacco have a significant immunosuppressive effect, affecting particularly the humoral antibody response by greatly reducing immune globulin levels in blood serum [89-95]. The depression of IgG and IgM concentration seems to be especially marked [96]. It has been also noted that the blocking factor preventing fetal rejection seems to be a component of IgG, which may partly explain the increased susceptibility to miscarriages among expectant mothers who smoke cigarettes whilst pregnant [4]. THE ADVERSE EFFECTS OF MATERNAL SMOKING ON CHILD HEALTH: Over the last decade several retrospective studies have reported an increased frequency of both physical and mental health problems among young children born to mothers who smoked cigarettes during pregnancy [47,60,97-102]. Furthermore, it has been suggested that the impairment in both physical and mental health of these children born to mothers who smoked during pregnancy may have its origin in the fetal period [97]. Dr Paula Rantakallio from Finland compared childhood diseases of the first 5 years of life of children born to 1821 mothers who had smoked during pregnancy, with children born to non- smoking mothers [60]. Morbidity was measured by attendance at family doctors' surgeries and hospital admissions and by the length of the stay in a hospital. The results showed a significantly higher prevalence of morbidity among children born to mothers who had smoked whilst pregnant, compared to children born to non-smokers. Diseases of the respiratory system were found to be most widespread among children born to mothers who smoked, followed by various diseases of the nervous system and the sense organs, then the blood and blood forming organs, the skin and the subcutaneous tissue and, finally, diseases of the genitourinary system. It has been thought that inherited weakened immune response may partly be responsible for the increased susceptibility to physical malaise found in children born to maternal smokers [4]. Doctors Richard Naeye and Ellen Peters [47] analyzed data from a large prospective study to see whether or not maternal cigarette consumption during pregnancy would affect childhood mental development. Many confounding variables were controlled by multiple regression analysis and by intrapair comparisons of siblings whose mothers had smoked during one, but not in the other, of two pregnancies. The result showed that hyperactivity, short attention span, and lower scores on spelling and reading tests were more frequent in children when the mother had smoked when pregnant. This intrapair comparison of siblings was able to supply clear evidence that smoking during pregnancy, independently of any other demographic factors and genetic influences, is indeed a cause of childhood hyperactivity and impaired mental development. Several other studies have also reported an increased frequency of intellectual impairments and behavioural abnormalities in children born to mothers who had smoked cigarettes whilst pregnant, which include short attention span, a four to five-month retardation level in reading and mathematical skills, slightly lower intelligence quotient values as well as various forms of hyperactive behaviours [97,98,101,102]. Research has also found 10.3% incidence of delinquency by the age of 22 years in the sons of mothers who smoked whilst pregnant, compared to 4.6% among sons of non-smokers [103]. Through animal experiments it has been found that carbon monoxide both decreases concentrations of brain protein, DNA, noradrenaline, and serotonin, as well as having a prolonged effect on dopamine turnover during the critical stage of brain development [2]. The above, combined with nicotine- induced fetal brain hypoxemia, have been thought to contribute to the genesis of maternal smoking-associated childhood behavioural abnormalities [47]. THE ADVERSE EFFECT OF SMOKING ON ADULT HEALTH: The harmful effects of tobacco smoking, and in particular cigarette smoking, on health are now well accepted. Such effects include the direct action of cigarettes on the respiratory tract, causing bronchitis, emphysema and cancer of the lung, as well as more indirect action on other organs such as arteries and heart [104,105]. It has also been suggested that tobacco smoking may increase the incidence of cancer involving the pancreas, the bladder and other organs. Furthermore, it has been observed that smoking may also potentiate the action of other carcinogenic substances [105]. As previously noted, smoking has a depressant