Ion Rachel, Bernal Andrés López
Obstetrics & Gynaecology, St Michael's Hospital, Bristol, United Kingdom
Obstetrics & Gynaecology, St Michael's Hospital, Bristol, United Kingdom School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
Reprod Sci. 2015 Aug;22(8):918-26. doi: 10.1177/1933719114556486. Epub 2014 Nov 12.
Premature birth is a significant global problem and the leading cause of newborn deaths. Tobacco smoking has been associated with premature birth for over 50 years. The mechanisms through which smoking exerts its effects on pregnancy outcomes remain unclear. In this review, we discuss rates of prematurity and smoking in pregnancy, the evidence of a causal relationship between tobacco and preterm birth, and proposed biochemical pathways through which the interaction is mediated. The suggested mechanisms include nicotine-induced vasoconstriction, carbon monoxide-induced fetal hypoxia, cadmium disruption of calcium signaling, altered steroid hormone production, disruption of prostaglandin synthesis, and changed responses to oxytocin. The relative importance of each of these pathways is yet to be ascertained. Further research is necessary to explore the mechanisms through which smoking exerts its effect on gestational length and the process of parturition. Moreover, the risks of nicotine replacement in pregnancy should be investigated further.
早产是一个重大的全球性问题，也是新生儿死亡的主要原因。吸烟与早产的关联已超过50年。吸烟对妊娠结局产生影响的机制尚不清楚。在本综述中，我们讨论了妊娠中的早产率和吸烟情况、烟草与早产之间因果关系的证据，以及介导这种相互作用的生化途径。所提出的机制包括尼古丁诱导的血管收缩、一氧化碳诱导的胎儿缺氧、镉对钙信号传导的干扰、类固醇激素分泌改变、前列腺素合成受阻以及对催产素反应的变化。这些途径中每条途径的相对重要性尚待确定。有必要进一步开展研究，以探索吸烟对妊娠期长度和分娩过程产生影响的机制。此外，还应进一步研究孕期使用尼古丁替代疗法的风险。
