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[Physiological and Psychological Data influencing Pregnant Women Smoking Behavior - CNGOF-SFT Expert Report and Guidelines for Smoking Management during Pregnancy].

Authors
  • Berveiller, P1
  • Rault, E2
  • Guerby, P3
  • 1 Service de gynécologie-obstétrique, CHI de Poissy St-Germain, 78300 Poissy, France. Electronic address: [email protected] , (France)
  • 2 Service d'obstétrique, hospices civils de Lyon, hôpital Femme-Mère-Enfant Lyon, 69500 Bron, France. , (France)
  • 3 Service de gynécologie-obstétrique, CHU de Toulouse, 31300 Toulouse, France. , (France)
Type
Published Article
Journal
Gynecologie, obstetrique, fertilite & senologie
Publication Date
Jan 01, 2020
Volume
48
Issue
7-8
Pages
551–558
Identifiers
DOI: 10.1016/j.gofs.2020.03.023
PMID: 32247097
Source
Medline
Keywords
Language
French
License
Unknown

Abstract

Nicotine is the main addictive substance in tobacco and its addictive effects mainly involve dopamine. Nicotine is mainly metabolized (C-oxidation) in the liver to cotinine by the cytochrome P450 enzyme system. Nicotine half-life is short being about 2hours. Nicotine metabolism appears to be increased during pregnancy, mainly due to an increased cytochrome activity and maternal cardiac output. Thus, the smoking behavior of the pregnant woman is subsequently modified with an increase in withdrawal syndromes and an increased desire to smoke. These pharmacological elements should be taken into account when prescribing nicotine replacement therapy. Regarding the markers of tobacco intoxication, there is a good correlation between the importance of smoking and the measurement of expired air carbon monoxide. Although there is no evidence of decreased obstetrical complications related to its use, it is simple and non-invasive and therefore may be useful in routine practice. It gives an instantaneous value of tobacco intoxication, and represents a starting point for dialogue and management and can help to highlight the reality of withdrawal. Regarding the evaluation of tobacco addiction, the most commonly used questionnaires are the Fagerström tests (FTCD, HSI…), which are well correlated with cotinine concentration. However, there is insufficient evidence of their usefulness in reducing tobacco consumption during pregnancy to recommend them in current practice. DSM-V diagnostic criteria for addiction should be known as they can also be used to characterize the intensity of this addiction. Copyright © 2020 Elsevier Masson SAS. All rights reserved.

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