This page has links to slides and resources presented at a recent Workshop on Smoking and Pregnancy given by Woolcock Institute of Medical Research 23-24 Aug 2005 Smoking Cessation Unit.
A newborn infant
Workshop issues discussed were: nicotine pharmacology, australian statistics, developmental effects, clinical programs, nicotine replacement therapy, carbon monoxide monitoring, "You are not giving up smoking, you are becoming a non-smoker".
For the developmental abnormalities presentation, resources from UNSW Embryology on normal development of the embryo, uterus, placenta, fetus, neonatal and postnatal were used in conjunction with recent research literature on smokings effects on development. In addition, statistics from recent comprehensive review on "Women and Smoking" (A Report of the Surgeon General United States - 2001) were cited.
Of great concern was the increasing number of young women, of child-bearing age, who are commencing smoking. Australian Institute of Health and Welfare (AIHW) report (25 August 2005) that predicts the male rate expected rate to decrease by 1% from 2001 to 2011, and the female rate is expected to increase by 2% "The contrast between the slightly declining trend in incidence rates for men and the increasing trend for women is even greater for lung cancer and other smoking-related cancers." From an earlier smoking report (29 July 2005) "Men, on the whole, were more likely to smoke daily than women-but not for the 14-19 years age group, where 12% of girls were daily smokers compared with 10% of boys."
Smoking effects are 100% preventable.
Page Links: Introduction | Presentation Slides | Quick Links | Smoking and Pregnancy | NSW Quitline | Behavioural Tips to Quit Smoking | Nicotine Replacement Therapy | Teratogens | Nicotine | Australian National Drug Strategy Household Survey 1995 | References | Search PubMed | British Medical Journal |NHMRCrecommendations | Web Links |
The links below are to PDF versions of lecture slides. Note that movies shown in lecture will not run in these documents and are linked below.
A teratogen is any agent that causes a structural abnormality following fetal exposure during pregnancy Infectious agents (rubella, cytomegalovirus, varicella, herpes simplex, syphilis), Physical agents (ionizing agents, hyperthermia), Maternal health factors (diabetes, maternal PKU), Environmental chemicals (organic mercury compounds, PCB, herbicides and solvents), Drugs (prescription, over- the-counter, recreational).
Teratogenic Chemicals
More suspected teratogens than before due mainly to an increase in synthetic chemical compounds in use.
Clinical recognition of subtle malformations as teratogenic effects: fetal alcohol syndrome, fetal hydantoin syndrome, fetal trimethadione syndrome, fetal warfarin syndrome , smoking associated with low birth weight infants
Teratogenic Effects
Dose Response - greater the dose, the greater the effect
Time of Exposure -certain stages of embryonic and fetal development are more vulnerable
Smoking may be modestly related to an increased risk for certain birth defects: oral clefts, limb reductions, urogenital or gastrointestinal
CO and nicotine from cigarette smoke may increase risks for fetal hypoxia and vascular disruption which can cause birth defects (Czeizel et al. 1994; Li et al. 1996; Werler 1996)
Other Possible Mechanisms
Cigarette smoke may produce birth defects by: toxic metabolites present in the smoke (Li et al. 1996), decreased use of folate (Alderman et al.1994) and mutagenic effects (Seidman et al. 1990).
Data from: Quitting smoking in pregnancy Raoul A Walsh, John B Lowe, Peter J Hopkins (MJA 2001; 175: 320-323)
Phone: Quitline 131 848 is a free confidential telephone based service primarily designed to help smokers quit smoking.
Fax:Quitline Fax Referral form Alliance of Divisions of GPs
Procedure to refer a patient/client to the NSW Quitline
The five Ds
Recall and practise the five Ds when they feel the urge to smoke:
Delay, even for a short while
Drink water
Deep breathing
Do something different and
Discuss the craving with another person
Other tips
(from Quitting smoking in pregnancy Raoul A Walsh, John B Lowe, Peter J Hopkins (MJA 2001; 175: 320-323)
See also Woolcock Institute of Medical Research - smoking cessation
Below are excerpted statistics from the 1995 household survey.
For more information please email CEIDA Information Centre
Nicotine is a natural ingredient in tobacco leaves, where as an alkaloid it provides some protection for the plant being eaten by insects by acting as a botanical insecticide.
Tobacco also contains other minor alkaloids nornicotine, anatabine and anabasine.
There is a chemical datasheet for nicotine, the pure chemical, note that commercial tobacco products include many additional chemicals.
Neonates have a decreased ability to metabolise nicotine, with a 3-4 times longer half-life in newborns exposed to tobacco smoke compared with adults.
Cytochrome P450, Subfamily IIA, Polypeptide 6 (CYP2A6) is the main enzyme in the liver responsible for metabolism (oxidation) of nicotine. (More? OMIM Entry CYP2A6) and there are known mutations that occur in this gene which would also impact on nicotine metabolism.
See also the recent review paper Metabolism and disposition kinetics of nicotine. Hukkanen J, Jacob P 3rd, Benowitz NL. Pharmacol Rev. 2005 Mar;57(1):79-115. | Nicotine metabolism and elimination kinetics in newborns. Dempsey D, Jacob P 3rd, Benowitz NL. Clin Pharmacol Ther. 2000 May;67(5):458-65. | OMIM Entry CYP2A6
Nicotine replacement therapy (NRT) is a therapeutic method of replacing cigarette nicotine by either nicotine transdermal patches, nicotine gum, nicotine lozenges or nicotine inhalers. NRT has been shown to be safe and effective in helping people stop using cigarettes when used as part of a comprehensive smoking cessation program. In the USA there are public safety issues concerning the patches, including indications, contraindications, warnings and precautions, and issues such as effectiveness, potential abuse and advertising and marketing.
In relation to pregnancy, it does not remove the harmful effects of nicotine (although given at a lower dose), but does remove the effects of other harmful cigarette chemicals including carbon monoxide.
In 2005 a PubMed search results "smoking and pregnancy" will retrieve 8247 citations and 920 reviews.
A Report of the United States Surgeon General Women and Smoking 2001
Walsh RA, Lowe, JB, Hopkins PJ Quitting smoking in pregnancy MJA 2001; 175: 320-323
Shiverick KT, Salafia C. Cigarette smoking and pregnancy I: ovarian, uterine and placental effects. Placenta. 1999 May;20(4):265-72. Review.
Salafia C, Shiverick K. Cigarette smoking and pregnancy II: vascular effects. Placenta. 1999 May;20(4):273-9. Review.
Stocks J, Dezateux C. The effect of parental smoking on lung function and development during infancy. Respirology. 2003 Sep;8(3):266-85. Review.
JP Hanrahan, etal. The effect of maternal smoking during pregnancy on early infant lung function Am Rev Respir Dis. 1992 May;145(5):1129-35.
Bibby E, Stewart A. The epidemiology of preterm birth. Neuro Endocrinol Lett. 2004 Dec;25 Suppl 1:43-7. Review.
Hukkanen J, Jacob P 3rd, Benowitz NL. Metabolism and disposition kinetics of nicotine. Pharmacol Rev. 2005 Mar;57(1):79-115. Review.
Dempsey D, Jacob P 3rd, Benowitz NL. Nicotine metabolism and elimination kinetics in newborns. Clin Pharmacol Ther. 2000 May;67(5):458-65.
OMIM Entry for the enzyme CYP2A6
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