Download PDF
Am J Perinatol 2018; 35(05): 521-526
DOI: 10.1055/s-0037-1608810
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Independent Contribution of Uterine Blood Flow to Birth Weight and Body Composition in Smoking Mothers

Kylie M. Cooper
1   Department of Maternal Fetal Medicine, University of Vermont Medical Center, Burlington, Vermont
,
Ira M. Bernstein
2   Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Medical Center, Burlington, Vermont
,
Joan M. Skelly
3   Department of Biostatistician, Medical Biostatistics, University of Vermont, Burlington, Vermont
,
Sarah H. Heil
4   Department of Psychiatry and Psychological Science, Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont
,
Stephen T. Higgins
5   Department of Psychiatry, University of Vermont, Burlington, Vermont
› Author Affiliations Funding Funding was provided by the National Institute on Drug Abuse, grant number DA14028.
Further Information

Publication History

06 May 2017

12 October 2017

Publication Date:
28 November 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Objective This study aims to evaluate the relationship of maternal smoking to uterine artery hemodynamics and examine independent contributions to birth weight and fetal body composition.

Study Design Women were enrolled in a prospective randomized controlled study targeting smoking abstinence. Uterine artery Doppler ultrasound was performed and volumetric blood flow was calculated. Third trimester ultrasound estimates of fetal body composition were performed and birth weight was recorded.

Results Uterine artery volumetric flow and resistance index (RI) were significantly correlated with birth weight adjusted for gestational age (R = 0.35, p = 0.002; R = − 0.27, p = 0.02). Volumetric flow was significantly associated with fetal fat mass (R = 0.30, p = 0.018). Smoking status did not have significant effects on lean body mass (t [61] = 0.60, p = 0.55), fat mass (t [61] = 1.67, p = 0.10), or volumetric flow (t = 0.86, df = 87, p = 0.39). Stepwise regression identified volumetric flow (β = 0.81, 95% confidence interval [CI]: 0.35–1.27, p < 0.001), maternal prepregnancy body mass index (β = 16.04, 95% CI: 2.57–29.50, p = 0.02), and fetal sex (β = 346.28, 95% CI: −532.64 to 159.91, p < 0.001, where male = 0 and female = 1) as independent contributors to birth weight adjusted for gestational age.

Conclusion No direct relationship of smoking to uterine artery hemodynamics was demonstrated. Volumetric flow was an independent contributor to birth weight and was associated with fetal fat deposition, while smoking was not independently associated with either outcome.

Keywords

maternal smoking - uterine artery Doppler - fetal body composition - birth weight
 

