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Neglecting health risks to 'cigarette babies.'(Brief Article)

The medical community, government, and media have neglected unequivocal scientific evidence that nicotine from maternal smoking causes possibly 100,000 fetal deaths each year as well as massive numbers of crib deaths, according to Theodore Slotkin, professor of pharmacology, Duke University Medical Center, Durham, N.C. Also neglected are the severe neurological problems in "cigarette babies" of women who smoked during pregnancy. This neglect comes despite the fact that the widespread, chronic ingestion of nicotine by one-fourth of all pregnant women probably produces far more damage than the more limited and episodic use of cocaine, he maintains.

"Maternal smoking during pregnancy kills between tens of thousands and possibly over 100,000 babies each year in utero. 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. Smoking is also responsible for one-third to two-thirds of all cases of sudden infant death syndrome [SIDS]. And none of these figures takes into account the enormous increase in learning disabilities, attention deficit and hyperactivity disorder, and other behavioral problems that we know are part of the outcome of maternal smoking."

Slotkin assets that the worldwide increase in smoking will eclipse AIDS in the death and societal disruption it causes. He calls for a nationwide campaign to persuade pregnant women to quit smoking. That campaign should concentrate on counseling, although it can include careful use of nicotine patches, inhalers, and gum during the first trimester of pregnancy. This strategy is contrary to popular belief 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.

Nicotine overstimulates cells in the peripheral nervous system and adrenal glands. The fetus and newborn depend on the adrenal hormone system to "alert" its body to react to periods of hypoxia (inadequate oxygen)--for example, during birth itself and after birth during mild apnea while asleep--by increasing breathing and heart rate. The infant needs the adrenal system because its heart and respiratory system are not yet wired fully with nerve cells to allow them to respond reflexively to hypoxia. Thus, nicotine's damage to this critical survival system may predispose the newborn to crib death, or SIDS.

Despite such clear dangers, Slotkin points out, "the sad truth is that most women who smoke don't quit during pregnancy." Although about half of smoking pregnant women report that they have quit, blood or urine tests show that the proportion who actually stop smoking during pregnancy is small.

Slotkin emphasizes to obstetricians the inadequacy of the Surgeon General's warning that links evidence of smoking-related fetal damage primarily to low birth weight. "We have fallen into the trap of thinking that if a baby is of normal weight, then no damage has been done. But in our animal studies--in which we could simulate smoking levels from two packs a day down to half a pack--we find that all the brain damage that occurs at growth-retarding levels of nicotine is still present at doses that don't affect growth. The brain is much more sensitive than the rest of the body."
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Publication:USA Today (Magazine)
Article Type:Brief Article
Date:Oct 1, 1998
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