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Life and Fitness

Cigarette Smoking, Alcohol Use and Adverse Pregnancy Outcomes: Implications for Micronutrient Supplementation1
Mary E. Cogswell,*2 Pamela Weisberg*y and Catherine Spong**
*Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, y Rollins School of PublicHealth, Emory University, Atlanta, GA 30322 and **Pregnancy and Perinatalogy Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892
ABSTRACT This literature review examines whether smoking or alcohol use during pregnancy increases maternal micronutrient requirements and whether smoking or alcohol use interacts with micronutrientdeficiencies to affect pregnancy outcomes. Studies suggest that vitamin C requirements increase for pregnant smokers. Studies also indicate that b-carotene, vitamin B-12, vitamin B-6 and folate concentrations appear lower in pregnant smokers than in pregnant nonsmokers, although it is unclear whether lower serum concentrations are due to increased requirements, lower dietary or supplement intakes or otherfactors. Experimental animal studies suggest that iron supplementation partially ameliorates impaired fetal growth caused by cadmium, a heavy metal inhaled from cigarette smoke, but studies in humans have not substantiated cadmium’s effect on fetal growth. Animal studies also suggest chronic alcohol consumption at levels of 20–50% of energy intake during pregnancy may mobilize fetal vitamin Aconcentration from the liver and result in increases in vitamin A in fetal organs and subsequent defects. Evidence is lacking, however, on whether zinc metabolism is altered by alcohol intake during pregnancy. Health care practitioners should consider increasing nutrient levels in pregnant women who do not meet the Recommended Dietary Allowances through their diet. Future studies that examine thenutrient levels of women exposed to cigarette smoke and alcohol should control for dietary intake. In addition, randomized controlled studies of the health impact of micronutrient supplementation in pregnant women should consider stratification by exposure to cigarette smoke and alcohol use. J. Nutr. 133: 1722S–1731S, 2003. KEY WORDS:  cigarette smoking  alcohol use  pregnancy  vitamins  mineralsDownloaded from jn.nutrition.org by guest on November 27, 2011

Although research studies document the adverse effects of smoking and alcohol use during pregnancy, the effects of these substances on micronutrient levels are not well defined. Imbalances in these nutrients may contribute to many of the pathological effects of smoking and alcohol use on the mother and fetus. Past reviews on theinteractions between substance use and micronutrient status during pregnancy have typically focused on a specific micronutrient (1) or substance (2,3). The purpose of this review is twofold: 1) to examine whether smoking and alcohol use during pregnancy increase a woman’s micronutrient requirements and 2) to examine whether smoking and alcohol use interact with micronutrient deficiency

to affectpregnancy outcomes. Substance use could cause micronutrient deficiency, thus affecting pregnancy outcomes. It is also possible, however, that micronutrient deficiency or excess may increase the risk of adverse pregnancy outcomes in women who smoke or drink alcohol. We reviewed the published literature in attempt to address these issues. We identified articles through a Medline search from 1966 throughOctober 2001 using various search terms including micronutrients, alcohol and tobacco and pregnancy. (We will provide a full list of search terms on request.) We reviewed all abstracts and included only English language articles of original studies with information about micronutrient concentrations during pregnancy by substance exposure and about the risks of adverse pregnancy outcomes by...
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