effect on immune system function [89-96] and thus greatly reduces resistance to infectious diseases [106]. Therefore, it is not surprising that smokers, when compared to non-smokers, have been found to have an increased susceptibility to infectious diseases, such as influenza [107], respiratory [108] and urinary tract infections [109,110]. Nicotine inhalation also causes a shock-wave in blood sugar levels, due to stimulation of the adrenal hormones, followed by a rapid fall of the blood sugar levels as soon as nicotine activation has ceased, leading in susceptible individuals to symptomatic reactive hypoglycaemia [lll]. Symptomatic reactive hypoglycaemia in turn has been strongly linked with various personality [112], psychiatric [113], psychological [114] and psychosomatic [115] disorders, such as panic attacks [116], neuroses [117-119], schizophrenic episodes [120] and even criminal activity [121,122]. The effect of cadmium during tobacco smoking: Tobacco smoking also results in an increased intake and accumulation of cadmium in humans [104,123-l26]. Owing to the appreciable absorption of cadmium from the lungs i.e. 25-50% [104] it has been established that cigarette smoking is indeed likely to be the largest single source of cadmium found in the tissues when more than 20 cigarettes are smoked daily [127]. Absorbed cadmium accumulates mainly in the kidneys. For instance, when livers, kidneys and lungs obtained at autopsy from 172 subjects were analysed, results showed that cadmium concentration in the kidneys of cigarette smokers was approximately twice as high as of non-smokers. Furthermore, that cadmium concentration seemed to have risen parallel with the number of cigarettes smoked [124,125]. Similar results were found by other investigators [128]. Other detrimental effects of cadmium include damage to the liver, necrosis of testis, hypertension and, probably, certain chronic lesions in the connective tissue [104,129-131]. Dr Neil Ward and his team studied 37 placental element levels of known potential relevance to the fetal development of 100 obstetrically normal births. The results showed that mothers who smoked cigarettes during pregnancy tended to have significantly raised placental cadmium levels, which in turn showed highly significant negative dose-related correlations with infant birth weight as well as head circumference [132]. Cadmium levels have also been found to be considerably raised in the amniotic fluid of cigarette smoking mothers [133]. Raised cadmium levels in turn have been found to interfere with metabolism and utilisation of zinc, making it unavailable for foetal growth, thus leading to small-for-date births and maybe also contributing to various other birth abnormalities [132,134-136]. In addition, animal studies have been able to show that cadmium is also able to reduce placental blood flow [137], which, as noted previously, has been suggested as a cause for the childhood hyperactivity and socially negative behaviour that tends to develop in the children born to mothers who have been consuming cigarettes whilst pregnant [47]. Cadmium intake also reduces considerably male semen quality and fertility status. Dr Neil Ward and his team at Surrey University, England, conducted a study among 367 couples suffering from fertility problems and found significantly higher hair cadmium concentrations in men with low sperm count, malformed sperm and poor sperm motility compared with fertile men.
Besides greatly reducing foetal zinc status, tobacco smoking affects also maternal serum ascorbic acid metabolism which has been found to be approximately 30% lower in smokers than in non-smokers, and up to 40% lower in individuals who consume more than 20 cigarettes per day [138]. Both premature rupture of membranes and pre-eclampsia have been directly associated with reduced serum ascorbic acid levels [139,140]. Tobacco smoking also produces deficiencies in vitamin B6, magnesium, cobalt and chromium, as well as interfering with normal fat and essential fatty acid metabolism [2,4,141,142]. Besides increasing body cadmium, it is also known to cause an excessive body copper burden [143]. Furthermore, there is now abundant evidence that cigarette smoking exerts many adverse effects on the lungs and the cardiovascular system, as well as being associated with the development of emphysema, lung cancer, myocardial infarction, stroke and atherosclerosis. How exactly cigarette smoking is associated with the above mentioned conditions is still