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Freedom from Nicotine - a cold turkey nicotine dependency recovery forum
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Smoking and Pregnancy
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Re: Smoking and Pregnancy
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Comment
Sal GOLD
Smoking and Pregnancy
#1
[url]
[-]
Sep 23 06 11:12 PM
From:
John (Gold)
Sent: 1/30/2006 8:58 PM
If you are pregnant and reading this message Dr. Slotkin of Duke Medical University, who is referenced in the above study, has a few words he wants to read and think about. Please keep in mind that Dr. Slotkin is one of the world's lead toxicologists studying nicotine's path of destruction during fetal animal development.
From:
Theodore Slotkin
t.slotkin@duke.edu
To:
John R. Polito
john@whyquit.com
Sent:
Monday, January 09, 2006 11:33 AM
Subject:
Re: NRT pregnancy use
I certainly have no objections to your sharing my comments - I'm on record for this information in a number of reviews and primary research papers, and I think it's important to get that information out to practitioners and to smokers.
One of my main concerns is that, although NRT is fine for smoking cessation in nonpregnant smokers, the assumption that it is safe in pregnancy leads people away from thinking about more effective (albeit more costly) ways of addressing the issue. It's easy to dispense drugs (even if they don't work and cause damage to the fetus, and damage to the developing brain doesn't show up as an obvious "birth defect") and although it's harder to go one-on-one with a pregnant smoker to try to get the desired results, it's probably more effective. Also, the patch is the "easiest" NRT approach, and it turns out that this is the absolute worst form of nicotine administration for the fetus.
Essentially, achieving a continuous steady-state plasma level of nicotine in the mother removes the protective effect of the placenta (delay of entry to fetus, partial catabolism of nicotine) because all water spaces become saturated with nicotine. A recent paper from Walter Lichtensteiger's group showed that the brains of fetal mice wound up with 3x the nicotine concentration found in maternal plasma when a continuous administration paradigm was used.
So NRT might be OK, but not on a continuous basis - at the very least, removing the patch at night would allow for some "wash-out" from the fetus (but probably not much, since fetal clearance of nicotine is lower than in mom). Beyond that, there is still the nagging problem that the only two controlled studies on quit rate in pregnant smokers found no help from NRT. So promoting NRT in pregnancy still needs someone to show that the benefits outweigh the risks.
Regards,
Ted Slotkin
Edited 1 time by
JohnPolito
Jan 27 11 9:39 AM.
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