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SMOKING AND HUMAN REPRODUCTION

SMOKING AND HUMAN REPRODUCTION. Actual knowledge Medical students https://is.muni.cz/el/1411/podzim2012/VLPL9X1a/seminar-30-31-qwarp. DAMAGES of REPRODUCTION. ARE THE EARLIEST MANIFESTATION of THE SERIOUS EFFECTS of SMOKING on HUMAN HEALTH

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SMOKING AND HUMAN REPRODUCTION

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  1. SMOKING AND HUMAN REPRODUCTION Actual knowledge Medical students https://is.muni.cz/el/1411/podzim2012/VLPL9X1a/seminar-30-31-qwarp

  2. DAMAGES of REPRODUCTION • ARE THE EARLIEST MANIFESTATION of THE SERIOUS EFFECTS of SMOKING on HUMAN HEALTH • BOTH MEN´S and WOMEN´S REPRODUCTIVE FUNCTIONS ARE AFFECTED, AND • THE DEVELOPMENT AND HEALTH OF FEATUS and CHILD ARE DAMAGED

  3. CAUSES/MECHANISMS: • HYPOXIA • OXIDATIVE STRESS • DIRECT INFLUENCE of SOME CHEMICALS:: TOXIC, MUTAGENIC, CARCINOGENIC

  4. MEN´S REPRODUCTION • IMPOTENCE (erectile dysfunctions): • SYMPATICOTONUS (due to nicotine) • VASOKONSTRICTION IN CORPUS CAVERNOSUS (YOUNG MEN) • DUE TO PRELIMINARY ATHEROSCLEROSIS OF PELVIC ARTERIES (IN MIDDLE AGES) • NICOTIN, CARBON MONOOXIDE

  5. MORE SERIOUS DAMAGES • SPERMIOGENESIS: • LOWER VOLUME OF EJACULATE • LESS COUNT OF SPERMIA CELLS • LESS NUMBER OF MOTILE SPERMS • MORE ABNORMAL SPERMS • MORE ANEUPLOID SPERMS

  6. WOMEN´S DAMAGES • IRREGULAR AND PAINFULL MENSTRUAL CYCLE • EARLIER MENOPAUSE ( 5 - 8 YEARS) • LESS MATURATED OOCYTES • MORE FREQUENT INFERTILITY • POOR EFFECT OF IVF TREATMENT

  7. WHY NOT SMOKE IN PREGNANCY • MOTHER´S HEALTH • COMPLICATIONS OF PREGNANCY • FETAL DEVELOPMENT • CHILD´S HEALTH • PROGRAMING OF HEALTH IN ADULTHOOD

  8. MOTHER´S HEALTH – CVD (OR) • STROKE………………………. 1.7 • MI…………………………..….. 4.6 • LUNG´S EMBOLIE ………. 2.5 • VENOS THROMBOSIS ….. 1.3 • CARDIOMYOPATHY………. 1.4 • HYPERTENSION……………. 1.2

  9. MOTHER´S HEALTH – INFECTIOUS DISEASIS (OR) • PNEUMONY ………………………..2.9 • BRONCHITIS ……………………..15.2 • BACTERIAL INF. ………..……… 1.2 • PYELONEFRITIS ……………….. 1.2 • HIV/AIDS …………………………. 1.5

  10. MOTHER´S HEALTH – OTHER • ASTHMA ………………….. 4.0 • DIABETES ..……………… 1.2 • ULCUS DUOD………….... 3.7 • ANEMIE …………………… 1.4 • ALCOHOL/DRUGS .……14.1 • MALNUTRITION………. 2.4

  11. PREGNANCY COMPLICATIONS (OR) • PREGNANCY EXTRAUTERINA..……..5.4 • PLACENTA PREVIA ……………………..1.2 • PLACENTAL ABRUPTIO ..……………..1.4 • BLEEDING ………………………………….1.3 • HYPEREMESIS …………………………… 1.2 • PREECLAMPSIA, ECLAMPSIA ………. 0.8

  12. DAMAGES IN UTERO • PLACENTAL (structure, integrity, function) • CHANGES OF UMBILICAL CIRCULATION • CHANGES OF FETAL CIRCULATION • LOW OXYGENAL SATURATION OF FETAL Hb • DIRECT EFFECT ON FETAL CELLS

