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Association of Intrauterine Cigarette Smoke Exposure With Indices of Fetal Lung Maturation

From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston; the Department of Maternal and Child Health, Harvard School of Public Health, Boston; the Joint Program in Neonatology, Children's Hospital, Boston; the Channing Laboratory, Brigham and Women's Hospital, Boston; the Pulmonary and Critical Care Division, Beth Israel Hospital, Boston; and the Department of Biochemistry, Brandeis University, Waltham, Massachusetts

Abstract

The timing of fetal lung maturation is regulated, at least in part, by the fetal endocrine milieu, which in turn may be influenced by environmental factors. Infants of smoking mothers are at decreased risk of neonatal respiratory distress syndrome (RDS), a disease of lung immaturity. Therefore, we measured fetal lung maturity and cigarette smoke exposure to determine whether the lungs of smoke-exposed fetuses mature more quickly and whether changes in maturation are associated with alterations in amniotic fluid (AF) cortisol levels. Amniotic fluid lecithin-sphingomyelin ratio (L/S) and saturated phosphatidylcholine levels were used as measures of lung maturity, while smoke exposure was assessed by measuring AF cotinine, a stable nicotine metabolite. Lung maturity was more advanced in smoke-exposed fetuses as measured by saturated phosphatidylcholine (P=.02) and L/S ratio (P=.04). Smoke-exposed fetuses attained sufficient lung maturity to minimize the risk of RDS approximately 1 week earlier than in unexposed fetuses. The AF of smoke-exposed fetuses also had higher levels of free, conjugated, and total cortisol. Acceleration of lung maturation in smoke-exposed fetuses is consistent with the decreased risk of RDS in infants of smoking mothers. Maternal smoking could influence lung maturation by directly or indirectly enhancing the production and/or secretion of cortisol. Despite the decreased risk of RDS, the developmental process by which smoke-exposed fetuses attain early pulmonary maturity is abnormal and may contribute to the decreased lung function and increased respiratory illness noted in infants of smoking mothers.

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