Hi,
My name is Bob. I am a nursing student in the nursing program at IVY Tech
Community College in Indiana. I am currently enrolled in an OB class, which
I find very interesting, since I have never had any children myself. I have
been doing some research on the physiological effects of maternal smoking on
infants. To date, a considerable amount of research has been dedicated to
the effects drugs and other chemicals have on breastfeeding infants
(American Academy of Pediatrics: Committee on Drugs, 2001) but very little
has been directed to the physiological effects maternal nicotine has on the
infant's physiology and/or behavior.
It is well known that cigarette smoking creates an addiction to nicotine in
adults as well as a host of other physiological responses reviewed by
Ginzel, Maritz, Marks, Neuberger, Pauly, Polito, Schulte-Hermann, & Slotkin,
2007.
Question 1: Does cigarette smoking and thus nicotine have a
behavioral/physiological effect in infants of mothers who smoke and are
breastfeeding?
Dahlstrom, Ebersjo, & Lundell in their 2004 paper provide evidence that
mother's milk does indeed contain nicotine following a smoking event by the
mother. Even passive environmental or second hand smoke is absorbed by and
can be found in an infant's blood measured by the metabolite of nicotine,
cotinine, which is found in the urine (Greenburg, Bauman, Strecher, Keyes,
Glover, Haley, Stedman & Loda, 1991).
As recently as 2001 the Committee on Drugs of the American Academy of
Pediatrics did not place nicotine and thus smoking in any of their tables of
drugs that have an impact on infants while breastfeeding. In fact they went
so far as to say, “Because the benefits of breastfeeding outweigh the risks
of nicotine exposure, nicotine is no longer listed as a drug that is
contraindicated during breastfeeding”.
In a new study just published in September (Mennella, Yourshaw, & Morgan,
2007) there is support for my hypothesis that nicotine does indeed have a
effect on the breastfeeding infant. It is not benign. Their study
indicated that infants of mothers who just smoked spent 45% less time
sleeping after breastfeeding compared with the infants of mothers who had
not smoked. In addition, with greater amounts of nicotine in the milk the
duration of sleep declined.
Question 2: If nicotine is in the infants blood what is its
pathophysiological effect? Is it having the same addictive effect in the
infant as in an adult? What else is it doing?
Perhaps this recent finding will create an opportunity for us step back and
take another look at the effects of maternal smoking on infants who are
breastfeeding?
__________________________________________
American Academy of Pediatrics Committee on Drugs. (2001). The transfer of
drugs and other chemicals into human milk. Pediatrics, 108, 776-739.
Dahlstrom, A., Ebersjo, C., & Lundell, B. (2004). Nicotine exposure in
breastfed infants. Acta Paediatrica, 93, 810-816.
Ginzel, K. H., Maritz, G.S., Marks, D. F., Neuberger, M., Pauly, J. R.,
Polito, J. R., Schulte-Hermann, R., & Slotkin, T. A. (2007). Critical
Review: Nicotine for the fetus, the infant and the adolescent?. Journal of
Health Psychology, 12(2), 215-224.
Greenburg, R. A., Bauman, K. E., Strecher, V. J., Keyes, L. L., Glover, L.
H., Haley, N. J., Stedman, H. C. & Loda, F. A. (1991). Passive smoking
during the first year of life. American Journal of Public HealthI, 81(7),
850-853.
Mennella, J. A., Yourshaw, L. M., & Morgan, L. K. (2007). Breastfeeding and
Smoking: Short-term Effects on Infant Feeding and Sleep. Pediatrics,120(3),
497-502.
I would appreciate your comments.
Thanks
Bob Hunchberger MA, MS, nursing student
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