SMOKING AND HUMAN REPRODUCTION Actual knowledge Medical students https://is.muni.cz/el/1411/podzim2012/VLPL9X1a/seminar-30-31-qwarp DAMAGES of REPRODUCTION nARE THE EARLIEST MANIFESTATION of THE SERIOUS EFFECTS of SMOKING on HUMAN HEALTH nBOTH MEN´S and WOMEN´S REPRODUCTIVE FUNCTIONS ARE AFFECTED, AND nTHE DEVELOPMENT AND HEALTH OF FEATUS and CHILD ARE DAMAGED CAUSES/MECHANISMS: nHYPOXIA nOXIDATIVE STRESS nDIRECT INFLUENCE of SOME CHEMICALS:: TOXIC, MUTAGENIC, CARCINOGENIC MEN´S REPRODUCTION nIMPOTENCE (erectile dysfunctions): nSYMPATICOTONUS (due to nicotine) nVASOKONSTRICTION IN CORPUS CAVERNOSUS (YOUNG MEN) nDUE TO PRELIMINARY ATHEROSCLEROSIS OF PELVIC ARTERIES (IN MIDDLE AGES) nNICOTIN, CARBON MONOOXIDE MORE SERIOUS DAMAGES nSPERMIOGENESIS: nLOWER VOLUME OF EJACULATE nLESS COUNT OF SPERMIA CELLS nLESS NUMBER OF MOTILE SPERMS nMORE ABNORMAL SPERMS nMORE ANEUPLOID SPERMS WOMEN´S DAMAGES nIRREGULAR AND PAINFULL MENSTRUAL CYCLE nEARLIER MENOPAUSE ( 5 - 8 YEARS) nLESS MATURATED OOCYTES nMORE FREQUENT INFERTILITY nPOOR EFFECT OF IVF TREATMENT WHY NOT SMOKE IN PREGNANCY nMOTHER´S HEALTH nCOMPLICATIONS OF PREGNANCY nFETAL DEVELOPMENT nCHILD´S HEALTH nPROGRAMING OF HEALTH IN ADULTHOOD MOTHER´S HEALTH – CVD (OR) nSTROKE………………………. 1.7 nMI…………………………..….. 4.6 nLUNG´S EMBOLIE ………. 2.5 nVENOS THROMBOSIS ….. 1.3 nCARDIOMYOPATHY………. 1.4 nHYPERTENSION……………. 1.2 MOTHER´S HEALTH – INFECTIOUS DISEASIS (OR) nPNEUMONY ………………………..2.9 nBRONCHITIS ……………………..15.2 nBACTERIAL INF. ………..……… 1.2 nPYELONEFRITIS ……………….. 1.2 nHIV/AIDS …………………………. 1.5 MOTHER´S HEALTH – OTHER nASTHMA ………………….. 4.0 nDIABETES ..……………… 1.2 nULCUS DUOD………….... 3.7 nANEMIE …………………… 1.4 nALCOHOL/DRUGS .……14.1 nMALNUTRITION………. 2.4 PREGNANCY COMPLICATIONS (OR) nPREGNANCY EXTRAUTERINA..……..5.4 nPLACENTA PREVIA ……………………..1.2 nPLACENTAL ABRUPTIO ..……………..1.4 nBLEEDING ………………………………….1.3 nHYPEREMESIS …………………………… 1.2 nPREECLAMPSIA, ECLAMPSIA ………. 0.8 DAMAGES IN UTERO nPLACENTAL (structure, integrity, function) nCHANGES OF UMBILICAL CIRCULATION nCHANGES OF FETAL CIRCULATION nLOW OXYGENAL SATURATION OF FETAL Hb nDIRECT EFFECT ON FETAL CELLS DAMAGES OF FETAL DEVELOPMENT n nPRELIMINARY MEMBRANOUS RUPTURE ………………………………………………... 1.7 nPRELIMINARY DELIVERY/ABORT .. 1.3 nFETAL DEATH ………………………….. 