under discussion. However, it has been speculated that the reason may be found in the excessive smoking-related free-radical formation especially peroxyl radicals, which not only attack and damage biological molecules such as polyunsaturated fatty acids in membranes, but also greatly deplete anti-oxidant nutrients, particularly vitamin C, vitamin E and betacarotene, which are in turn all essential for protection from freeradical tissue damage. The gas phase of cigarette smoke further contains nitric oxide and nitric dioxide, which can also been termed as free- radicals as both of them carry an unpaired electron and are therefore toxic and capable of initiating further free radical chain reactions [144,145]. DISCUSSION AND RESULTS: The dangers to health of adult smoking are still the subject of continuous debate, but there can be no more dispute that maternal cigarette consumption during pregnancy does indeed cause great damage to the unborn child. The risk of miscarriage is particularly high, which has been found to increase as much as 27% among maternal smokers compared to non-smokers [146]. While neonatal mortality has greatly declined through improved paediatric care, unfortunately there seems to be no similar reduction in the incidence of infant morbidity and in the occurrence of childhood developmental disorders of the brain and intellect. The reasons for this are manifold; however, several investigations have now been able to provide ample evidence that the pre-term and low birth weight infant carries the major risk of suffering from developmental delay, whether mental or physical. In addition, more serious conditions such as mental retardation, retinopathy of prematurity, broncho-pulmonary dysplasia, brain haemorrhage, spasticity, cerebral palsy, blindness, deafness, autism and epilepsy are a frequent consequence of pre-term birth [147,148]. In addition, low birth weight has also been linked in later life with a greater risk of hypertension [149], coronary heart disease [150,151] and with impaired glucose tolerance [152]. It is estimated that approximately 54.000 infants are now born in the U.K. each year either pre-term or with a low birth weight [148]. The reasons for these are naturally multiple, but one of the major causes has been suggested to be maternal cigarette smoking during pregnancy [153]. Several investigations have also detected a significantly higher prevalence of childhood illnesses among young children born to mothers who have smoked whilst pregnant, compared to children born to non-smoking mothers. Diseases of the respiratory system, such as asthma , bronchitis and lung infections have been found to be extremely common among children born to smokers, followed by diseases of the nervous system and the sense organs, the blood and blood forming organs, the skin and the subcutaneous tissue and diseases of the genitourinary system. In addition, maternal cigarette consumption has been directly linked with abnormal childhood mental development, including intellectual impairment, behaviour abnormalities, short attention span, reduction in learning abilities as well as with various forms of hyperactive behaviour. New evidence recently released by the Institute of Child Health, Bristol, U.K. found that maternal smoking during pregnancy may also reduce the fertility of her unborn child. Professor Jean Golding invited 14,9t33 pregnant mothers, with the expected date of delivery between April 1st 1991 and December 3lst 1992, to fill in detailed questionnaires during their pregnancy. The results indicated that mothers who smoked whilst pregnant, suffered considerably more complications during pregnancy than non-smoking mothers. These included nausea, vomiting, diarrhoea, thrush, urinary tract infections and admissions to hospital. Furthermore, as a part of the survey, these mothers were also asked whether their own mothers had been smokers whilst expecting them: The results showed that mothers born to women who were smoking during pregnancy, and who were not smokers themselves, were significantly more likely to have had an earlier menarche as well as D&C. In addition, once pregnant, they appeared to be more at risk of early bleeding, and having a considerably higher, risk of miscarriage. Data from an earlier survey was able to show that boys born to mothers who smoked whilst pregnant were significantly more likely to be born with undescended testes. The explanation offered was that amongst the hundreds of chemicals found in tobacco