  13. DAMAGES OF FETAL DEVELOPMENT • PRELIMINARY MEMBRANOUS RUPTURE ………………………………………………... 1.7 • PRELIMINARY DELIVERY/ABORT .. 1.3 • FETAL DEATH ………………………….. 1.1 • FETAL TOBACCO SYNDROME……… 2.6

  14. HEREDITARY MALFORMATIONS • LACK OF UNIVERSAL DEFINITION • STRUKTURAL, FUNCTIONAL, METABOLICAL, CHEMICAL CHANGES • ALMOST 8 MILIONS ANNUALLY • 4 % vs. 8 % OF LIFE BIRTHS • 3.3 mil. DIE UP TO 5th YEAR OF AGE • 3.2 mil. LONG-LIFE DAMAGES

  15. MALFORMATIONS • 30 % GENETIC BASIS • 70 % ENVIRONMENTAL FACTORS, SOCIAL STATUS, CULTURAL TRADITIONS AND ENVIRONMENT, HEALTH CURE SUBSTANTIAL GEOGRAPHIC DIFFERENCES

  16. HUMAN´S TERRATOGENS • ALCOHOL, • SMOKING, NIKOTINE • ORGANIC MERCURY • THALIDOMID, DRUGS • RADIATION, HEAVY METALS, ORG. SOLVENTS • MOTHER´S INFECTIOUS /CHRONIC D. • DEFICIT of FOLIC ACID, Zn

  17. SMOKING and MALFORMATIONS • CARDIAL • RESPIRATORY • CLEFTS • LIMBS DEFORMATIONS • HYPOSPADIE • GASTROSCHISIS

  18. REVIEW:173 687 CASES and 11,7 MIL. CONTROLS - OR • CARDIOVASKULAR 1.09 • MUSKULOSKELETAL 1.16 • LIMBS (REDUCTION) 1.26 • FINGERS 1.18 • „PES EQUINOVARUS“ 1.28 Hackshaw A.,aj. Hum Reprod Update 2011

  19. MALFORMATIONS - continue • CRANIOSYNOSTOSIS 1.33 • FACIAL DEFECTS 1.19 • EYES DEFECTS 1.25 • CLEFTS 1.28

  20. MALFORMATIONS - contiue • GASTROINTESTINAL DEFECTS 1.27 • GASTROSCHISIS 1.50 • ANAL ATHRESIA 1.20 • HERNIA 1.40 • DAMAGES OF TESTES 1.13 • HYPOSPADIE 0.90 • SKIN DEFECTS 0.82

  21. POSTNATAL CONSEQUENCES • => PRENATAL PROGRAMMING: • RESPIRATORY • NEURO – PSYCHICAL • CARDIOVASCULAR • GENOTOXIC

  22. CRITIC „WINDOWS“ • in 1st TRIMESTER = THE QUIECKEST GROWING and DEVELOPMENT of ALL ESENTIAL FETAL COMPLEMENTS • THE EXPOSURE TO DAMAGING FACTORS CAN INFLUENCE FURTHER PRE-NATAL and POST-NATAL DEVELOPMENT

  23. „CROWN-BOTTY„ LENGTH • AT 1st TRIMESTER PREDICTS: • FETAL INTRAUTERINE GROWTH, • BIRTH WEIGH AND LENGTH • POST-NATAL PHYSICAL DEVELOPMENT • Risk factors: ENHANCED DIAST. BP, HEMATOCRITE, SMOKING, LOW INTAKE of FOLIC ACIDE

  24. FOAD HYPOTHESIS • Fetal Origin of Adult Disease: • LOW BITH WEIGH (by 150 – 300 g) • INCREASES THE RISK of OBESITY in CHILDHOOD and ADULTHOOD • METAANALYSIS of 17 STUDIES from 7 COUNTIRES (ALMOST 100.000 PERSONS => OR 1.64)

  25. PROGRAMING • „INHOSPITABLE“ ENVIRONMENT IN UTERO – FETAL METABOLIC ADAPTATION • HYPOTHALAMUS (regulation of food intake) • ABNORMALITIES IN FAT CELLS • HORMONAL DYSBALANCE (insulin) • PERSISTS EVEN AFTER DELIVERY, WHEN NUTRITION IS BETTER

