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Critical Review:
Nicotine for the Fetus, the Infant and the Adolescent?

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By K. H. Ginzel, MD, Gert S. Maritz, PhD, David F. Marks, PhD, Manfred Neuberger, MD, Jim R. Pauly, PhD, John R. Polito, JD, Rolf Schulte-Hermann, PhD, Theodore A. Slotkin, PhD

Nico Womb PatchFor more than 20 years 'Nicotine Replacement Therapy' (NRT) for smoking cessation has been expanding with more forms of application and new indications for use. However, the evidence shows that long-term success has been weak or altogether absent with high levels of relapse to smoking. Indefinite continuing use of NRT has been deemed preferable to continued smoking. Last year, the National Health Service in the UK extended the use of NRT to pregnancy, to children from age twelve, and advocated NRT use even while still smoking. Similar trends are discernible in the US and Europe. In light of this growing emphasis on NRT, nicotine had to be made palatable by playing down or even denying its toxicity and declaring it "as innocent as caffeine."

This Critical Review, published in the Journal of Health Psychology takes issue with the grave risk of this irresponsible policy especially for the newly added target population. Nicotine interacts with the very basic functions of the peripheral and central nervous system, i.e., the nerves supplying organs and tissues of the body and the vital command stations in the brain. When these systems are formed during fetal life, nicotine from the mother exposed to smoking, secondhand smoke, or NRT can critically impair their normal development.

Perinatal nicotine exposure has been implicated in 'Sudden Infant Death Syndrome' (SIDS), in 'Attention Deficit Hyperactivity Disorder' (ADHD), in affective and behavioral problems, cognitive and learning deficits, depression and nicotine addiction in adolescence.

In the amounts ingested from smoking or NRT, nicotine also plays a prominent role in tobacco-related carcinogenesis, in the incidence of cardiovascular disease, pulmonary emphysema, kidney disease, stomach and duodenal ulcers, and macula degeneration.

Tobacco control must be nicotine control. Without nicotine control, nicotine addiction and nicotine's multifarious impact on the user would persist and spread at the peril of the unborn, the next generation, and public health in general.

Pregnant? Ready to quit?
Read FFN-TJH, Chapter 6, Pages 56-69


Critical Review links:

UK NRT Pregnancy and Adolescent Use Policy Change Documents:

U.S. NRT Use Policy Change Concerns:

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Written February 18, 2007 and last updated December 26, 2013 last updated December 27, 2013 by John R. Polito