smoke, some may mimic the effect and behaviour of oestrogen hormones, thus creating a disturbance in the formation of the reproductive organs of the offspring, which in turn may lead to various disabilities in the reproduction capacities of the second generation [146]. The final evaluation of this research is still in process. The long-held assumption is that both infertility and fetal abnormalities are primarily 'female problems'. It is gradually becoming more accepted also as a `male problem'. A recent review of 61 research papers published between 1938 and 1991, totalling 14,947 males, indicated a 50% overall decline in the sperm quality and density, suggesting a possibly similar reduction in the male fertility status [154]. Some research has already indicated that up to 60% of infertility, found in one in every six couples today, may be entirely due to male infertility or subfertility [155]. The causes are naturally manifold, but cigarette smoking could most certainly be included as one of the possible reasons for the high male reproductive failure. CONCLUSION: As seen from the above, cigarette smoking is not only harmful to an individual. It is particularly detrimental during the reproductive period, when it may not only harm the unborn child, but may also damage the reproductive capacity of the next generation. Even though tobacco smoking seems to be decreasing considerably among the older age group, unfortunately the same is not happening among the younger generation. It is estimated that in the U.K. 38% of males and 39% of females between ages of 20-24 are regular smokers and more children than ever before start their smoking habit at a very young age. Considering that the most regular and the heaviest smokers are presently found among the women and men in childbearing years, it is most important that information about the harmful effect of tobacco in reproduction is available and widely disseminated among the general public and, in order to achieve this, the following steps should be taken forthwith:
ACKNOWLEDGEMENTS: This study was supported by a grant from FORESIGHT, The Association for the Promotion of Preconceptual Care. This article was accepted for publication in the journal: "Nutrition and Health" (AB Academic Publishers, P.O.Box 1174, Tacoma, WA 98401, USA). REFERENCES 1. Mackaness R:A Little of What You Fancy. pp 94-95 Fontana Paperbacks, 1985. 2. Grant ECG: Allergies, Smoking and the Contraceptive Pill. In: Biological Aspects of Schizophrenia, Ed: Hemmings G. pub. John Wiley & Sons Ltd, 1982 3. Brodie I: Tobbaco moguls say cigarettes are not addictive. The Times, 15th April, 1994 4. Wynn M and Wynn A: The Prevention of Handicap of Early Pregnancy Origin, pp28-33, Foundation for Education and Research in Childbearing, 27 Walpole Street, London SW3, 1981. 5. Barnes B and Bradley SG: Planning for a Healthy Baby, pp96-97, Ebury Press, London, 1990 6. Kelly J, Mathews KA, O'Connor M: Smoking during pregnancy: effects on mother and the fetus. Br J Obstet Gynaecol, 91:111-117, 1984 7. Lehtovirta P and Forss M: The acute effects of smoking on intravillous blood flow of the placenta. Br J Obstet Gynaecol, 85:729-731, 1978 8. Naeye RL: Effects of maternal cigarette smoking on the fetus and placenta. Br J Obstet Gynaecol, 85:732-737, 1978 9. Friberg L, Nystrom A, Swanberg H: Transplacental diffusion of carbon monoxide in human subjects. Acta Physiol Scand, 45: 363-368, 1959 10. Haddon W, Nesbitt REL, Garcia R: Smoking and pregnancy: carbon monoxide in blood during gestation and at term. Obstet Gynecol, 18:262-267, 1961 11. Longo LD: Carbon monoxide in pregnant mother and fetus and its exchange across the placenta. Ann NY Acad Sci, 174:313-341, 1970. 12. Longo LD: The boilogical effects of carbon monoxide on the pregant woman, fetus and newborn infant. Am J Obstet Gynecol, 129:69-103, 1977. 13. Andrews Z and McGarry JM: A community study on smoking in pregnancy. J Obstet Gynaecol Br Commonw, 79:10571073, 1972. 