Pregnant Smokers

Addington J, el-Guebaly N, Campbell W, et al Smoking cessation treatment for patients with schizophrenia. Am J Psychiatry 135 974-976, 1998 American Psychiatric Association Practice Guideline for the Treatment of Patients With Substance Use Disorders, 2nd Edition. Washington, DC, American Psychiatric Association (in press) 

Briggs G, Freeman R, Yaffe S Drugs in Pregnancy and Lactation A Reference Guide to Maternal and Fetal Risk. Philadelphia, Lippincott, Williams Wilkins, 2002 Chengappa KN, Kambhampati R, Perkins K, et al Bupropion sustained release as a smoking cessation treatment in remitted depressed patients maintained on neatment with selective serotonin reuptake inhibitor antidepressants. J Clin Psychiatry 62 503—508, 2001 

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Dwoskin LP, Crooks PA A novel mechanism of action and potential use for lobeline as a treatment for psychostimulant abuse. Biochem Pharmacol 63 89-98, 2002 

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Oncken CA, Hatsukami DK, Lupo VR, et al Effects of short-term use of nicotine gum in pregnant smokers. Clin Pharmacol Ther 59 654-61, 1996 Pomerleau OF, Pomerleau CS Neuroregulators and the reinforcement of smoking towards a biobehavioral explanation. Neurosci Biobehav Rev 8 503—513, 1984 Prochazka AV, Weaver MJ, Keller RT, et al A randomized trial of nortriptyline for smoking cessation. Arch Intern Med 158 2035-2039, 1998 Puska P, Korhonen HJ, Vartiainen E, et al Combined use of nicotine patch and gum compared with gum alone in smoking cessation a clinical trial in North Karelia. Tob Control 4 231-235, 1995... 

Dempsey D, Jacob P, 3rd, Benowitz NL (2002) Accelerated metabolism of nicotine and cotinine in pregnant smokers. J Pharmacol Exp Ther 301(2) 594-598 Dempsey D, Tutka P, Jacob P, 3rd, Allen F, Schoedel K, Tyndale RF, Benowitz NL (2004) Nicotine metabolite ratio as an index of cytochrome P450 2A6 metabolic activity. Clin Pharmacol Ther 76 64-72... 

Wisborg K, Henriksen TB, Jespersen LB, et al. Nicotine patches for pregnant smokers A randomized controlled trial. Obstet Gynecol 2000 96 967-971. 

Tappin DM, Lumsden MA, Giknour WH, et al. (2005) Randomised controlled trial of home based motivational interviewing by midwives to help pregnant smokers quit or cut down. BMJ 331 373-377. 

Dempsey D, Jacob III P, BenowitzNL (2002) Accelerated metabolism of nicotine and cotinine in pregnant smokers. J Pharmacol Exp Ther 301 594-598... 

Swamy GK, Roelands JJ, Peterson BL, Fish LJ, Oncken CA, Fletsch PK, Myers ER, Whitecar PW, Poliak KI. Predictors of adverse events among pregnant smokers exposed in a nicotine replacement therapy trials. Am J Obstet Gynecol 2009 201(4) 354.el-7. 

Certain subgroups of the population may be more susceptible to the toxic effects of lead exposure. These include crawling and house-bound children (<6 years old), pregnant women (and the fetus), the elderly, smokers, alcoholics, and people with genetic diseases affecting heme synthesis, nutritional deficiencies, and neurological or kidney dysfunction. This is not an exhaustive list and reflects only current data available, further research may identify additional susceptible subgroups. 

No human health effects have been detected at COHb blood levels below about 2% ( background levels in non-smokers average about 0.5%). Subtle effects on the nervous system, such as reduced ability to sense certain time intervals, have been reported at blood levels of 2.5%. At COHb levels of 5% certain cardiovascular changes are detectable, especially in patients with coronary heart disease. Heavy smokers exhibit COHb levels in the range of 5-6%, and if they happen to be pregnant, the fetus can suffer the effects of oxygen deprivation. 

Six healthy volunteers, three males and three females, aged 20-25 years, and weighing 50-60 kg, participated in the study. Female volunteers were non-pregnant. All subjects were non-smokers. After informed consent was obtained, all subjects refrained from tea, coffee, carbonated beverage and chocolate for six days before and during the study. 

The limited data available suggest that certain subgroups of the population may be more susceptible to barium exposure than the general population. These include people with cardiovascular problems, those taking certain prescription drugs, children, pregnant women, smokers, and people with lung disease. 

Long-term marijuana use also produces changes in the brain. It affects the lungs, which may lead to chronic bronchitis and more frequent chest cold. Regardless of THC content, the amount of tar inhaled and level of carbon monoxide absorbed by marijuana smokers are 3 to 5 times greater than those for tobacco smokers. Pregnant women addicted to marijuana impart effects to the fetus, leading to fetotoxicity. 

Women also face some unique health consequences of smoking. For example, women who smoke are at higher risk of cervical cancer, unwanted side effects of using oral contraceptives, and early menopause (Ernster, 1993). Furthermore, smokers who arc pregnant incur a higher risk of spontaneous abortion, preterm births, low-weight babies, and fetal and infant deaths. If the infant is born healthy, there still is risk from nicotine present in the mother s milk (USDHHS, 1987b). 

All smokers trying to quit, except in the presence of special circumstances. Special consideration should be given before using pharmacotherapy with selected populations those with medical contraindications, those smoking fewer than 10 cigarettes/day, pregnant/breast-feeding women, and adolescent smokers. 

Although nicotine is a stimulant, it may induce muscle relaxation, depending on the user s physical state. It has also been shown to decrease one s appetite, speed up metabolism, and increase levels of dopamine, a mood-altering chemical in the brain that induces feelings of pleasure. Low levels of dopamine play a role in the development of Parkinson s disease. Research has shown that smokers, with higher levels of dopamine, have a reduced risk of the disease. Women who are pregnant are advised not to use any product containing nicotine. Nicotine in any form is harmful to an unborn child. It rapidly crosses the placenta and enters the fetus s body. 

Zareba, A., Strugala-Stawik, H., Rudkowski, Z., Dembicka, D., Pastuszek, B., 1996. Blood levels of lead and cadmium in pregnant women, active and passive smokers and their neonates. In Abstracts of International Conference Environmental Pollution and Child Health Critical Needs and Issues for Central and Eastern Europe, Sosnowiec, Poland. 

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