Are nicotine replacement therapy, varenicline or bupropion options for pregnant mothers to quit smoking? Effects on the respiratory system of the offspring

Abstract

Nicotine occurs in tobacco smoke. It is a habit-forming substance and is prescribed by health professionals to assist smokers to quit smoking. It is rapidly absorbed from the lungs of smokers. It crosses the placenta and accumulates in the developing fetus. Nicotine induces formation of oxygen radicals and at the same time also reduces the antioxidant capacity of the lungs. Nicotine and the oxidants cause point mutations in the DNA molecule thereby changing the program that controls lung growth and maintenance of lung structure. The data available indicate that maternal nicotine exposure induces a persistent inhibition of glycolysis and a drastically increased AMP level. These metabolic changes are thought to contribute to the faster aging of the lungs of the offspring of mothers that are exposed to nicotine via the placenta and mother's milk. The lungs of these animals are more susceptible to damage as shown by the gradual deterioration of the lung parenchyma. The rapid metabolic and structural aging of the lungs of the animals exposed to nicotine via the placenta and mother's milk, and thus during phases of lung development characterized by rapid cell division, is likely due to 'programming' induced by nicotine. Since varenicline, a partial nicotine agonist, has basically the same structure as nicotine, and also binds to acetylcholine receptors in competition with nicotine (but with largely the same effect), it is not advisable to use nicotine or varenicline during gestation and lactation. Furthermore, the use of individual vitamin supplements is also not advisable because of the negative impact on the program that controls maintenance of lung structural and functional integrity and aging. A more appropriate smoking cessation program will also include a mixture of antioxidant nutrients such as in tomato juice.

Electronic cigarette aerosols suppress cellular antioxidant defenses and induce significant oxidative DNA damage

“…Tobacco smoke has been previously shown to reduce the antioxidant capacity of tissues [86]. Here, we showed that like MS smoke, long-term exposure to EC aerosol significantly increases cellular ROS and decreases total cellular antioxidant capacity.…”

HIV-Infected Adolescent, Young Adult and Pregnant Smokers: Important Targets for Effective Tobacco Control Programs

“…In experimental studies, nicotine was capable of crossing the placenta as well as achieving concentrations in breast milk 2–3 times higher than in plasma [150]. In animal models, it has been associated with fetal central nervous system abnormalities, cardiac malformations, pulmonary hypoplasia, uteroplacental insufficiency, and sudden infant death syndrome [150,151]. In humans, it has been linked to negative birth outcomes as well.…”

Prenatal nicotine exposure in rhesus monkeys compromises development of brainstem and cardiac monoamine pathways involved in perinatal adaptation and sudden infant death syndrome: Amelioration by Vitamin C

“…Although tobacco smoke contains thousands of biologically active compounds, nicotine itself is a major contributor to neurodevelopmental and autonomic abnormalities [33,34]. Accordingly, there are serious concerns as to whether the use of nicotine replacement products to achieve smoking cessation in pregnant women actually lessens perinatal risk or the subsequent appearance of neurodevelopmental deficits [4,5,20,26,34]. …”