14. Meyer MB, Jonas BS, Tonascia JA: Perinatal events associated with maternal smoking in pregnancy. Am J Epidemiol, 103:464-476, 1976 15. Frazier TM, Davis GH, Goldstein H et al.: Cigarette smoking and prematurity: A predictive study. Am J Obstet Gynecol, 81:988-996, 1961 16. Peterson WF, Morense KN, Kaltreider DF:Smoking and prematurity: A preliminary report based on study of 7740 Caucasians. Obstet Gynecol, 26:775-779, 1965 17. Jansson I: Aetiological factors in prematurity. Acta Obstet Gynecol Scand, 45:279-300, 1966 18. Reinke WA and Henderson M: Smoking and prematurity in the presence of other variables. Arch Environ Health (Chicago) 12:313-316, 1966 19. Frederick J, Anderson A: Factors associated with spontaneous pre-term birth. Br J Obstet Gynaecol, 83:342 1976 20. Simpson WJ and Linda L: A preliminary report on cigarette smoking and the incidence of prematurity. Am J Obstet Gynecol, 73:808-815, 1957 21. Lowe CR: Effect of mothers' smoking habits on birth weight of their children. Br Med J, 2:673-676, 1959 22. Herriot A, Billewics WZ, Hytten FE: Cigarette smoking in pregnancy. The Lancet, 1:771-773, 1962 23. O'Lane JM: Some fetal effects of maternal cigarette smoking. Am J Obstet Gynecol, 22:181-184, 1963 24. Zabriskie JR: Effect of cigarette smoking during pregnancy: Study of 2000 cases. Obstet Gynecol, 21:405-411, 1963 25. MacMahon B, Alpert M, Salber EJ: Infant weight and parental smoking habits. Am J Epidemiol, 82:247-261, 1965 26. Ravenholt RT and Levinski MJ: Smoking during pregnancy. The Lancet, 1:961 1965 27. Underwood P, Hester LL. Latiffe T et al.:The relationship of smoking to the outcome of pregnancy. Am J Obstet Gynecol, 91:270-276, 1965 28. Albernathy JR, Greenberg BG, Wells HB et al.: Smoking as independent variable in a multiple regression analysis upon birth weight and gestation. Am J Public Health, 56:626-633, 1966 29. Ravenholt RT, Levinski MJ, Nellist DJ et al.: Effects of smoking upon reproduction. Am J Obstet Gynecol, 96:267- 281, 1966 30. Russell C, Scott TR, Maddison RN:Some effects of smoking in pregnancy. J Obstet Gynaecol Br Commonw, 73:742-746, 1966 31. Underwood PB, Kesler KF, O'Lane JM et al.:Parental smoking empirically related to pregnancy outcome. Obestet Gynecol, 29:1-8, 1967 32. Mulcahy R: Effect of age, parity, and cigarette smoking on outcome of pregnancy. Am J Obstet Gynecol, 101:844-849, 1968 33. Butler NR and Alberman ED: Perinatal Problems. p 82, Livingstone, London and Edinburgh, 1969 34. Rantakallio P:Groups at risk in low birth weight infants and perinatal mortality. Acta Paediatr Scand, 193 (Suppl):1-71, 1969 35. Bailey RR:The effect of maternal smoking on the infant birthweight. NZ Med J, 71:293-294, 1970 36. Comstock GW, Shah FK, Meyer MB, Abbey H:Low birth weight and neonatal mortality rate related to maternal smoking and socioeconomic status. Am J Obstet Gynecol, 111:53-59, 1971 37. Butler NR, Goldstein H, Ross EM: Cigarette smoking in pregnancy: its influence on birth weight and perinatal mortality. Br Med J, 2:127-130, 1972 38. Rush D and Kass EH: Maternal smoking:A reassessment of the association with perinatal mortality. Am J Epidemiol, 96(3):183-196, 1972 39. Chamberlain G, Philipp E, Howlett B, Masters K: British Births 1970, Vol:2, Obstetric Care, Heineman, London, 1978 40. Meyer MB:How does maternal smoking affect birth weight and maternal weight gain. Am J Obstet, Gynecol, 131:888- 893, 1978 41. Persson PH, Grennert L, Gensser G, Kullander S:A study of smoking during pregnancy with special reference to fetal growth. Acta Obstet Gynecol Scand, Suppl. 78:33-39, 1978 42. Landesman-Dwyer S and Emanuel I: Smoking during pregnancy. Teratology, 19:119-126, 1979 43. Pelkonen O, Karki NT, Koivisto M, Tuimala R, Kauppila A: Maternal cigarette smoking, placental aryl hydrocarbon hydroxylase and neonatal size. Toxicology Letters, 3:331- 335, 1979 44. Naeye RL: Influence of maternal cigarette smoking during pregnancy on fetal and childhood growth. Obstet Gynecol, 57:18 1981 45. Naeye RL and Tafari N: Risk factors in Pregnancy, Diseases of the Fetus and Newborn. Baltimore, MD, Williams & Wilkins Co, 1983 46. Rush D and Cassano P: Relationship of cigarette smoking and social class to birth weight and perinatal mortality among all births in Britc~in, 5-10 April, 1970 J Epidemiol Community Health, 37(4):249-255, 1983 47. Naeye RL and Peters EC: Mental development of children whose mothers smoked during pregnancy. Obstet Gynecol, 64(5):601-607, 1984 48. Savel LE and Roth E: Effects of smoking in pregnancy:A continuing retrospective study. Obstet Gynecol, 20:313-316, 1962 49. Yerushalmy J:Mother's cigarette smoking and survival of infant. Am J Obstet Gynecol, 88:505-518, 1964 50. Comstock GW and Lundin FE:Parental smoking and perinatal mortality. Am J Obstet Gynecol, 98:708-718, 1967 51. Perinatal Mortality Study, Ten University Teaching Hospitals, Ontario, Canada, Publ: The Ontario Department of Health, Toronto, p 173, 1967 52. Butler NR and Alberman ED:Perinatal Problems:The Second Report of the 1958 British Perinatal Mortality