1.1 nFETAL TOBACCO SYNDROME……… 2.6 n HEREDITARY MALFORMATIONS nLACK OF UNIVERSAL DEFINITION nSTRUKTURAL, FUNCTIONAL, METABOLICAL, CHEMICAL CHANGES nALMOST 8 MILIONS ANNUALLY n4 % vs. 8 % OF LIFE BIRTHS n3.3 mil. DIE UP TO 5th YEAR OF AGE n3.2 mil. LONG-LIFE DAMAGES MALFORMATIONS n30 % GENETIC BASIS n70 % ENVIRONMENTAL FACTORS, SOCIAL STATUS, CULTURAL TRADITIONS AND ENVIRONMENT, n HEALTH CURE nSUBSTANTIAL GEOGRAPHIC DIFFERENCES HUMAN´S TERRATOGENS nALCOHOL, nSMOKING, NIKOTINE nORGANIC MERCURY nTHALIDOMID, DRUGS nRADIATION, HEAVY METALS, ORG. SOLVENTS nMOTHER´S INFECTIOUS /CHRONIC D. nDEFICIT of FOLIC ACID, Zn SMOKING and MALFORMATIONS nCARDIAL nRESPIRATORY nCLEFTS nLIMBS DEFORMATIONS nHYPOSPADIE nGASTROSCHISIS REVIEW:173 687 CASES and 11,7 MIL. CONTROLS - OR nCARDIOVASKULAR 1.09 nMUSKULOSKELETAL 1.16 nLIMBS (REDUCTION) 1.26 nFINGERS 1.18 n„PES EQUINOVARUS“ 1.28 n nHackshaw A.,aj. Hum Reprod Update 2011 n MALFORMATIONS - continue nCRANIOSYNOSTOSIS 1.33 nFACIAL DEFECTS 1.19 nEYES DEFECTS 1.25 nCLEFTS 1.28 MALFORMATIONS - contiue nGASTROINTESTINAL DEFECTS 1.27 nGASTROSCHISIS 1.50 nANAL ATHRESIA 1.20 nHERNIA 1.40 nDAMAGES OF TESTES 1.13 nHYPOSPADIE 0.90 nSKIN DEFECTS 0.82 n POSTNATAL CONSEQUENCES n=> PRENATAL PROGRAMMING: -RESPIRATORY -NEURO – PSYCHICAL -CARDIOVASCULAR -GENOTOXIC CRITIC „WINDOWS“ nin 1st TRIMESTER = THE QUIECKEST GROWING and DEVELOPMENT of ALL ESENTIAL FETAL COMPLEMENTS nTHE EXPOSURE TO DAMAGING FACTORS CAN INFLUENCE FURTHER PRE-NATAL and POST-NATAL DEVELOPMENT „CROWN-BOTTY„ LENGTH nAT 1st TRIMESTER PREDICTS: nFETAL INTRAUTERINE GROWTH, nBIRTH WEIGH AND LENGTH nPOST-NATAL PHYSICAL DEVELOPMENT nRisk factors: ENHANCED DIAST. BP, HEMATOCRITE, SMOKING, LOW INTAKE of FOLIC ACIDE FOAD HYPOTHESIS nFetal Origin of Adult Disease: nLOW BITH WEIGH (by 150 – 300 g) nINCREASES THE RISK of OBESITY in CHILDHOOD and ADULTHOOD nMETAANALYSIS of 17 STUDIES from 7 COUNTIRES (ALMOST 100.000 PERSONS => OR 1.64) PROGRAMING n„INHOSPITABLE“ ENVIRONMENT IN UTERO – FETAL METABOLIC ADAPTATION nHYPOTHALAMUS (regulation of food intake) nABNORMALITIES IN FAT CELLS nHORMONAL DYSBALANCE (insulin) nPERSISTS EVEN AFTER DELIVERY, WHEN NUTRITION IS BETTER NICOTINE nHAS THE MAIN ROLE nDUE TO PRE-NATAL STIMULATION of ACETYLCHOLIN NICOTINIC RECEPTORS (AchR) nINCLUDING THOSE WHICH REGULATE ENERGETIC INCOME AND OUTCOME CARDIOVASCULAR RISK FACTORS nOBESITY nBLOOD LIPIDS nBLOOD PRESSURE nCAN BE