UTJECAJ PUŠENJA NA SELEKTIRANE HEMATOLOŠKE PARAMETRE ERITROPOETSKOG SISTEMA KOD TRUDNICA I POROĐAJNU TEŽINU NOVOROĐENČADI
THE IMPACT OF SMOKING ON SELECTED HEMATOLOGICAL PARAMETERS OF THE ERYTHROPOIETIC SYSTEM IN PREGNANT WOMEN AND THE BIRTH WEIGHT OF NEWBORNS

Summary/Abstract: According to the World Health Organization, smoking is the most significant risk factor for adverse pregnancy outcomes. The placenta, which supplies oxygen and nutrients between the mother and fetus, may mediate the effects of smoking on fetal growth. Nicotine causes changes in the mother's hematological parameters and reduces uteroplacental circulation, leading to negative fetal outcomes such as small for gestational age, low birth weight, slowed growth, and disrupted neurological development. Numerous studies have documented a strong association between active smoking during pregnancy, adverse effects on hematological parameters, and fetal growth restriction. Objectives: The aim of this study was to analyze the impact of smoking during pregnancy on maternal hemoglobin, erythrocyte count, hematocrit values, and newborn birth weight. Methods: A retrospective study analyzed 556 pregnancies with recorded data on smoking during pregnancy, hematological parameters, and birth weight of newborns, as documented in the pregnancy database of the Department of Health in Velika Kladuša, Bosnia and Herzegovina. Results and Discussion: Analysis revealed that 23.5% of women smoked during pregnancy. The mean hemoglobin level in non-smoking pregnant women was 120 g/L, compared to 121 g/L in smoking pregnant women, indicating an increase in hemoglobin levels among smokers. The mean erythrocyte count was 3.95 x 10^12/L in non-smokers and 3.92 x 10^12/L in smokers, showing a decrease in erythrocyte count among smokers. The mean hematocrit level was 34.6% in non-smokers and 34.9% in smokers, indicating an increase in hematocrit among smokers. The average birth weight of newborns from non-smoking mothers was 3470 g, while the average birth weight from smoking mothers was 3300 g. The birth weight of newborns from smoking mothers was 170 g lower than that from nonsmoking mothers, indicating a statistically significant lower birth weight in newborns of smokers (*p<0.001). Conclusions: Smoking during pregnancy significantly affects the hematological parameters of the pregnant woman and the birth weight of the newborn, and thus the outcome of the pregnancy. In pregnant women who smoked, there was an increase in hemoglobin and hematocrit levels, while the number of red blood cells decreased. The birth weight of newborns from smoking mothers was significantly lower. Future research should focus on investigating the coagulation status of smoking versus non-smoking pregnant women. Hypothetically, smoking women would be expected to have increased physiological coagulability, as pregnancy leads to increased coagulation with diminished fibrinolytic activity, which ultimately affects the pregnancy outcome. Recommendations: Health care strategies for pregnant women should focus on complete cessation of smoking during pregnancy. Future research should concentrate on predictors of smoking during pregnancy and, most importantly, the development of effective and efficient interventions to reduce tobacco use and prevent smoking during pregnancy in the most vulnerable populations.

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