Survey. Edinburgh, Livingstone, 1969 53. Kullander S and Kallen B:A prospective study of smoking in pregnancy. Acta Obstet Gynecol Scand, 50:83-94, 1971 54. Palmgren B and Wallander B:Cigarettesokning och abort: kondervativ prospectiv undersokning av 4312 graviditeter. Lakartidningen, 68:2611-2616, 1971 55. The Health Consequences of Smoking:A Report of the Surgeon General: U.S. Department of Health Education and Welfare, 1039(10):123-137, 1973 56. Meyer MB, Tonascia jA, Buck C:The interrelationship of maternal smoking and increased perinatal mortality with other risk factors. Further analysis of the Ontario Perinatal Mortality Study. Am J Epidemiol, 100:443-452, 1974 57. Himmelberger DV, Brown BW, Cohen EN:Cigarette srnoking during pregnancy and the occurrence of spontaneous abortion and congenital malformation. Am J Epidemiol, 108:470-479, 1978 58. Kline JO, Stein ZA, Susser M, Warburton D: Smoking: a risk factor for spontaneous abortion. N Engl J Med, 297:793-796, 1977 59. McKean HE: Smoking and abortion. N Engl J Med, 298:113114, 1978 60. Rantakallio P: Relationship of maternal smoking to morbidity and mortality of the child up to age of five. Acta Paediatr Scand, 67:621-631, 1978 61. Fergusson DM, Horwood LJ, Shannon FT: Smoking during pregnancy. N.Z. Med J, 89:41-43, 1979 62. Goujard S, Rumeau C, Schwartz N: Smoking during pregnancy, stillbirth and abruptio placentae. Biomedicine, 23:20-22, 1965 63. Fielding JE and Rosso PK: Smoking during pregnancy. N Engl J Med, 298:337-339, 1978 64. Naeye R: The duration of maternal cigarette smoking and placental disorders. Early Hum Dev, 3:229-237, 1979 65. Haworth JC and Ford JD: Comparison of the effects of maternal undernutrition and exposure to cigarette smoke on the cellular growth of the rat fetus. Am J Obstet Gynecol, 112:653 1972 66. Leuchtenberger C, Leuchtenberger R, Ritter U, Inui N: Effects of marihuana and tobacco smoke on DNA and chromosomal complement in human lung extracts 67. Yager H: Alveolar cells: depressant effect of cigarette smoke on protein synthesis. Proc Soc Exp Biol Med, 131:147-150, 1969 68. Bridges BA, Clemmensen J, Sugimura T: Cigarette smoking does it carry genetic risk? Mutat Res, 65:71-81, 1979 69. U.S. Public Health Service: The Health Consequences of Smoking for Women: A Report of the U.S. Surgeon-General, Office of Smoking and Health, U.S. Dept of Health and Human Services, Rockville MD, 1980 70. Kelsey JL, Theodore RH, Bracken MB: Maternal smoking and congenital malformations: An epidemiological study. J Epidem Community Health, 32:103-107, 1978 7l. Sontag LW and Wallace RF: The effects of cigarette smoking during pregnancy upon the fetal heart rate. Am J Obstet Gynecol, 29:77-83, 1935 72. Hellman LM, Johnson HL, Tolles WE et al.: Some factors affecting fetal heart rate. Am J Obstet Gynecol, 82:1055- 1063, 1961 73. Fedrick J, Alberman E, Goldstein H: Possible teratogenic effect of cigarette smoking. Nature, 231:529-530, 1971 74. Hemsworth BN: Deformation of the mouse foetus after ingestion of nicotine by the male. IRCS Medical Science, 9:728-729, 1981 75. Gustavson KH, Hagberg B, Hagberg G, Sars K: Severe mental retardation in a Swedish country. Neuropadiatrie, 8:293-304, 1977 76. Bernard P: Die Wirkung des Rauchens auf Frau and Mutter. Munch Med Wochenschr, 104:1826 1962 77. Jick H, Porter J, Morrison AS: Relation between smoking and age of natural menopause. The Lancet, 1:1354-1355, 1977 78. Linquist O and Bengtsson C: Menopausal age in relation to smoking. Acta Med Scand, 205:73-77, 1979 79. Campbell AM: Excessive cigarette smoking in women and its effect upon their reproductive efficiency. J Mich Med Soc, 34:146-151, 1935 80. Viczian M: Ergebnisse von Spermautersuchungen bei Zigarettenrauchen. Z Haut Geschlectskr, 44:183-187, 1969 81. Campbell JM and Harrison KL: Smoking and infertility. Med J Austr, 1:342-343, 1979 82. Kulikauskas V, Blaustein D, Ablin RJ: Cigarette smoking and its possible effect on sperm. Fertil Steril, 44:526-528, 1985 83. Handelsman DJ, Conway AJ, Boylan LM, Turtle JR: Testicular function in potential sperm donors: normal ranges and the effects of smoking and varicocele. Int J Androl, 7:369-382, 1984 84. Rantala ML and Koskimies AI: Semen quality of infertile couples - comparison between smokers and non-smokers. Andrologia, 19:42-46, 1986 85. Saaranen M, Suonio S, Kauhanen O, Saarikoski S: Tupakka ja siemennesteen laatu. Suomen Laakarilehti, 36:3466-3470, 1986 86. Briggs MH: Cigarette smoking and infertility in men. Med J Austr, 1:616 1973 