[Pathophysiological aspects of smoking in pregnancy]

Smoking in pregnancy has, besides the effects on maternal health, well documented negative effects on pregnancy outcome, fetal growth and neonatal health. Most of the pathophysiological mechanisms of harm are not readily understood, often analogies to animal studies or mechanisms of disease known in adults are presumed to be effective in intrauterine life as well.

A Medline literature search was performed to retrieve articles on smoking, pregnancy and pathophysiology. Some aspects of pathophysiology are described here.

Adaptation of the circulation to acute intrauterine stress is well documented in diseases of the trophoblast like the HELLP syndrome. Only few authors have focused their work on the unique physiological aspects of intrauterine life and growth in chronic exposure to nicotine and carbon monoxide. Some effects like disproportional growth impairment of the extremities vs. the head occur only in the intrauterine phase of life. Thus more scientific work is needed on the intrauterine effects of nicotine and carbon monoxide.