Deficient hypoxia awakening response in infants of smoking mothers: possible relationship to sudden infant death syndrome.
OBJECTIVE
To determine whether fetal exposure to cigarette smoke impairs postnatal chemoreceptor control of ventilation and hypercapnic and hypoxic awakening responses.


METHODS
Smoking (n = 13) and nonsmoking (n = 34) women were recruited during pregnancy. Serum cotinine levels were measured to assess level of nicotine exposure. The infants were studied at 2 to 3 months of age for ventilatory and awakening responses to hypoxia (17%, 15% and 13% inspired O2) and hypercapnia 4%, 6%, and 8% inspired CO2). Continuous measures were analyzed with unpaired t tests and analysis of variance for repeated measures. Proportions of awakening and periodic breathing were analyzed by means of a comparison of proportions.


RESULTS
The infants of smokers had lower birth weights (3022 +/- 566 vs 3518 +/- 491 gm; p < or = 0.005) and were older at the time of study (10.4 +/- 2.8 vs 8.7 +/- 1.3 weeks; p < 0.01) than the control infants. Maternal cotinine levels were higher in smokers (97.8 +/- 107 ng/ml vs no cotinine; p < 0.0001). More infants of smokers failed to awaken with hypoxia than did control infants (54% vs 15%; p = 0.006). The ventilatory responses to hypoxia and hypercapnia were similar in the two groups. All infants awakened with hypercapnia, and there was no difference in the awakening threshold for carbon dioxide (50.3 +/- 4.5 vs 48.3 +/- 5.4 mm Hg; p = 0.28).


CONCLUSIONS
Infants of mothers who smoked during pregnancy have deficient hypoxic awakening responses, which may contribute to the increased risk of sudden infant death syndrome in infants of smoking mothers.
D000328:Adult; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000503:physiopathology; D000860:Hypoxia / Q000503:physiopathology*; D007223:Infant; D008297:Male; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D012129:Respiratory Function Tests / Q000379:methods / Q000706:statistics & numerical data; D013398:Sudden Infant Death / Q000209:etiology*; D014028:Tobacco Smoke Pollution / Q000009:adverse effects* / Q000706:statistics & numerical data; D014851:Wakefulness
D014028:Tobacco Smoke Pollution