Nicotine
|
Routes |
·
Smoking (inhaling); mucosal absorption
(chewed); snorting (rare) |
|
Harmful Effects |
·
Fetal effects: first trimester - increased
risk of spontaneous abortion, third trimester - increased risk of
intrauterine growth restriction and prematurity ·
Obstetrical complications: increased risk of
placental abruption, placenta previa, premature
rupture of membranes ·
Neonatal effects: increased irritability and hypertonia in newborns – resolve with no treatment,
20% increase in perinatal morality rate, doubled
incidence of low birth weight (LBW) infants (<2500
g), increased risk of sudden infant death syndrome (SIDS) ·
Second-hand smoke effects: increased risk of
SIDS, increased incidence of bronchitis, pneumonia, otitis
media, asthma, allergies and behavioural
difficulties |
|
Symptoms of Intoxication |
·
Mild euphoria (or feeling of well-being),
increased arousal (increased heart rate, blood pressure), enhanced ability to
concentrate, relaxation ·
Decreased appetite, increased metabolic rate,
lower body weight set point |
|
Symptoms of Overdose |
·
Nausea, salivation, abdominal pain, sweating,
headache, dizziness ·
Occurs with ingestion of nicotine |
|
Symptoms of Withdrawal |
·
Irritability, restlessness, anxiety, insomnia,
fatigue, lack of concentration ·
Symptoms are worse in first 3-4 days, may
persist for a week or longer ·
Cravings may persist for months or years |
|
Smoking Cessation Therapy |
·
Offer brief interventions (simple advice),
group or individual counseling and self-help materials before pharmacotherapy ·
Behavioural
interventions: self-help guide, group interventions ·
Less success quitting if partner smokes and
increased risk of resumption after birth ·
Encourage smoking reduction as an alternative
to smoking cessation for those unable to quit ·
Consider pharmacotherapy – weigh benefits
and risks |
|
Pharmacotherapy |
·
Nicotine Replacement Therapy (NRT) (e.g. gum, lozenge, patch, inhaler)
indicated for heavily nicotine-dependent women and women unable to quit with behavioural intervention. ·
NRT safer than
smoking for pregnant woman and fetus because other toxins of cigarettes are
eliminated ·
Start with 21 mg nicotine patch if smoking
>10 cigarettes daily; patch can be taken off at bedtime ·
Look at www.pregnets.com
for more details on specific doses of different NRT
products ·
Bupropion (Zyban) not contraindicated during pregnancy, but further
research is needed; only use if benefits outweigh risks – decreases cravings
and moderates withdrawal symptoms ·
Verenicline (Champix) not studied or indicated in pregnancy –
decreases withdrawal and blocks benefits from nicotine exposure |
|
Breastfeeding |
·
Nicotine and its metabolite are detected in
breast milk ·
Heavy smoking may decrease quantity and
quality of breast milk by one third ·
Cigarette smoking should be minimized while
breastfeeding ·
Nicotine Replacement Therapy (NRT) poses no problems for breastfeeding infant ·
Risks to baby of not breastfeeding greater
than risks of breastfeeding and smoking |
|
Resources |
Provincial Smoker's Helplines: ·
BC 1-877-455-2233 ·
·
NS 1-877-513-5333 ·
NB 1-877-513-5333 ·
QC 1-866-527-7383 ·
ON 1-877-513-5333 ·
MB 1-877-513-5333 ·
SK 1-877-513-5333 ·
AB 1-866-332-2322 (or 1-866-33AADAC) ·
NFLD 1-800-363-5864 ·
NNV 1-866-877-3845 ·
YK 1-800-661-0408
(x8393) ·
NWT No line ·
Motherrisk Alcohol
and Substance Use Helpine: 1-877-327-4636 |