  26. NICOTINE • HAS THE MAIN ROLE • DUE TO PRE-NATAL STIMULATION of ACETYLCHOLIN NICOTINIC RECEPTORS (AchR) • INCLUDING THOSE WHICH REGULATE ENERGETIC INCOME AND OUTCOME

  27. CARDIOVASCULAR RISK FACTORS • OBESITY • BLOOD LIPIDS • BLOOD PRESSURE CAN BE MODIFICATED BY PRE-NATAL EXPOSURE TO SMOKING / NICOTINE

  28. LOW BIRTH WEIGH • INCREASES THE RISK of OBESITY in CHILDHOOD and ADULTHOOD • IN ADOLESCENCE TRENDS TO ABDOMINAL OBESITY: + 26 až 33 % • PERSIST TO ADULTHOOD • (parasympatical predominance in autonomous cardiovascular regulation)

  29. ABDOMINAL OBESITY • IS AN IMPORTANT RISK FOR: • CARDIOVASCULAR DISEASES • METABOLIC SYNDROME • INSULIN´S INTOLERANCE • SOME TUMORS

  30. ENDOTELIAL FUNCTIONS: • EFFECT OF NICOTINE: • LOWER AVAILABILITY of NO • LOWER ACTIVITY of ENDOTELIAL NO SYNTHESIS in PLACENTAL AND UMBILICAL TISSUE • ENHANCED THICKNESS of MEDIAL LAYER of INTIMA

  31. AUTONOMOUS CONTROL • CHANGES in TONUS of SYMPATIC and PARASYMPATIC NERVOUS SYSTEMS – DYSBALANCE • 1st SYMPATIC PREDOMINANCY : • HYPERREACTIVITY AFTER DELIVERY • CONTINUES into THE CHRONIC STATUS

  32. EARLY EXPOSURE to SMOKING • CAN CAUSE THE CHRONICAL PROGRAMMING of BLOOD PRESSURE CONTROL = • HYPERTENSION

  33. NICOTINE also ENHANCES • THE FETAL GLUCOCORTICOIDS´ ACTIVITY and • NEWBORNS´ STRESS HORMONES LEVELS => ANOTHER CONTRIBUTION to HYPERTENSION

  34. 2nd VAGUS´ PREDOMINANCE • INFLUENCES HEART FRQUENCY, VASCULAR RESISTENCE OF VESSELS, BLOOD PRESURE • ORTHOSTATIC INTOLERANCE (REFLEX COMPENSATION IN POSTURAL CHANGES –sitting, standing, walking) = • CHR. ORTHOSTATIC DYSFUNKCTION

  35. „NICOTINIC“ RECEPTORS • ALFA 4, BETA 2; ALFA 6 • OCCURE EVEN AT 1st TRIMESTER • PREMATURE ACTIVATION by NICOTINE = • DAMAGES THE DEVELOPMENT OF DOMAPINERGIC and SEROTONERGIC SYSTEMS, and • REDUCES THE NEURAL CELLS QANTITY

  36. CONSEQUENCES: • SIDS • CONDUCT DISORDERS (SOCIALIZATION) • POOR SCHOOL RESULTS • ADHD • SCHIZOFRENIE • RISK of DRUG DEPENDENCE • CRIMINALITY

  37. ANOTHER POST-NATAL RISKS • POORER RESPIRATORY FUNCTIONS • DAMAGES of IMMUNE SYSTEM => LONG-TIME SUPRESSION of IMMUNE RESPONSE => (infectious, alergic dis.) • SHORTER BREAST-FFEDING • ENHANCED RISK of CARRIES

  38. GENOTOXICITY • HIGHER LEVELS of DNA ADDUCTS in PLACENTA and FETUS of SMOKERS (both active and i passive) • HIGHER FREQENCY of SISTER CHROMATIDES EXCHANGES among NEWBORNS of SMOKERS • HIGHER INCIDENCY OF BRAIN TUMORS, LEUKEMIA and LYMFOMAS

  39. SMOKING in PREGNANCY • IS A GREAT RISK DURING THE WHOLE TIME of PREGNENCY and AFTER DELIVERY • IT IS NON-ETHICAL TO TOLERATE SMOKING IN PREGNANCY • PREGNANT WOMEN HAVE THE STRONG MOTIVATION TO CHANGE THEIR LIFE-STYLE • THE MEDICATION SUPPORT of SMOKING CESSATION IS PROBLEMATIC

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