87. Evans HJ, Fletcher J, Torrance M, Hardgreave TB: Sperm abnormalities and cigarette smoking. The Lancet, 1:627-629, 1981 88. Wichmann L: The value of semen analysis in predicting pregnancy. Acta Universitatis Tamperensis, ser A, vol 346, 1992 89. Silvette H, Larson PS, Haag HB: Immunological aspects of tobacco smoke. Am J Med Sci, 234:561-589, 1967 90. Esber HJ, Menninger FF, Bogden AE, Mason MM: Immunological deficiency associated with cigarette smoke inhalalation by mice. Arch Environ Health, 27:99 1973 91. Roszman TL and Rogers AS: The immunosuppressive potential of products derived from cigarette smoke. Am Rev Resp Dis, 108:1158-1163, 1973 92. Thomas W, Holt PG, Keast D: Effect of cigarette smoking on primary and secondary humoral response of mice. Nature, 234:240-241, 1973 93. Thomas WR, Holt PG, Keast D: Humoral immune response of mice chronically exposed to cigarette smoke. Arch Environ Health, 30:78-80, 1975 94. Holt PG, Keast D, Mackenzie JS: Immunosuppression in the mouse induced by long-term exposure to cigarette smoke. Am J Pathol, 90:281-284, 1978 95. Kraal JH: Immunoglobulin levels in relation to smoking and coffee consumption. Am J Clin Nutr, 31:198-200, 1978 96. Gulsvik A and Fagerhol MK: Smoking and immuno-globulin levels. The Lancet, 1:449 1979 97. Butler NR and Goldstein M: Smoking during pregnancy and subsequent child development. Br Med J, 4:573-575, 1973 98. Denson R, Nanson JL, McWatters MA: Hyperkinesis and maternal smoking. Can Psychiatr Assoc J, 20:183 1975 99. Rantakallio P: The effect of maternal smoking on birthweight and the subsequent health of the child. Early Hum Dev, 2:371-382, 1978 100. Rantakallio P: Social background of mothers who smoked during pregnancy and the influence of these factors on the offspring. Soc Sci Med, 13A:423-429, 1979 101. Rantakallio P: A follow-up study up to the age of 14 of children whose mothers smoked during pregnancy. Acta Pediatr Scand, 72:747 1983 102. Saxton DW: The behaviour of infants whose mothers smoke in pregnancy. Early Hum Dev, 2:363 1978 103. Rantakallio P, Laara E, Isohanni M, Moilanen I: Maternal smoking during pregnancy and delinquency of the offspring: an association without causation? Int J Epidemiol, 21:1106-1113, 1992 104. Ostergaard K: The concentration of cadmium in renal tissue from smokers and non-smokers. Acta Med Scand, 202:193195, 1977 105. Kjeldsen K: Smoking and atherosclerosis. Munksgaard, Copenhagen, 1969 106. Holt PG, Thomas WR, Keast D: Smoking and immunity. The Lancet, 1:1316 1973 107. Finklea JF, Hasselblad V et al.: Cigarette smoking and hemaglutination inhibition response to influenza after natural disease of immunization. Am Rev Resp Dis, 104:368 1971 108. Demarest GB, Hudson LD, Altman LC: Impaired alveolar macrophage chemitaxis in patients with acute smoke inhalation. Am Rev Resp Dis, 119:276-286, 1979 109. Nymand G: Maternal smoking and immunity. The Lancet, II:1379 1974 110. Martin-Boyle A, David G, Schwartz D: Alcool, tabac et infections genito-urinaires masculines. Rev Epidemiol Sante Publique, 25:209-216, 1977 111. Maxwell G and Berry MD: Tobacco hypoglycaemia Ann Int Med, 50:1149-1157, 1959 112. Hypoglycaemia and Personality. Br Med J, p 134, April, 20, 1974 113. Tuormaa TE: An Alternative to Psychiatry. pp 132-161 (refs. therein) The Book Guild Ltd, 1991 114. Wilder J: Psychological problems in hypoglycaemia. Am J Digest Dis, 10, 11:428-435, 1943 115. Landmann HR and Sutherland RL: Incidence and significance of hypoglycaemia in unselected admissions to a psychosamatic service. Am J Digest Dis, 105-108, April, 1950 116. Gorman JM, Martinez JM, Liebowitz MR, Fryer AJ, Klein DF: Hypoglycaemia and panic attacks. Am J Psychiatr, 141 (1 ):101-102, 1984 117. Rynaerson EH and Moersch FP: Neurologic manifestations of hyperinsulinism and other hypoglycaemic states. J AM Med Assoc, 1196-1199, Qctober 20, 1934 118. Jones MS: Hypoglycaemia in the neuroses. Br Med J, 945- 946, November 16, 1935 119. Salzer HM: Relative hypoglycaemia as a cause of neuropsychiatric illness. J Nat Med Assoc, 12-17, January, 1966 120. Moiers RL: Relative hypoglycaemia in schizophrenia. pp 452-462, Orthomolecular Psychiatry, Eds: D Hawkins, L Pauling, W.H. Freeman & Co, 1973 121. Virkkunen M: Reactive hypoglycaemic tendency among habitually violent offenders. Nutr Rev, Suppl, 94-103, May, 1986 122. Virkkunen M: Reactive hypoglycaemic tendency among arsonists. Acta Psychiatr Scand, 69:445-452, 1984 123. Nandi M, Slone D, Jick H, Shapiro S, Lewis GP: Cadmium content of cigarettes. The