  • References

  • 1 Tobacco Use and Pregnancy. Centers for Disease Control and Prevention. http://www.cdc.gov/reproductivehealth/tobaccousepregnancy/ . Accessed July 7, 2012.
    PubMed
  • 2 Hackshaw A, Rodeck C, Boniface S. Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls. Hum Reprod Update 2011; 17 (05) 589-604
    CrossrefPubMedGoogle Scholar
  • 3 Palmer SK, Zamudio S, Coffin C, Parker S, Stamm E, Moore LG. Quantitative estimation of human uterine artery blood flow and pelvic blood flow redistribution in pregnancy. Obstet Gynecol 1992; 80 (06) 1000-1006
    PubMedGoogle Scholar
  • 4 Thaler I, Manor D, Itskovitz J. , et al. Changes in uterine blood flow during human pregnancy. Am J Obstet Gynecol 1990; 162 (01) 121-125
    CrossrefPubMedGoogle Scholar
  • 5 Gabbe SG, Niebyl JR, Simpson JL. Obstetrics: Normal and Problem Pregnancies. New York: Churchill Livingstone; 2002: 785-886
    Google Scholar
  • 6 Ferrazzi E, Rigano S, Padoan A, Boito S, Pennati G, Galan HL. Uterine artery blood flow volume in pregnant women with an abnormal pulsatility index of the uterine arteries delivering normal or intrauterine growth restricted newborns. Placenta 2011; 32 (07) 487-492
    CrossrefPubMedGoogle Scholar
  • 7 Mari G. Doppler ultrasonography in obstetrics: from the diagnosis of fetal anemia to the treatment of intrauterine growth-restricted fetuses. Am J Obstet Gynecol 2009; 200 (06) 613.e1-613.e9
    CrossrefPubMedGoogle Scholar
  • 8 Gandley RE, Jeyabalan A, Desai K, McGonigal S, Rohland J, DeLoia JA. Cigarette exposure induces changes in maternal vascular function in a pregnant mouse model. Am J Physiol Regul Integr Comp Physiol 2010; 298 (05) R1249-R1256
    CrossrefPubMedGoogle Scholar
  • 9 Ates U, Ata B, Armagan F, Has R, Sidal B. Acute effects of maternal smoking on fetal hemodynamics. Int J Gynaecol Obstet 2004; 87 (01) 14-18
    CrossrefPubMedGoogle Scholar
  • 10 Kho EM, North RA, Chan E, Stone PR, Dekker GA, McCowan LM. ; SCOPE consortium. Changes in Doppler flow velocity waveforms and fetal size at 20 weeks gestation among cigarette smokers. BJOG 2009; 116 (10) 1300-1306
    CrossrefPubMedGoogle Scholar
  • 11 Bruner JP, Forouzan I. Smoking and buccally administered nicotine. Acute effect on uterine and umbilical artery Doppler flow velocity waveforms. J Reprod Med 1991; 36 (06) 435-440
    PubMedGoogle Scholar
  • 12 Albuquerque CA, Smith KR, Johnson C, Chao R, Harding R. Influence of maternal tobacco smoking during pregnancy on uterine, umbilical and fetal cerebral artery blood flows. Early Hum Dev 2004; 80 (01) 31-42
    CrossrefPubMedGoogle Scholar
  • 13 Machado JdeB, Plínio Filho VM, Petersen GO, Chatkin JM. Quantitative effects of tobacco smoking exposure on the maternal-fetal circulation. BMC Pregnancy Childbirth 2011; 11 (01) 24
    CrossrefPubMedGoogle Scholar
  • 14 Jeanty P, Cousaert E, de Maertelaer V, Cantraine F. Sonographic detection of smoking-related decreased fetal growth. J Ultrasound Med 1987; 6 (01) 13-18
    CrossrefPubMedGoogle Scholar
  • 15 Newnham JP, Patterson L, James I, Reid SE. Effects of maternal cigarette smoking on ultrasonic measurements of fetal growth and on Doppler flow velocity waveforms. Early Hum Dev 1990; 24 (01) 23-36
    CrossrefPubMedGoogle Scholar
  • 16 Bernstein IM, Goran MI, Amini SB, Catalano PM. Differential growth of fetal tissues during the second half of pregnancy. Am J Obstet Gynecol 1997; 176 (1 Pt 1): 28-32
    CrossrefPubMedGoogle Scholar
  • 17 Samper MP, Jiménez-Muro A, Nerín I, Marqueta A, Ventura P, Rodríguez G. Maternal active smoking and newborn body composition. Early Hum Dev 2012; 88 (03) 141-145
    CrossrefPubMedGoogle Scholar
  • 18 Bernstein IM, Plociennik K, Stahle S, Badger GJ, Secker-Walker R. Impact of maternal cigarette smoking on fetal growth and body composition. Am J Obstet Gynecol 2000; 183 (04) 883-886
    CrossrefPubMedGoogle Scholar
  • 19 Reeves S, Bernstein I. Effects of maternal tobacco-smoke exposure on fetal growth and neonatal size. Expert Rev Obstet Gynecol 2008; 3 (06) 719-730
    PubMedGoogle Scholar
  • 20 Jaddoe VW, Verburg BO, de Ridder MA. , et al. Maternal smoking and fetal growth characteristics in different periods of pregnancy: the Generation R Study. Am J Epidemiol 2007; 165 (10) 1207-1215
    CrossrefPubMedGoogle Scholar
  • 21 Padoan A, Rigano S, Ferrazzi E, Beaty BL, Battaglia FC, Galan HL. Differences in fat and lean mass proportions in normal and growth-restricted fetuses. Am J Obstet Gynecol 2004; 191 (04) 1459-1464
    CrossrefPubMedGoogle Scholar
  • 22 Cliver SP, Goldenberg RL, Cutter GR, Hoffman HJ, Davis RO, Nelson KG. The effect of cigarette smoking on neonatal anthropometric measurements. Obstet Gynecol 1995; 85 (04) 625-630
    CrossrefPubMedGoogle Scholar
  • 23 Winn HN, Holcomb WL. Fetal nonmuscular soft tissue: a prenatal assessment. J Ultrasound Med 1993; 12 (04) 197-199
    CrossrefPubMedGoogle Scholar
  • 24 Higgins ST, Heil SH, Solomon LJ. , et al. A pilot study on voucher-based incentives to promote abstinence from cigarette smoking during pregnancy and postpartum. Nicotine Tob Res 2004; 6 (06) 1015-1020
    CrossrefPubMedGoogle Scholar
  • 25 Heil SH, Higgins ST, Bernstein IM. , et al. Effects of voucher-based incentives on abstinence from cigarette smoking and fetal growth among pregnant women. Addiction 2008; 103 (06) 1009-1018
    CrossrefPubMedGoogle Scholar
  • 26 Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements--a prospective study. Am J Obstet Gynecol 1985; 151 (03) 333-337
    CrossrefPubMedGoogle Scholar
  • 27 Bernstein IM, Mohs G, Rucquoi M, Badger GJ. Case for hybrid “fetal growth curves”: a population-based estimation of normal fetal size across gestational age. J Matern Fetal Med 1996; 5 (03) 124-127
    PubMedGoogle Scholar
  • 28 Acharya G, Sitras V, Erkinaro T. , et al. Experimental validation of uterine artery volume blood flow measurement by Doppler ultrasonography in pregnant sheep. Ultrasound Obstet Gynecol 2007; 29 (04) 401-406
    CrossrefPubMedGoogle Scholar
  • 29 Rigano S, Ferrazzi E, Boito S, Pennati G, Padoan A, Galan H. Blood flow volume of uterine arteries in human pregnancies determined using 3D and bi-dimensional imaging, angio-Doppler, and fluid-dynamic modeling. Placenta 2010; 31 (01) 37-43
    CrossrefPubMedGoogle Scholar
  • 30 Konje JC, Howarth ES, Kaufmann P, Taylor DJ. Longitudinal quantification of uterine artery blood volume flow changes during gestation in pregnancies complicated by intrauterine growth restriction. BJOG 2003; 110 (03) 301-305
    CrossrefPubMedGoogle Scholar