(01-04-12) Synergistic Effect of Maternal Smoking and Obesity on Birth Defects

Offspring of obese women who smoke during pregnancy face particularly high risk for congenital heart anomalies.
Smoking has long been known to adversely affect pregnancy outcomes; more recently, adverse effects of obesity have also been shown (JW Womens Health Mar 23 2004 and Pregnancy Hypertens 2011; 1:6). In a case-control study, Dutch investigators used a population-based birth defects registry to examine the interaction of these two risk factors in 797 infants and fetuses born between 1997 and 2008 with isolated nonsyndromic congenital heart anomalies; controls were 322 infants and fetuses from the registry with other chromosomal anomalies but no cardiac defects. Nineteen case mothers were both smokers and obese (based on prepregnancy weight).
In analyses adjusted for maternal age, education, folic acid use, and periconceptional alcohol consumption, the odds for congenital heart anomalies (including septal defects, right or left ventricular outflow tract obstructive anomalies, and conotruncal defects) among offspring of obese mothers who smoked were at least two to four times higher than the odds among offspring of normal-weight or nonsmoking mothers.
Comment: These findings highlight the importance of helping women optimize their health before conceiving. Because both obesity and smoking compromise vascular and placental function, their synergistic effect on congenital anomalies is not surprising. However, weight-loss and smoking-cessation efforts rarely meet with immediate success. Thus, highly effective contraceptives (e.g., intrauterine devices and subdermal implants) play an important role in providing these high-risk women the time they need to prepare for pregnancy.
? Eleanor Bimla Schwarz, MD, MS

Source: Published in Journal Watch Women's Health March 1, 2012

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