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Nicotine is a potential foetal teratogen based on studies in animals and might contribute to sudden infant death syndrome and neurobehavioral deficits in the offspring. However these effects are dose-related in animals, and NRT products have not been demonstrated to be teratogenic in humans.



Smoking during pregnancy is a major preventable cause of poor pregnancy and childhood outcomes. Maternal smoking increases the risk of spontaneous abortion, placenta previa and abruption, low birth weight, premature delivery, perinatal mortality, cleft lip and sudden infant death syndrome SIDS (USDHHS, 2001; Steyn, 2006). Furthermore, maternal smoking has been linked to cognitive deficits in the offspring (i.e., lower scores on overall IQ and on tests requiring auditory processing) (Fried et al., 1998; Jacobsen et al., 2007) as well as behavioral abnormalities (i.e., hyperactivity and attention deficit disorder) (Romano et al., 2006). Although many studies have shown an association between maternal smoking and lower IQ scores in the offspring, one large epidemiological study suggests that controlling for maternal education and IQ  markedly attenuates if not eliminates this association (Batty et al., 2006). 

Many toxicants in tobacco smoke, including carbon monoxide, nicotine, cyanide, cadmium, and a number of carcinogens, could be responsible for these poor outcomes. It is unclear how much of the harm of smoking during pregnancy is due to nicotine, carbon monoxide or other toxicants. Carbon monoxide is considered to be the most biologically significant reproductive toxin in tobacco smoke, (Benowitz & Dempsey, 2004). Carbon monoxide exposure reduces oxygen delivery to the foetus, and carbon monoxide exposure during pregnancy is a well-established cause of abnormal foetal brain development and behavioral problems in the newborn. Carbon monoxide and carcinogens have also been implicated in reduced fetal growth (Gomez et al., 2005; Wang et al., 2002).  Nicotine could reduce oxygen and nutrient availability to the foetus by reducing placental blood flow, and could directly affect neuronal and other cell development. Children of smokers have an increased risk of Sudden Infant Death and this could be contributed to by nicotine exposure in utero. Research in rats indicates that exposure of the foetus to nicotine during pregnancy results in delayed and abnormal brain development and behavioral disturbances in the newborn which may extend into adolescence (Slotkin, 1998; Slotkin et al., 2006).   Furthermore, one animal study showed that the offspring of rats exposed to nicotine prenatally were unable to mount an appropriate cardiorespiratory response to a hypoxic challenge, linking nicotine administration in the animal model to SIDS (Slotkin et al., 1995).



U.S. Department of Health and Human Services. Women and Smoking: a Report of the Surgeon General, in 2001 Surgeon General's Report. Public Health Service, Center for Disease Control and Prevention, Washington, DC. pp 272-306.

Steyn K, de Wet T, Saloojee Y, Nel H, Yach D. The influence of maternal cigarette smoking, snuff use and passive smoking on pregnancy outcomes: the Birth To Ten Study. Paediatr Perinat Epidemiol. 2006; 20: 90-99.

Fried PA, Watkinson B, Gray R
. Differential effects on cognitive functioning in 9-to 12-year olds prenatally exposed to cigarettes and marijuana. Neurotoxicol Teratol. 1998; 20: 293-306.

Jacobsen LK, Slotkin TA, Mencl WE, Frost SJ, Pugh KR
. Gender-specific effects of prenatal and adolescent exposure to tobacco smoke on auditory and visual attention. Neuropsychopharmacology. 2007; 32: 2453-2464.

Romano E, Tremblay RE, Farhat A, Côté A. Development and prediction of hyperactive symptoms from 2 to 7 years in a population-wide sample. Pediatrics. 2006; 117: 2101-2110.

Batty GD, Der G, Deary IJ. Effect of maternal smoking during pregnancy on offspring’s cognitive ability: Empirical Evidence for complete confounding in the US National Longitudinal Survey of Youth. Pediatrics. 2006; 118: 943-950.

Benowitz N, Dempsey D. Pharmacotherapy for smoking cessation during pregnancy. Nicotine Tob Res. 2004; 6 Suppl 2: S189-S202.

Gomez C, Berlin I, Marquis P, Delcroix M. Expired air carbon monoxide concentration in mothers and their spouses above 5 ppm is associated with decreased fetal growth. Prev Med. 2005; 40: 10-15.

Wang X, Zuckerman B, Pearson C, Kaufman G, Chen C, Wang G, Niu T, Wise PH, Bauchner H, Xu X. Maternal cigarette smoking, metabolic gene polymorphism, and infant birth weight. JAMA. 2002; 287: 195-202.

Slotkin TA. Fetal nicotine or cocaine exposure: Which one is worse? J Pharmacol Exp Ther. 1998; 285: 931-945.

Slotkin TA, Tate CA, Cousins MM, Seidler FJ. Prenatal nicotine exposure alters the responses to subsequent nicotine administration and withdrawal in adolescence: Serotonin receptors and cell signaling. Neuropsychopharmacology. 2006; 31: 2462-2475.

Slotkin TA, Lappi SE, McCook EC, Lorber BA, Seidler FJ
. Loss of neonatal hypoxia tolerance after prenatal nicotine exposure: implications for sudden infant death syndrome. Brain Research Bull. 1995; 38: 69-75.

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