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

Introduction:
This text provides an analysis of the current knowledge about Nicotine Replacement Therapy (NRT) and Electronic Nicotine Delivery Systems (ENDS) and their impact on fetal brain development. The review includes international guidelines on tobacco smoke cessation and scientific studies published from the year 2000 until now. The text also summarizes the pharmacokinetics and dynamics of nicotine, NRT, and ENDS during pregnancy and postnatal environmental exposure.

Key Points:

* The neurotoxic properties of nicotine are associated with fetal neurodevelopmental disorders and perinatal morbimortality.
* Recent research has demonstrated the efacts of nicotine toxicity on genetic and epigenetic alterations.
* Smoking cessation strategies including NRT and 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.

Main Message:
The text highlights the lack of clear evidence of effectiveness and safety of NRT and ENDS during pregnancy. While some studies suggest that intermittent use of NRT and certain ENDS may be safe, others raise concerns about their potential negative impact on fetal brain development. The text emphasizes the need for further research and cautious consideration when recommending these smoking cessation strategies to pregnant women.

Sailer S, Sebastiani G, andreu-Férnández V, García-algar O. Impact of Nicotine Replacement and Electronic Nicotine Delivery Systems on Fetal Brain Development. International journal of environmental research and public health. 2019;16(24). doi:10.3390/ijerph16245113