Maternal smoking during pregnancy represents a serious health hazard for the fetus and the neonate; its consequences may persist well into later life. Environmental tobacco smoke is also a threat to pre- and postnatal life. Although tobacco smoke contains thousands of compounds whose effects have not been fully studied, most of its detrimental effects are presumed to be mediated by nicotine. Cotinine, a nicotine metabolite, is used as a biomarker of tobacco exposure, and it has allowed an objective measure of smoke-related adverse events spanning from preterm birth, intrauterine growth retardation, and low birth weight to congenital malformations. Deficient cardiovascular and respiratory functions have also been linked to intrauterine and neonatal exposure to tobacco smoke such as an increased risk of metabolic syndrome in adulthood. Nicotine’s complex interaction with fetal and neonatal neurotransmitters induces behavioral alterations in the newborn period and may help to explain the higher incidence of SIDS and ADHD described in offspring of smoking mothers.
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