Nicotine replacement therapy and e-cigarettes in pregnancy and infant respiratory outcomes

Abstract Background Nicotine replacement therapy (NRT) and e-cigarettes are recommended to pregnant women who wish to stop smoking. Albeit eliminating other harmful components of cigarettes, those alternatives still expose the developing fetus to nicotine. The lungs may be particularly vulnerable to damage by nicotine as there is widespread nicotinic-acetylcholine receptor expression in the lungs. There is, however, a paucity of information about the effect of NRT and e-cigarette use in pregnancy on infant respiratory outcomes. Aims To explore the effect of NRT and e-cigarettes on the developing lung. Study design A literature search was undertaken to examine the use and safety of nicotine-replacement strategies in pregnancy, with a focus on infant respiratory outcomes. This included experimental studies investigating the effect of isolated “gestational” nicotine on the developing lung. Outcome measures Respiratory outcomes in animal studies and infants. Results Animal studies investigating the effect of gestational nicotine exposure on fetal lung development demonstrated abnormal lung growth; including abnormal airway branching and alveolar development. Consequently, offspring display altered pulmonary mechanics, including both increased respiratory rate and airway resistance. These findings mirror respiratory pathology observed in infants born to smoking mothers. Human trials of NRT and e-cigarette use in pregnancy have not identified adverse perinatal outcomes regarding reduced birthweight or prematurity, but have not considered infant and childhood respiratory outcomes. Conclusions Nicotine can impair fetal lung development, leading to concerns regarding the safety of NRT and e-cigarettes in pregnancy. Studies have yet to explore the impact of these nicotine-containing products on infant respiratory outcomes.