MODIFICATED BY PRE-NATAL EXPOSURE TO SMOKING / NICOTINE LOW BIRTH WEIGH nINCREASES THE RISK of OBESITY in CHILDHOOD and ADULTHOOD nIN ADOLESCENCE TRENDS TO ABDOMINAL OBESITY: + 26 až 33 % nPERSIST TO ADULTHOOD n(parasympatical predominance in autonomous cardiovascular regulation) ABDOMINAL OBESITY nIS AN IMPORTANT RISK FOR: nCARDIOVASCULAR DISEASES nMETABOLIC SYNDROME nINSULIN´S INTOLERANCE nSOME TUMORS ENDOTELIAL FUNCTIONS: nEFFECT OF NICOTINE: nLOWER AVAILABILITY of NO nLOWER ACTIVITY of ENDOTELIAL NO SYNTHESIS in PLACENTAL AND UMBILICAL TISSUE nENHANCED THICKNESS of MEDIAL LAYER of INTIMA AUTONOMOUS CONTROL nCHANGES in TONUS of SYMPATIC and PARASYMPATIC NERVOUS SYSTEMS – DYSBALANCE n1st SYMPATIC PREDOMINANCY : nHYPERREACTIVITY AFTER DELIVERY nCONTINUES into THE CHRONIC STATUS n EARLY EXPOSURE to SMOKING nCAN CAUSE THE CHRONICAL PROGRAMMING of BLOOD PRESSURE CONTROL n = n n HYPERTENSION NICOTINE also ENHANCES nTHE FETAL GLUCOCORTICOIDS´ ACTIVITY n and nNEWBORNS´ STRESS HORMONES LEVELS n => nANOTHER CONTRIBUTION to n HYPERTENSION 2nd VAGUS´ PREDOMINANCE nINFLUENCES HEART FRQUENCY, VASCULAR RESISTENCE OF VESSELS, BLOOD PRESURE nORTHOSTATIC INTOLERANCE (REFLEX COMPENSATION IN POSTURAL CHANGES –sitting, standing, walking) = nCHR. ORTHOSTATIC DYSFUNKCTION n „NICOTINIC“ RECEPTORS nALFA 4, BETA 2; ALFA 6 nOCCURE EVEN AT 1st TRIMESTER nPREMATURE ACTIVATION by NICOTINE = nDAMAGES THE DEVELOPMENT OF DOMAPINERGIC and SEROTONERGIC SYSTEMS, and nREDUCES THE NEURAL CELLS QANTITY CONSEQUENCES: nSIDS nCONDUCT DISORDERS (SOCIALIZATION) nPOOR SCHOOL RESULTS nADHD nSCHIZOFRENIE nRISK of DRUG DEPENDENCE nCRIMINALITY ANOTHER POST-NATAL RISKS nPOORER RESPIRATORY FUNCTIONS nDAMAGES of IMMUNE SYSTEM => LONG-TIME SUPRESSION of IMMUNE RESPONSE => (infectious, alergic dis.) nSHORTER BREAST-FFEDING nENHANCED RISK of CARRIES GENOTOXICITY nHIGHER LEVELS of DNA ADDUCTS in PLACENTA and FETUS of SMOKERS (both active and i passive) nHIGHER FREQENCY of SISTER CHROMATIDES EXCHANGES among NEWBORNS of SMOKERS nHIGHER INCIDENCY OF BRAIN TUMORS, LEUKEMIA and LYMFOMAS SMOKING in PREGNANCY nIS A GREAT RISK DURING THE WHOLE TIME of PREGNENCY and AFTER DELIVERY nIT IS NON-ETHICAL TO TOLERATE SMOKING IN PREGNANCY nPREGNANT WOMEN HAVE THE STRONG MOTIVATION TO CHANGE THEIR LIFE-STYLE nTHE MEDICATION SUPPORT of SMOKING CESSATION IS PROBLEMATIC