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Open AccessReview

Impact of Nicotine Replacement and Electronic Nicotine Delivery Systems on Fetal Brain Development

1
Neonatology Unit, Hospital Clinic-Maternitat, ICGON, BCNatal, 08028 Barcelona, Spain
2
Grup de Recerca Infancia i Entorn (GRIE), Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08028 Barcelona, Spain
3
Department of Nutrition and Health, Valencian International University, 46002 Valencia, Spain
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(24), 5113; https://doi.org/10.3390/ijerph16245113
Received: 13 November 2019 / Revised: 9 December 2019 / Accepted: 12 December 2019 / Published: 14 December 2019
Maternal tobacco smoking during pregnancy remains a major public health issue. The neurotoxic properties of nicotine are associated with fetal neurodevelopmental disorders and perinatal morbimortality. Recent research has demonstrated the effects of nicotine toxicity on genetic and epigenetic alterations. Smoking cessation strategies including nicotine replacement therapy (NRT) and electronic nicotine delivery systems (ENDS) show lack of clear evidence of effectiveness and safety in pregnant women. Limited trials using randomized controls concluded that the intermittent use formulation of NRT (gum, sprays, inhaler) in pregnant women is safe because the total dose of nicotine delivered to the fetus is less than continuous-use formulations (transdermal patch). Electronic nicotine delivery systems (ENDS) were hyped as a safer alternative during pregnancy. However, refill liquids of ENDS are suspected to be cytotoxic for the fetus. Animal studies revealed the impact of ENDS on neural stem cells, showing a similar risk of pre- and postnatal neurobiological and neurobehavioral disorders to that associated with the exposure to traditional tobacco smoking during early life. There is currently no clear evidence of impact on fetal brain development, but recent research suggests that the current guidelines should be reconsidered. The safety of NRT and ENDS is increasingly being called into question. In this review, we discuss the special features (pharmacodynamics, pharmacokinetics, and metabolism) of nicotine, NRT, and ENDS during pregnancy and postnatal environmental exposure. Further, we assess their impact on pre- and postnatal neurodevelopment. View Full-Text
Keywords: E-cigarettes; electronic nicotine delivery systems; nicotine replacement therapy; fetal brain development; pharmacodynamics; pharmacokinetics E-cigarettes; electronic nicotine delivery systems; nicotine replacement therapy; fetal brain development; pharmacodynamics; pharmacokinetics
MDPI and ACS Style

Sailer, S.; Sebastiani, G.; Andreu-Férnández, V.; García-Algar, O. Impact of Nicotine Replacement and Electronic Nicotine Delivery Systems on Fetal Brain Development. Int. J. Environ. Res. Public Health 2019, 16, 5113.

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