Action on Smoking and Health  A National Legal-Action Antismoking Organization  Entirely Supported by Tax-Deductible Contributions       Info About ASH  | ash.org |  To Join ASH

Tobacco smoking by pregnant women is far more deadly and far more harmful to society than crack smoking, at least according to a new study. Below is ASH's press release on the topic, excerpts from a news article, and a copy of the abstract of the study.

ASH's PRESS RELEASE:

STUDY SHOWS MOMS' TOBACCO SMOKING MORE DANGEROUS THAN CRACK USE

EMPHASIS ON "CRACK BABIES" MISPLACED, SAYS RESEARCHER

IMPLICATIONS FOR RIGHT-TO-LIFE SUPPORTERS AS WELL AS PHYSICIANS

Despite all of the publicity regarding "crack babies," maternal smoking of tobacco is far more dangerous to the fetus -- and a much greater problem for society -- than maternal crack smoking, according to a new study which has major implication for society, says Action on Smoking and Health.

Maternal smoking annually causes as many as 100,000 miscarriages and stillborns, tens of thousands of admissions to intensive-care units, and extensive brain damage -- a toll which dwarfs that of crack-cocaine use -- according to a new study in this month's Journal of Pharmacology and Experimental Therapeutics.

Indeed, the article shows that cocaine use, which is more limited and episodic than cigarette smoking, probably produces far less damage to the fetus in terms of malformations, pre-term births and low birth weights.

The article also shows, for the first time, how even levels of nicotine too low to cause underweight births kills brain cells and retards brain development in children of mothers who smoke tobacco.< /p>

One bright spot in the new report is that most of the damage to the fetus doesn't occur early in the pregnancy as previously believed, but rather during the second and third trimesters. This means pregnant women have a "window of opportunity" to quit before much irreparable damage occurs.

"This report provides yet another reason for Congress to pass comprehensive antismoking legislation, and that includes many of the pro-life supporters in the Senate who helped to kill legislation which could have done so much to protect the life and health of the unborn," says ASH.

In light of this information, gynecologists who don't take all reasonable steps to persuade and actively assist their pregnant patients to quit smoking could be sued for the damage caused by nicotine, says law professor John Banzhaf, ASH's Executive Director.

**********

Excerpts from PREGNANCY, SMOKING ALARM SOUNDED

by Susan Kaufman, News-Observer [06/25/98
 
      Crack babies make the headlines and attract medical research dollars, but the threat to far more babies comes from a legal drug -- cigarettes -- a Duke professor of pharmacology says.
     Ted Slotkin wants to pull cigarettes out of the mouths of pregnant women and shake up the media, government and medical profession. He has new research that indicates risks from pregnant smokers go far beyond the widely known chance of stunting a baby's growth.
     Nicotine damages the fetal brain even at levels too low to cause underweight infants, Slotkin writes in this month's issue of the Journal of Pharmacology and Experimental Therapeutics.
     His article, "Fetal Nicotine or Cocaine Exposure: Which One is Worse?" details numerous research findings, including his own studies on animals. Slotkin, an award-winning specialist in tobacco-related diseases, injected nicotine into the bloodstream of pregnant rats. Evaluations of their offspring showed that nicotine both killed brain cells and retarded the development of the brain.
     He says the findings translate to humans. He thinks that when a pregnant woman smokes, she increases the possibility that her child will suffer from learning disabilities, attention deficit disorder and hyperactivity.
     "It's not conjecture anymore," Slotkin says. "It's not just statistics and correlation. The breakthrough was in developing an animal model that tells you nicotine does it. It damages the fetal brain."
     Slotkin takes on the medical community, the media and the government in his article. They're ignoring conclusive data, he says, about the great harm that babies can suffer from a mother's cigarette smoking.
     Smoking during pregnancy makes a baby more likely to be born early -- or not at all. Deaths from miscarriages and stillbirths due to smoking could be as high as 100,000 a year, says Slotkin, whose estimate was confirmed by other researchers.
     "It also results in tens of thousands of admissions to intensive-care units after birth and kills or brain-damages more during the birth process," says Slotkin, who also attributes at least a third of the cases of Sudden Infant Death Syndrome to smoking.
     The national emphasis on babies born to cocaine users is misplaced, he contends. Studies show that cocaine use, which is more limited and episodic than cigarette smoking, probably produces far less damage to the fetus in terms of malformations, preterm births and low birth weights, he points out.
     "Cocaine's not the real problem for our society," he says. "It's tobacco and pregnancy, yet we educate physicians to think tobacco is not as important as cocaine or heroin."
     Numerous national studies show that at least one in four women smoke while they are pregnant. In places such as central North Carolina, medical professionals say, that percentage can be as high as 40 percent.
     Slotkin's article already is shaking up the medical and public health community.
     "Other studies have implicated parental smoking in SIDS and found that secondhand smoke can contribute to asthma and ear infections," says Chuck Bridger, the American Cancer Society's project manager for N.C. Project ASSIST (American Stop Smoking Intervention Study). "But the news that nicotine from mom plays a role in the development of the brain is cutting-edge. It's very much of an eyebrow-raising article for a lot of us."
     Slotkin calls for more research -- and a nationwide campaign to persuade pregnant women to quit smoking. The campaign should concentrate on counseling, although it can include careful use of nicotine patches, inhalers and gum during the first trimester of pregnancy.
     His recommendation disputes the notion that drugs are most harmful to the fetus during that early period. His findings show that nicotine does most damage to the fetus during the second and third trimesters, meaning that pregnant women have a "window of opportunity," early in pregnancy, to quit smoking.

