Coppens M, Vindla S, James D K, Sahota D S
Division of Fetomaternal Medicine, University Department of Obstetrics and Gynecology, Queens Medical Centre, Nottingham, United Kingdom.
Am J Obstet Gynecol. 2001 Aug;185(2):421-6. doi: 10.1067/mob.2001.115992.
To investigate the acute and chronic changes in fetal heart rate and fetal activity in association with maternal smoking by means of a computerized fetal behavior assessment program.
In 13 term nonsmokers and 13 term smokers, fetal behavior was analyzed for 2 consecutive periods of >60 minutes. In between these 2 periods, the smokers were allowed to smoke 1 cigarette, the nonsmokers were allowed a short break of comparable time span. Fetal heart rate variation and fetal activity were recorded by a single 1.5-MHZ ultrasound transducer. The percentage of time spent in low and high fetal heart rate variation and fetal activity were analyzed by computer before and after the short break for nonsmokers and before and after the smokers smoked the 1 cigarette. Smoking-induced changes in Doppler umbilical artery recordings were also investigated. Chronic exposure to cigarette smoke was objectively evaluated by measuring the carbon monoxide concentration in expired air in all participating women after breath holding.
Fetuses chronically exposed to cigarette smoke spent significantly more time in a low fetal heart rate variation pattern, while fetal activity was decreased both in high and low fetal heart rate variation periods. After maternal smoking, no acute changes were observed in fetal heart rate variation, yet a reduction in fetal activity was noted; however, this only reached statistical significance in periods of high fetal heart rate variation. No significant change in mean fetal heart rate was observed, yet a significant reduction in the frequency of accelerations was noted. Smoking caused an acute and transient increase in the mean pulsatility index in the umbilical artery.
The computer program was able to detect changes in fetal behavioral variables in association with acute and chronic smoking. These changes may be suggestive of altered neurodevelopmental maturation possibly resulting from chronic fetal hypoxemia. This computer program offers a real possibility that analysis of fetal behavioral variables can be brought into routine clinical practice. Incorporating an analysis of these behavioral variables into smoking cessation programs may render them more successful.
通过计算机化胎儿行为评估程序，研究与孕妇吸烟相关的胎儿心率和胎儿活动的急性和慢性变化。
对13名足月不吸烟孕妇和13名足月吸烟孕妇的胎儿行为进行连续2个超过60分钟时间段的分析。在这2个时间段之间，允许吸烟孕妇吸1支烟，不吸烟孕妇有一段时长相当的短暂休息。用单个1.5兆赫超声换能器记录胎儿心率变化和胎儿活动。由计算机分析不吸烟孕妇短暂休息前后以及吸烟孕妇吸1支烟前后，胎儿处于低和高心率变化及胎儿活动状态的时间百分比。还研究了吸烟引起的多普勒脐动脉记录变化。通过测量所有参与研究的妇女屏气后呼出气体中的一氧化碳浓度，客观评估长期接触香烟烟雾的情况。
长期暴露于香烟烟雾中的胎儿处于低胎儿心率变化模式的时间显著更长，而在高和低胎儿心率变化期胎儿活动均减少。孕妇吸烟后，未观察到胎儿心率变化有急性改变，但注意到胎儿活动减少；然而，这仅在高胎儿心率变化期达到统计学意义。未观察到平均胎儿心率有显著变化，但注意到加速频率显著降低。吸烟导致脐动脉平均搏动指数急性短暂升高。
该计算机程序能够检测与急性和慢性吸烟相关的胎儿行为变量变化。这些变化可能提示神经发育成熟改变可能是慢性胎儿低氧血症所致。该计算机程序提供了将胎儿行为变量分析纳入常规临床实践的实际可能性。将这些行为变量分析纳入戒烟计划可能会使其更成功。
