[Consequences of smoking on fetal development and risk of intra-uterine growth retardation or in utero fetal death].

Active and passive smoking constitutes one of the most serious public health problems due to the deleterious effect on the expected infant and the mother. These effects are dose dependent as illustrated by intra-uterine growth retardation, where the effect worsens with duration of smoking during pregnancy, and also by other conditions such as abrutio placentae or placenta praevia, premature rupture of the membranes and preterm birth, where the risk is multiplied by two (or even three)! In utero death is the ultimate sanction. Studies on the consequences of maternal smoking on fetal development have demonstrated the cardiovascular effect (CO and nicotine) and the respiratory effect (CO) which can be aggravated after birth by passive smoking. Teratogenic and cancerogenic effects have also been clearly demonstrated. Maternal smoking would also affect fetal brain development with negative effects on the major neurotransmitter systems (domaminergic, serotinergic, noradrenergic) and on the development of key structures such as the prefrontal cortex, certain limbic structures including the hippocampus and other structures implicated in motor function such as the ventral striatum. These development anomalies of the brain could give rise, after birth, to psychological, behavioral, attention and cognitive disorders, further arguments in favor of an effective anti-smoking policy including appropriate care for smoking pregnant mothers in both hospital and outpatient settings.