Maternal Smoking Effects on Preeclampsia and Pregnancy Outcomes

Maternal cigarette smoking exerts a complex influence on gestation, simultaneously exacerbating a range of adverse outcomes while paradoxically reducing the incidence of preeclampsia. Tobacco exposure disrupts placental development and maternal vascular adaptation through oxidative stress, endothelial dysfunction and aberrant immune signalling. Key bioactive constituents such as nicotine modulate trophoblast invasion and immune cell polarisation via cholinergic pathways, whereas carbon monoxide can attenuate angiogenic imbalance. The net result is an elevated risk of fetal growth restriction, low birth weight, preterm birth, obstetric complications including placental abruption and hypertensive disorders of pregnancy, yet epidemiological data consistently report a lower frequency of preeclampsia among smokers. Emerging evidence emphasises molecular mediators—exosomal cargo, pro- and anti-inflammatory cytokines, angiogenic factors—and highlights epigenetic and metabolic perturbations with long-term offspring implications. Understanding these dual effects is globally significant for refining public-health messaging, developing targeted interventions and dissecting the protective mechanisms against preeclampsia for novel therapy development.

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Maternal Smoking Effects on Preeclampsia and Pregnancy Outcomes publication trend

The graph below shows the total number of articles in maternal smoking effects on preeclampsia and pregnancy outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Preeclampsia: A pregnancy-specific syndrome of new-onset hypertension and organ dysfunction, typically after 20 weeks’ gestation.

Trophoblast: Placental epithelial cells essential for uterine invasion, nutrient exchange and vascular remodelling.

Exosomes: Nano-sized extracellular vesicles that transport proteins and nucleic acids between cells, mediating intercellular communication.

Hypertensive disorders of pregnancy: A group of conditions including gestational hypertension and preeclampsia characterised by elevated maternal blood pressure and related complications.

α7 Nicotinic Acetylcholine Receptor (α7nAChR): A ligand-gated ion channel on immune and placental cells through which nicotine modulates inflammatory responses.

References

1. The Influence of Nicotine on Trophoblast-Derived Exosomes in a Mouse Model of Pathogenic Preeclampsia. International Journal of Molecular Sciences (2023).
2. Impact of smoking on Galectin-3 and GDF-15 among pregnant women. Tamjeed Journal of Healthcare Engineering and Science Technology (2024).
3. Secondhand smoke exposure is associated with the risk of hypertensive disorders of pregnancy: the Japan Environment and Children’s Study. Hypertension Research (2023).
4. Cigarette smoking during pregnancy and preeclampsia risk: a systematic review and meta-analysis of prospective studies. Oncotarget (2015).
5. Association Between Maternal Smoking During Pregnancy and Birth Weight: An Appropriately Adjusted Model From the Japan Environment and Children’s Study. Journal of Epidemiology (2016).
6. Smoking During Pregnancy Increases Risks of Various Obstetric Complications: A Case-Cohort Study of the Japan Perinatal Registry Network Database. Journal of Epidemiology (2010).
7. Carbon Monoxide Prevents Hypertension and Proteinuria in an Adenovirus sFlt-1 Preeclampsia-Like Mouse Model. PLOS ONE (2014).
8. Stimulation of α7 Nicotinic Acetylcholine Receptor by Nicotine Suppresses Decidual M1 Macrophage Polarization Against Inflammation in Lipopolysaccharide-Induced Preeclampsia-Like Mouse Model. Frontiers in Immunology (2021).