WebMD Medical News
Laura J. Martin, MD
Aug. 29, 2011 -- Most moms-to-be are aware that you shouldn't smoke during pregnancy, but some have a hard time kicking the habit. Some turn to smokeless tobacco like snuff or other nicotine-replacement products.
But these products -- and the nicotine they release - are harmful for newborns, a study suggests.
The study is published in Pediatrics.
Snuff is a fine-grain tobacco that users "dip" between their lower lip and gum. The new study took place in Sweden where many people use snuff.
Using snuff during pregnancy may increase a newborn's risk for brief pauses in breathing during sleep (called sleep apnea) even more so than smoking cigarettes.
Michael Siegel, MD, the associate chairman of community health sciences at the Boston University School of Public Health, says we are not just talking about snuff. "The new study has broader implications."
It's the nicotine, not the way it is delivered, that may increase health risks in newborns, says Siegel. Siegel reviewed the study for WebMD.
These same risks may hold for other smokeless tobacco products and nicotine replacement therapy, he says. "Some doctors do tell pregnant women to quit smoking with nicotine replacement products."
"A cold turkey approach is what is called for among pregnant women," he says.
In the study, infants born to moms who used snuff during pregnancy were twice as likely to have apnea as babies born to moms who did not use any tobacco products. This risk was also higher among snuff users than smokers. In total, 7,599 pregnant women said they used snuff during pregnancy, and 481 women smoked cigarettes and used snuff.
Apnea sometimes goes away on its own. But it also can be linked to other serious health problems among infants, including sudden infant death syndrome.
It is more common in babies born early than those born at term. Snuff use increased risk for apnea even among babies born at term, the study shows.
Not all snuff is created equal. Some types contain nicotine, while others may not.
The study looked only at snuff with nicotine. The nicotine in snuff may disrupt the development of a newborn's nervous system, causing breathing problems, researchers suggest.
Snuff and other nicotine-containing products like lozenges or patches provide a steadier stream of nicotine than cigarettes. This may in part play a role in the risks seen among snuff users and their newborns.
The message is clear: There is no safe cigarette or tobacco product during pregnancy. "The safest way to quit smoking is to just stop," says Len Horovitz, MD. Horovitz is a pulmonary specialist at Lenox Hill Hospital in New York City
"Mothers who use snuff or other nicotine replacement therapies may be getting more nicotine than they would if they were smoking cigarettes," says Ana Krieger, MD. Krieger is the director of the Center for Sleep Medicine at New York-Presbyterian Hospital/Weill Cornell in New York City.
Some infants may grow out of their apnea, while others may have long-term health issues, she says. "We don't know if there is permanent damage from snuff use during pregnancy yet."
SOURCES:Gunnerbeck A. Pediatrics, 2011; vol128: pp 503-509.Len Horovitz, MD, pulmonary specialist, Lenox Hill Hospital, New York City.Ana Krieger, MD, director, Center for Sleep Medicine, New York-Presbyterian Hospital/Weill Cornell, New York City.Michael Siegel, MD, associate chairman, community health sciences, Boston University School of Public Health.
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