The American Journal of PATHOLOGY FEBRUARY 1978 * VOLUME 90, NUMBER 2
Relationship of Cigarette Smoking to Congenital Anomalies and Perinatal Death A Prospective Study Richard L. Naeye, MD
Congenital anomalies caused 3.43 perinatal deaths/1000 births, as reported in a large prospective study. At all gestational ages the mortality rates progressively increased when gravidas smoked more than 10 cigarettes/day. An excessive death rate was also found in males, in offspring of mothers over 39 years of age, and in women of low socioeconomic status. Placentas associated with the malformed infants had an increased frequency of single umbilical arteries and abnormal insertions of fetal membranes and umbilical cords into the placenta. (Am J Pathol 90:289-294, 1978)
CONGENITAL ANOMALIES were the fourth most frequent cause of perinatal death according to a recently published large US prospective study of pregnancy and its outcome.' Only a very small portion of the anomalies could be related to drugs." 2 In the present study we searched for nondrug teratogenic factors in the same study population. Materials and Methods The Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke provides a unique opportunity to study the origins of congenital malformations through the analysis of prospectively collected data. The study followed the course of 53,518 pregnancies in 12 US hospitals between 1959 and 1966 and recorded events of gestation, labor, delivery, and the neonatal period.3'4 Last menstrual periods were recorded at the time mothers registered for prenatal care, and gestational ages were calculated after birth. The present author reviewed the clinical and postmortem material, including microscopic sections from the unsuccessful pregnancies and infant deaths to standardize diagnoses. Four specially trained technicians reviewed microscopic From the Department of Pathology, M. S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania. Supported by Contract NOI-NS-3-2311 from the US Public Health Service. Accepted for publication October 11, 1977. Address reprint requests to Dr. Richard Naeye, Department of Pathology, M. S. Hershey Medical Center, Hershey, PA 17033. 289
290
American Journal of Pathology
NAEYE
Table 1-Influence of Independent Maternal and Fetal Factors on Perinatal Mortality Rates Due to Congenital Anomalies
Perinatal Mortality Rate/1000 Births Sex of infant Male Female Age of gravida (years) 13-19 20-34 35-39 >39 Socioeconomic index of family 0-1.9 2-7.9 >7.9
0.63 0.49
P
10.48 0.56 0.60 1.33
p< 0I04 P00
0.82 0.54 0.40
P
Relationship of Cigarette Smoking to Congenital Anomalies and Perinatal Death A Prospective Study Richard L. Naeye, MD
Congenital anomalies caused 3.43 perinatal deaths/1000 births, as reported in a large prospective study. At all gestational ages the mortality rates progressively increased when gravidas smoked more than 10 cigarettes/day. An excessive death rate was also found in males, in offspring of mothers over 39 years of age, and in women of low socioeconomic status. Placentas associated with the malformed infants had an increased frequency of single umbilical arteries and abnormal insertions of fetal membranes and umbilical cords into the placenta. (Am J Pathol 90:289-294, 1978)
CONGENITAL ANOMALIES were the fourth most frequent cause of perinatal death according to a recently published large US prospective study of pregnancy and its outcome.' Only a very small portion of the anomalies could be related to drugs." 2 In the present study we searched for nondrug teratogenic factors in the same study population. Materials and Methods The Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke provides a unique opportunity to study the origins of congenital malformations through the analysis of prospectively collected data. The study followed the course of 53,518 pregnancies in 12 US hospitals between 1959 and 1966 and recorded events of gestation, labor, delivery, and the neonatal period.3'4 Last menstrual periods were recorded at the time mothers registered for prenatal care, and gestational ages were calculated after birth. The present author reviewed the clinical and postmortem material, including microscopic sections from the unsuccessful pregnancies and infant deaths to standardize diagnoses. Four specially trained technicians reviewed microscopic From the Department of Pathology, M. S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania. Supported by Contract NOI-NS-3-2311 from the US Public Health Service. Accepted for publication October 11, 1977. Address reprint requests to Dr. Richard Naeye, Department of Pathology, M. S. Hershey Medical Center, Hershey, PA 17033. 289
290
American Journal of Pathology
NAEYE
Table 1-Influence of Independent Maternal and Fetal Factors on Perinatal Mortality Rates Due to Congenital Anomalies
Perinatal Mortality Rate/1000 Births Sex of infant Male Female Age of gravida (years) 13-19 20-34 35-39 >39 Socioeconomic index of family 0-1.9 2-7.9 >7.9
0.63 0.49
P
10.48 0.56 0.60 1.33
p< 0I04 P00
0.82 0.54 0.40
P
