Le Houezec J
Amzer-Glas, 176, rue de Brest, 35000 Rennes.
J Gynecol Obstet Biol Reprod (Paris). 2005 Apr;34 Spec No 1:3S182-93.
Tobacco smoking during pregnancy is the single largest modifiable risk for pregnancy-related morbidity and mortality. Tobacco smoke contains thousands of chemicals, many of which may contribute to reproductive toxicity. Carbon monoxide is the most biologically significant toxin for the fetus. The use of nicotine replacement therapy is probably not without risk, although the magnitude of risk to the mother and fetus is much lower than continuing smoking. Most pregnant women are motivated to stop. It is, therefore, a good time to initiate smoking cessation as early as possible during pregnancy, and to maintain abstinence during post-partum to protect the infant from passive smoking. If behavioral intervention fail to produce abstinence, a sign of high dependence, nicotine replacement therapy should be initiated promptly. Although bupropion is not recommended during pregnancy, this therapy should be considered when contraindications are carefully observed. It is recommended that all patients treated with nicotine or bupropion be reported to a pregnancy registry that collects pregnancy and obstetrical outcome data. This registry would allow health professionals to share their experience and should encourage them to use pharmacotherapy more frequently and lift psychological barriers concerning its use in pregnant women.
孕期吸烟是与妊娠相关发病和死亡的最大可改变风险因素。烟草烟雾含有数千种化学物质，其中许多可能导致生殖毒性。一氧化碳是对胎儿生物学意义最为重大的毒素。尼古丁替代疗法可能并非毫无风险，尽管对母亲和胎儿的风险程度远低于持续吸烟。大多数孕妇有戒烟的意愿。因此，孕期尽早开始戒烟并在产后保持戒烟状态，以保护婴儿免受被动吸烟影响，是个好时机。如果行为干预未能实现戒烟，这表明高度依赖，应立即开始尼古丁替代疗法。虽然孕期不推荐使用安非他酮，但在仔细观察禁忌证的情况下应考虑这种疗法。建议将所有接受尼古丁或安非他酮治疗的患者上报至一个收集妊娠及产科结局数据的妊娠登记处。该登记处将使卫生专业人员能够分享经验，并应鼓励他们更频繁地使用药物疗法，消除对其用于孕妇的心理障碍。
