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Submitted on August 20, 2004
Accepted on February 3, 2005
Centre for Human Growth and Maturation at the London Centre for Paediatric Endocrinology and Metabolism, Department of Obstetrics and Gynaecology, Rotunda Hospital, Dublin, Ireland, Department of Obstetrics and Gynaecology University College London W1T 3AA, UK. Program in Development and Fetal Health, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Canada
* To whom correspondence should be addressed. E-mail: p.hindmarsh{at}ucl.ac.uk.
Background: Maternal smoking during pregnancy is associated with a reduction in birth size. Very few studies have collated changes in fetal biometry, neonatal anthropometry, biochemical factors involved in fetal growth and measures of uterine and umbilical blood flow.
Methods: We related smoking status in 1650 low-risk, singleton Caucasian pregnancies delivering at term to measures of fetal growth, uterine and umbilical artery blood flow, placental appearance, birth size and cord concentrations of insulin-like growth factors (IGF) -1 and -2 and IGF binding protein (IGFBP) -3.
Results: Mothers who smoked in pregnancy were younger (P < 0.001), shorter (P = 0.03) and from lower socio-economic groups (P < 0.001). Mean umbilical artery blood flow at 20 weeks gestation was not associated with smoking status but was significantly higher in smokers at 30 weeks(P = 0.006). Uterine artery blood flow was unaffected. Smoking was associated with an increase in the percentage of abnormal placentas in a dose dependent manner and with a 3.1 fold increased risk (OR 3.1 95%CI 1.3-7.6) of abnormal umbilical artery blood flow (P = 0.009). Smoking was associated with a reduction in fetal femur length (P = 0.005) and abdominal circumference as well as birth weight, length and head circumference but not skinfold thickness. Cord plasma concentrations of IGF-1 and IGFBP-3 were lower in the babies of mother's who had smoked (P = 0.02 and P = 0.01 respectively).
Conclusion: Maternal smoking is associated with an altered placental appearance on ultrasonography, increased umbilical artery blood flow resistance and a reduction in longitudinal and intra-abdominal organ growth. Circulating concentrations of IGF-1 and IGFBP-3 are reduced along with measures of birth size but not markers of body fat suggesting smoking results in a reduction in organ size and function.
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