Lancet, 2:1329 1969 124. Lewis GP, Coughlin LL, Jusko JW, Hartz S: Contribution of cigarette smoking to cadmium accumulation in man. The Lancet, 1:291 1972 125. Lewis GP, Jusko WJ, Coughlin L: Cadmium accumulation in man: influence of smoking, occupation, alcohol habit and disease. J Chronic Dis, 25:717 1972 126. Menden EE, Elia VJ, Michael LW, Petering HG: Distribution of cadmium and nickel of tobacco during cigarette smoking. Environ Sci Technol, 6:830 1972 127. Cadmium in the environment and its significance to man. U.K. Department of the Environment, Pollution Paper No:l7, Her Majesty's Stationery Office, London 1980 128. Hammer DI, Calocci AV, Hasselblad V, Williams ME, Pinkerton C: Cadmium and lead in autopsy tissue. J Occup Med, 15:956 1973 129. Schroeder HA and Winton WH: Hypertension induced in rats by small doses of cadmium. Am J Physiol, 202:515 1962 130. Lener J and Bibr B: Cadmium and hypertension. The Lancet, , 1:970 1971 131. Kallerup HE, Kierkegord-Hansen G, Hansen JC: Exposure to cadmium as a possible precipitating factor in connective tissue disease. Ugerskr Laeger, 138:1396 1976 132. Ward NI, Watson R, Bryce-Smith D: Placental element levels in relation to fetal development for obstetrically normal births: A study of 37 elements. Evidence for effects of cadmium, lead and zinc on fetal growth, and smoking as a cause of cadmium. Int J Biosocial Res, 9(1):63-81, 1987 133. Siegers CP, Jungblut JR, Klink F, Oberhauser F: Effects of smoking on cadmium and lead concentrations in human amniotic fluid. Toxicol Letters, 19(3):327-331, 1983 134. Ward N.I.: The effect of cadmium from smoking activity (non, active and passive) on the outcome of pregnancy. Foresight Spring Newsletter, pp 10-13, 1994 135. Kuhnert BR, Kuhnert PM, et al: Smoking alters the relationship between maternal zinc intake and biochemical indices of foetal zinc status. Am J Clin Nutr. 55:981-984, 1992 136. Kuhnert PM, Kuhnert BR, Erhard P, et al: The effect of smoking on placental and fetal zinc status. Am J Obstet Gynecol. 157:1241-1246, 1987 137. Carmichael NG, Backhouse BL, Winder C, Lewis PD: Teratogenicity, toxicity, and perinatal effects of cadmium. Human Toxicol, 1:159-186, 1982 138. Pelletier O: ViEamin C and tobacco. In: Hanck A and Ritzel G: Re-evaluation of Vitamin C. Int J Vit Nutr Res, Suppl:l6, 1977 139. Wideman GL, Baird GH, Bolding OT: Ascorbic acid deficiency and premature rupture of membranes. Am J Obstet Gynecol, 88:592-595, 1964 140. Clemetson CAB and Anderson L: Ascorbic acid metabolism in preeclampsia. Obstet Gynecol, 24:774-782, 1964 141. Moynihan EJ: Trace elements in man. Phil Trans R Soc, London, 288:65 1979 142. Grant E: Sexual Chemistry. p. 135, Cedar Publications, 1994 143. Davidoff GN, Votaw ML, Coon WW, Hultquist FA, Filter EE, Wexler BJ: Elevations in serum copper, erythrocyte copper and ceruloplasmin concentrations in smokers. Am J Clin Path, 75:790 1978 144. Halliwell B: Free radicals and vascular disease: how much do we know? Br Med J, 307:885 1993 145. Halliwell B: Cigarette smoking and health: a radical view. J Roy Soc Health, April, 91-96, 1993 146. Golding J: The Consequences of Smoking in Pregnancy. Talk given to a conference on Smoking in Pregnancy commissioned by the Health Education Authority, 2nd February, 1994 147. Crawford MA: Maternal nutrition before conception and the prevention of neurodevelopmental disorders. The McCarrison Society Newsletter, Winter, 1992 148. Crawford MA, Doyle W; Leaf A, Leighfield M et al.: Nutrition and neurodevelopmental disorders. Nutrition and Health, 9:81-97, 1993 149. Barker DJP, Bull AR, Osmond C, Simonds SJ: Foetal and placental size and risk of hypertension in adult life. Br Med J, 301:259-262, 1990 150. Barker DJP, Winter PD, Osmond C et al.: Weight in infancy and death from coronary heart disease. The Lancet, II:577580, 1989 151. Barker DJP et al.: Growth in uterus, blood pressure in childhood and adult life, and mortality from cardiovascular disease. Br Med J, 298:564-567, 1989 152. Hales CN, Barker DJP et al.: Foetal and infant growth and impaired glucose tolerance at age 64. Br Med J, 303:10191022, 1991 153. Belsey M: The world health evidence: the mother is the key to the next generation. Nutrition and Health, 9:75-80, 1993 154. Carlsen E, Giwercman A, Keiding N, Skakkebaek NE: Evidence for decreasing quality of semen during past 50 years. Br Med J, 305:609-612, 1992 155. Fox M: Oestrogen mimics. Green Network News, pp 14-15, March, 1994
More:- Foresight Literature Summaries
|
