Maternal Cigarette Smoking and the Development of Necrotizing Enterocolitis

• Published in: Pediatrics (Evanston) Vol. 130; no. 1; pp. 78 - 82
• Main Authors: DOWNARD, Cynthia D, GRANT, Stephanie N, MAKI, Alexandra C, KRUPSKI, Mary C, MATHESON, Paul J, BENDON, Robert W, FALLAT, Mary E, NEAL GARRISON, R
• Format: Journal Article
• Language: English
• Published: Elk Grove Village, IL American Academy of Pediatrics 01-07-2012
• Subjects: Adult; Babies; Biological and medical sciences; Care and treatment; Case-Control Studies; Control; Correlation analysis; Diagnosis; Enterocolitis, Necrotizing - etiology; Enterocolitis, Neonatal necrotizing; Enterocolitis, Pseudomembranous; Female; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal diseases; General aspects; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - etiology; Linear Models; Male; Maternal Behavior; Medical sciences; Mothers; Multivariate Analysis; Necrotizing enterocolitis; Other diseases. Semiology; Pediatrics; Pregnancy; Prenatal Exposure Delayed Effects - etiology; Retrospective Studies; Risk Factors; Smoking; Smoking - adverse effects; Smoking in pregnancy; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tobacco, tobacco smoking; Toxicology; Human; Pediatrics; Tobacco smoking; Necrotizing enterocolitis; Pregnancy; Tobacco; Newborn; Mother; smoking; Development; Digestive diseases; Intestinal disease; Female; Woman
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2011-3808

The maternal variables that affect fetal development and correlate with necrotizing enterocolitis (NEC), the most common gastrointestinal emergency in premature infants, are not well defined. We hypothesized that maternal risk factors were the primary determinant of future development of NEC.
Patients with NEC were identified from an established NICU database and were control-matched with 2 neonates treated at the same institution. The medical records of each patient during the NICU admission as well as the prenatal and delivery record of the patient's mother were reviewed. Perinatal data, including maternal smoking, maternal hypertension, maternal BMI, maternal gestational diabetes, conduct of labor and type of delivery, Apgar scores, types of feedings, and placental pathology, were examined, with P < .05 deemed significant.
A total of 73 neonates diagnosed with NEC and 146 matched controls were identified. Medical records for each subject and their mothers were reviewed (438 records total). Maternal cigarette smoking was significantly associated with the future development of NEC (P = .02). Maternal gestational diabetes, maternal hypertension, formula feeding, and pathologic chorioamnionitis or uteroplacental insufficiency did not correlate with NEC.
These data identified maternal cigarette smoking as the only risk factor that is associated with the development of NEC in premature infants. Our data imply that smoking delivers toxins and nicotine to the uterine microenvironment that can affect microvascular development and may predispose the fetus to future NEC.