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Cigarette smoking, nicotine and pregnancy
1Clinics of Friedrich Schiller University Jena, Clinical Pharmacology, Erfurt, Germany.
Insights
Maternal smoking during pregnancy and nursing significantly harms fetal and infant health, increasing risks of birth defects and sudden infant death syndrome (SIDS). Tobacco combustion products, not nicotine, are primarily responsible for these adverse outcomes.
Area of Science:
- Obstetrics and Gynecology
- Pediatrics
- Toxicology
Background:
- Maternal smoking during pregnancy and nursing poses significant health risks to the fetus and infant.
- These risks include spontaneous abortion, premature placental abruption, low birth weight, and congenital deformities.
Purpose of the Study:
- To examine the health damage to fetuses and infants caused by maternal smoking.
- To differentiate the effects of nicotine versus other tobacco combustion products.
Main Methods:
- Review of existing studies on smoking during pregnancy and nursing.
- Analysis of data on congenital deformities and infant mortality linked to maternal smoking.
- Assessment of nicotine and cotinine levels in breast milk and infants exposed to passive smoking.
Main Results:
- Maternal smoking is linked to increased incidence of spontaneous abortion, premature birth, low birth weight, and congenital anomalies.
- Hypoxia and carboxyhemoglobinemia from tobacco combustion products, particularly carbon monoxide (CO), are identified as primary causes of damage.
- Sudden Infant Death Syndrome (SIDS) is also associated with maternal and passive smoking.
- Nicotine's direct role in causing specific deformities remains unclear, with limited human data.
- Nicotine passes into breast milk, and passive smoking increases nicotine and cotinine levels in milk and infants.
Conclusions:
- Tobacco combustion products, especially CO, are the main culprits behind smoking-related pregnancy and infant complications.
- The role of nicotine in causing congenital deformities is not definitively established.
- Findings support reconsidering smoking cessation therapies for pregnant and nursing women.
Abstract:
Smoking cigarettes during pregnancy and nursing causes considerable health damage to the fetus and to the infant during the initial growth phase. A smoking mother puts her child at considerable risk, not only of higher incidence of spontaneous abortion, premature ablatio placentae and reduced weight at birth, but also of deformities (cheilognathopalatoschisis, deformed extremities, polycystic kidneys, aortopulmonary septum defects, gastroschisis, skull deformation, etc.). Development of the Down syndrome is the subject of some controversy. These types of damage are caused by the hypoxia followed by carboxyhemoglobinemia occurring during smoking and are also observed in CO poisonings that also result in deformities. Numerous infants die during the first months of life of the so-called sudden infant death syndrome (SIDS), which can also be caused by maternal smoking and passive smoking. The contribution of nicotine to such health damage is still unclear, especially because only animal trial data are available, the applicability of which to human beings is questionable. It can be said that studies to date have revealed no deformities confirmed as having been caused by nicotine. Cardiopulmonary disturbances resulting from changes in the regulation of dopaminergic receptors are under discussion, but have not yet reached the status of a pathogenic principle. On the whole, all child health complications arising during pregnancy can be attributed almost exclusively to tobacco combustion products including the CO formed. Passage of nicotine into human milk has been confirmed in nursing smokers; passive smoking by mother and child also raises nicotine and cotinine levels in the milk and in the infant. These findings could lead to a reconsideration of smoking withdrawal therapy for pregnant women.