Das Fetale Tabaksyndrom – Ein Statement der Österreichischen Gesellschaften für Allgemein- und Familienmedizin (ÖGAM), Gynäkologie und Geburtshilfe (ÖGGG), Hygiene, Mikrobiologie und Präventivmedizin (ÖGHMP), Kinder- und Jugendheilkunde (ÖGKJ) sowie Pneumologie (ÖGP)

Abstract

Over more than 50 years, the nocuous effects of smoking in pregnancy on the fetus are well known. In the first years of science the focus was primarily on restricted fetal growth while in more recent years over 10.000 studies investigated the incomparably big sum of detrimental effects for the unborn's health. In this statement we want to present the recent scientific findings on this topic. The statement is aimed to show all doctors who treat pregnant women the present situation and evidence. In the beginning we give a short overview about the epidemiological situation in Europe. Then we present step by step the health effects with regards to pathophysiology and clinics. Furthermore the reader will learn about possibilities for smoking cessation in pregnancy. The problem of passive-smoking in pregnancy will be dealt with in a separate chapter. At present there is strong evidence that pregnant smoking has a detrimental effect on birth-weight, placenta-associated disease, stillbirth, sudden infant death syndrome (SIDS), childhood overweight, clefts, lung function, asthma, cardiovascular diseases and mental developmental disorders. These factors can be summarized by the term Fetal Tobacco Syndrome. There is supply for more studies for less investigated health effects. Pregnancy is a chance to stop smoking as most women show a high motivation in this period. Hence doctors of all disciplines should inform pregnant women about the detrimental effects of smoking on their unborn child and show them possibilities for smoking cessation.

Smoking prevalence among pregnant women from 2007 to 2012 at a tertiary-care hospital

“…The most recent data in Austria—derived from 2010—show that 20–30 % of pregnant women smoked [ 10 ]. However, the rates registered in the present study were consistently lower than 20 %.…”

“…A study comprising data from six European countries (Belgium, Bulgaria, Germany, Greece, Ireland, and Portugal) showed that the prevalence of smoking at the time of delivery varied between 7 % (Bulgaria) and 52.5 % (Ireland), with a mean smoking prevalence of 19.6 % [ 8 ]. Twenty-one percent of pregnant women smoked in Germany [ 18 ], while 20–30 % of pregnant women smoked in Austria in 2010 [ 10 ]. A study conducted in Spain in 2013, addressing the effects of smoking on fetal biometry, comprised 2478 women and revealed an overall smoking prevalence of 32 % [ 4 ].…”

“…It is the most important preventable risk factor for an adverse pregnancy outcome [ 1 , 11 ]. Horak et al [ 10 ] summarized the known effects as the fetal tobacco syndrome. Cigarette smoke contains toxins in quantities that affect placental and fetal cell growth, proliferation, and differentiation and exert harmful effects on the development of organ systems including the cardiovascular, respiratory, and nervous system.…”

“…Thus, smoking still is a public health concern. In addition to causing the fetal tobacco syndrome [ 10 ], it has been held responsible for the stagnation of infant mortality in the last decade in Austria, along with alcohol consumption and obesity in pregnant women [ 26 ]. Secondary complications due to maternal smoking lead to higher hospital admission rates of infants from the postnatal phase to the age of 5 years, which signifies higher health-care-related costs [ 2 , 16 ].…”

Präkonzeptionelle Beratung diabetischer Frauen

“…Neben den bekannten müt-terlichen Folgen nehmen die Risiken sowohl für Plazentadysfunktion, Früh-geburtlichkeit, Totgeburt, fetale Wachstumsretardierung, aber auch plötzli-chen Kindstod, jugendliche Adipositas, Asthma bronchiale und kardiovaskuläre Erkrankungen des Kindes zu. Dies führ-te zur Etablierung des Begriffs "fetales Tabaksyndrom" [15]. Im Rahmen der präkonzeptionellen Beratung sollte der Kinderwunsch als Motivation zur Nikotinkarenz dienen und entsprechende Angebote der Kassen, die ja auch im DMP vorgesehen sind, unterbreitet werden.…”