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 “The findings of our study were very concerning because smoking
during pregnancy is one of the most preventable causes for adverse
birth outcomes including preterm birth, stillbirth and infant
mortality,” said lead author Eric S. Hall of the Perinatal Institute
at Cincinnati Children's Hospital Medical Center in Ohio.
“So it is critical that we understand the magnitude of the problem
in order to better determine the resources that should be invested
in helping women quit smoking during pregnancy,” he said.
Nearly one in four mothers in the study were exposed to some level
of nicotine, including secondhand exposures, late in pregnancy, he
told Reuters Health by email.
The researchers analyzed data on 787 women who self-reported any
cigarette use during the last trimester of pregnancy and had
provided urine samples. The samples were tested for cotinine, which
indicates nicotine exposure, and for evidence of other drugs
including amphetamines, benzodiazepines, barbiturates, cannabinoids
such as marijuana, cocaine, muscle relaxants, short-acting opioids
such as heroin, long-acting opioids including buprenorphine and
methadone, and phencyclidine (PCP).
The average age was 28. Most of the women had private insurance,
while about a third were insured by Medicaid, the U.S. insurance
program for low-income families.
While only 67 of the 787 women reported any amount of cigarette
smoking during their final trimester, 117 tested positive for
high-level nicotine exposure based on their urine samples, according
to results in the Journal of Perinatology.
Another 53 women tested positive for low-level nicotine exposures,
which the authors say could represent second-hand smoke exposure, or
smoking by the pregnant woman herself that ceased more than a few
days before the urine test.
Almost 10 percent of the women tested positive for exposure to at
least one of the drugs of abuse, often cannabinoids or opioids, and
two percent tested positive for multiple drug exposures. Those
insured under Medicaid were more likely than others to test positive
for any drug.
“Nicotine is incredibly addictive and quitting smoking is
challenging for anyone,” Hall said. “It may be made more difficult
for pregnant mothers with additional stress or without adequate
clinical and social support.”
In a 2010 survey, 10 percent of pregnant women reported smoking
cigarettes during the last trimester of pregnancy. But this estimate
is limited by the possibility that not all women will admit to
smoking, and it doesn’t include other sources of nicotine exposure,
the authors write.
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Women may underreport smoking during pregnancy due to stigma. Also,
Hall said, the tools to ask about these exposures may also be to
blame, as surveys don’t usually include nicotine products like
cigarillos, cigars, smokeless tobacco or e-cigarettes.
“Although some people may assume that since e-cigarettes do not
contain smoke, they are safe, there is no evidence to show that
e-cigarettes are safer than regular cigarettes during pregnancy and
certainly, e-cigarettes are not safe,” he said.
Nicotine exposure during pregnancy may lead to miscarriage or
stillbirth, with body and brain sizes reduced due to diminished
blood supply to fetal organs, said Hamisu M. Salihu of the Chiles
Center for Healthy Mothers and Babies at the University of South
Florida in Tampa, who was not part of the new study.
“This could have later consequences such as poor academic
performance due to reduced brain size and cognitive function as well
as hypertension, type 2 diabetes and coronary artery disease (due to
smallness for gestational age at birth),” Salihu told Reuters
Health.
Health education and advice may not be enough to help women quit
smoking, but resources like quit lines, such as 1-800-QUIT NOW,
social support from counselors or home visitors can make a
difference, Hall said.
“Because nicotine replacement therapies such as patches or gum still
contain nicotine, they can be potentially dangerous for the fetus,”
he said. “Pregnant women should consult with their physicians about
the potential risks and benefits of nicotine replacement therapies
to help in quitting smoking.”
SOURCE: http://go.nature.com/29FtBHG Journal of Perinatology, online
July 7, 2016.
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