Premature infants whose mothers smoke are more susceptible to necrotizing enterocolitis, probably due to toxins in the womb’s microenvironment that affect microvascular development, according to recently published study results.
Cynthia D. Downard, MD, MMSc, of the pediatric surgery department at the University of Louisville in Kentucky, and colleagues looked at data on 73 infants diagnosed with necrotizing enterocolitis (NEC) and compared them with 146 matched controls. The researchers accounted for birth date, estimated gestational age and birth weight; maternal records for study participants were also reviewed.
Downard and colleagues said 48% of infants in the NEC group had mothers who smoked and were able to draw a direct link between smoking and predisposition to NEC. There was no link between maternal gestational diabetes, maternal hypertension, formula feeding and pathologic chorioamnionitis or uteroplacental insufficiency to NEC.
The researchers said this data identified smoking as the only risk factor in the development of NEC in premature infants, likely a result of toxins and nicotine to the uterine microenvironment affecting microvascular development.
“Our hope is that this study urges stronger counseling and more aggressive programs to stop smoking in pregnant women and in the antenatal period, because the delicate vascular development of the placenta and the fetus occurs in the first weeks of gestation,” the researchers wrote.
In addition, they said practitioners should warn pregnant woman about the risks of nicotine replacements thought to be a better alternative to smoking because the study found that nicotine is a toxic risk factor in the development of NEC.
Downard and colleagues also said although care of the infant with NEC is generally provided by neonatologists and pediatric surgeons, the findings of the current study are relevant to a much broader audience because physicians in the outpatient setting have a major role in identifying potential at-risk infants and providing earlier, primary prevention of NEC.
“Most women come in contact with a pediatrician at some point during their pregnancy. … These interactions between pediatrician and future mother can be a critical point of intervention for the smoking woman. The role of the pediatrician is to be an advocate for his/her patient,” the study researchers wrote.
Disclosure: Dr. Downard reports no relevant financial disclosures.