**********

ABSTRACT OF ARTICLE:

Vol. 285, Issue 3, 931-945, June 1998

FETAL NICOTINE OR COCAINE EXPOSURE: WHICH ONE IS WORSE?

Theodore A. Slotkin

Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, North Carolina

Despite extensive adverse publicity, tobacco use continues in approximately 25% of all pregnancies in the United States, overshadowing illicit drugs of abuse, including cocaine. The societal cost of maternal smoking is seen most readily in underweight newborns, in high rates of perinatal morbidity, mortality and Sudden Infant Death Syndrome and in persistent deficits in learning and behavior.

We have designed animal models of nicotine exposure to prove that nicotine itself is a neuroteratogen, thus providing a causative link between tobacco exposure and adverse perinatal outcomes. In particular, nicotine infusion paradigms that, like the transdermal patch used in man, produce drug exposure without the confounds of other components of tobacco or of episodic hypoxic-ischemic insult, have enabled a mechanistic dissection of the role played by nicotine in fetal brain damage.

Nicotine targets specific neurotransmitter receptors in the fetal brain, eliciting abnormalities of cell proliferation and differentiation, leading to shortfalls in the number of cells and eventually to altered synaptic activity. Because of the close regulatory association of cholinergic and catecholaminergic systems, adverse effects of nicotine involve multiple transmitter pathways and influence not only the immediate developmental events in fetal brain, but also the eventual programming of synaptic competence. Accordingly, defects may appear after a prolonged period of apparent normality, leading to cognitive and learning defects that appear in childhood or adolescence. Comparable alterations occur in peripheral autonomic pathways, leading to increased susceptibility to hypoxia-induced brain damage, perinatal mortality and Sudden Infant Death.

Identifying the receptor-driven mechanisms that underlie the neurobehavioral damage caused by fetal nicotine exposure provides a rational basis for decisions about nicotine substitution therapy for smoking cessation in pregnancy. In contrast to the effects of nicotine, animal models of crack cocaine use in pregnancy indicate a more restricted spectrum of effects, a reflection of differences both in pharmacokinetics and pharmacodynamics of the two drugs. Notably, although cocaine, like nicotine, also targets cell replication, its effects are short-lived, permitting recovery to occur in between doses, so that the eventual consequences are much less severe.

To some extent, the effects of cocaine on brain development resemble those of nicotine because the two share cardiovascular actions (vasoconstriction) that, under some circumstances, elicit fetal hypoxia-ischemia. In light of the fact that nearly all crack cocaine users smoke cigarettes, the identification of specific developmental effects of cocaine may prove difficult to detect. Although scientists and the public continue to pay far more attention to fetal cocaine effects than to those of nicotine or tobacco use, a change of focus to concentrate on tobacco could have a disproportionately larger impact on human health.

click here to return to ASH's Home Web Page: http://ash.org
click here for more information about Action on Smoking and Health (ASH)
click here to learn the many benefits of joining ASH on-line, over the Internet