nicotine + smoking
In this section, when we talk about smoking we're talking about tobacco products.
Tobacco is a leafy plant that contains large amounts of nicotine, a stimulant that affects the brain.
Nicotine is found in tobacco products like cigars, cigarettes, snus, spliffs (tobacco + cannabis), and chewing tobacco. It can also be the active ingredient in gums, patches, and e-juice for vaporizers (cartridges and liquids).
How nicotine is consumed changes its effect. Nicotine is most rapidly absorbed - and therefore has its most powerful effects in the brain - when it is inhaled. When it is chewed, the effects are more subtle.
Under the T21 law, retailers in the United States must not sell tobacco products to anyone under the age of 21 - including cigarettes, smokeless tobacco, hookah tobacco, cigars, pipe tobacco, electronic nicotine delivery systems including e-cigarettes and e-liquids.
Tobacco use is common. About 2 out of every 3 adults have tried tobacco. But tobacco use is less common than alcohol use. About 1 out of three adults has been a daily smoker at some point in their lives. Those rates are falling - especially as we understand more clearly the differences between the harms of smoking combustible tobacco and the lower risks of nicotine use.
Because of this evolving understanding, other types of nicotine delivery systems are gaining in popularity. It is generally accepted that these products are much safer than cigarette smoking.
For the purposes of this discussion, “smoking” will refer to use of combustible tobacco products, “smokeless tobacco” shall refer to chewing tobacco and snus, and “nicotine delivery systems” shall refer to patches, gum, and electronic cigarettes.
"Quitting smoking is one of the best things you can do for a healthy pregnancy and a healthy baby.
But that doesn’t make quitting easy. Whether before, during, or after baby, we have the tools and support to help you quit and stay quit."
Pharmacology is a branch of science that deals with the study of drugs and their actions on living systems - that is, the study of how drugs work in the body.
Nicotine is a naturally occurring chemical which acts on nicotinic receptors, with strongest binding capacity in the brain (1).
While nicotine dependence is thought to be the reason smokers continue to smoke, most of the problems associated with smoking are related to smoke inhalation, not nicotine (2-4).
Smoking has been associated with many health problems - primarily cancers, cardiovascular disease, and chronic lung diseases (2).
The hierarchy of risk from greatest to least is thought to be:
no tobacco/nicotine use (1-5).
Nicotine delivery systems include gum, patches, and e-cigarettes.
Use of e-cigarettes is not fully understood, but experts agree that it is likely to be safer than continuing to smoke (2, 4, 5).
There are medications which may be helpful in smoking cessation such as varenicline (6), bupropion (7), and many more.
What you vape matters.
Some vape juices have very highly concentrated nicotine. Some have less - or none.
Unregulated vape products, like those containing vitamin E oil, have been associated with serious respiratory illness.
Most of the information we have about the effects of tobacco and nicotine on pregnancy comes from research about smoking during pregnancy. Most of that research is on pregnant people who smoke cigarettes.
Nicotine is a stimulant found in tobacco. The FDA places nicotine in pregnancy category D.
"Category D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks."
Smoking and use of nicotine products during pregnancy has been linked to:
and respiratory, gastrointestinal, and metabolic disease in offspring (8-11).
While there is insufficient evidence to evaluate the effects of e-cigerettes in pregnancy or lactation, switching from smoking to e-cigarettes results in reduced short term adverse health outcomes and may improve periodontal health (5), which is important in pregnancy.
There is limited evidence of a withdrawal syndrome associated with prenatal exposure to cigarettes (12, 13).
Smoking during lactation has been associated with decreased milk supply and duration of lactation, altered composition of milk, increased incidence of Sudden Infant Death Syndrome (SIDS) and asthma in offspring (10, 14).
Despite the risks, breastfeeding while smoking is considered to be safer than formula feeding while smoking, because of the proven health benefits of breastfeeding, including a 50% reduction in the incidence of SIDS (10, 15, 16).
Nicotine overdose is unlikely with smoking, but could be a concern with contact with or ingestion of e-cigarette liquid, especially for children.
Learn more at PoisonControl.org then make a plan to keep children safe.
Call 1-800-222-1222 to get help.
Nicotine withdrawal is a normal physical and emotional reaction to rapidly quitting,
or significantly reducing, your nicotine intake. It usually happens when you drastically reduce or stop smoking after you've been ingesting nicotine every day for at least several weeks. - VeryWell Mind
1. Narahashi, T., Fenster, C. P., Quick, M. W., Lester, R. A., Marszalec, W., Aistrup, G. L., Sattelle, D. B., Martin, B. R., & Levin, E. D. (2000). Symposium overview: mechanism of action of nicotine on neuronal acetylcholine receptors, from molecule to behavior. Toxicological sciences : an official journal of the Society of Toxicology, 57(2), 193–202.
2. Royal College of Physicians. Harm reduction in nicotine addiction: helping people who can’t quit. A report by the Tobacco Advisory Group of the Royal College of Physicians. London: RCP, 2007
3. Foulds, J., Ramstrom, L., Burke, M., & Fagerström, K. (2003). Effect of smokeless tobacco (snus) on smoking and public health in Sweden. Tobacco control, 12(4), 349–359.
4. Farsalinos, K. E., & Le Houezec, J. (2015). Regulation in the face of uncertainty: the evidence on electronic nicotine delivery systems (e-cigarettes). Risk management and healthcare policy, 8, 157–167.
5. National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Population Health and Public Health Practice, Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems, Eaton, D. L., Kwan, L. Y., & Stratton, K. (Eds.). (2018). Public Health Consequences of E-Cigarettes. National Academies Press (US).
6. Pfizer Labs. (2016). Chantix: Highlights of prescribing information. Retrieved from
7. GlaxoSmithKline. (2016). Zyban: Highlights of prescribing information. Retrieved from
8. Committee on Underserved Women, & Committee on Obstetric Practice (2017). Committee Opinion No. 721: Smoking Cessation During Pregnancy. Obstetrics and gynecology, 130(4), e200–e204.
9. Einarson, A., & Riordan, S. (2009). Smoking in pregnancy and lactation: a review of risks and cessation strategies. European journal of clinical pharmacology, 65(4), 325–330.
10. Section on Breastfeeding (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e827–e841.
11. National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. (2014). The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Centers for Disease Control and Prevention (US).
12. Law, K. L., Stroud, L. R., LaGasse, L. L., Niaura, R., Liu, J., & Lester, B. M. (2003). Smoking during pregnancy and newborn neurobehavior. Pediatrics, 111(6 Pt 1), 1318–1323.
13. Stroud, L. R., Paster, R. L., Papandonatos, G. D., Niaura, R., Salisbury, A. L., Battle, C., Lagasse, L. L., & Lester, B. (2009). Maternal smoking during pregnancy and newborn neurobehavior: effects at 10 to 27 days. The Journal of pediatrics, 154(1), 10–16.
14. Napierala, M., Mazela, J., Merritt, T. A., & Florek, E. (2016). Tobacco smoking and breastfeeding: Effect on the lactation process, breast milk composition and infant development. A critical review. Environmental research, 151, 321–338.
15. Dorea J. G. (2007). Maternal smoking and infant feeding: breastfeeding is better and safer. Maternal and child health journal, 11(3), 287–291.
16. Vennemann, M. M., Bajanowski, T., Brinkmann, B., Jorch, G., Yücesan, K., Sauerland, C., Mitchell, E. A., & GeSID Study Group (2009). Does breastfeeding reduce the risk of sudden infant death syndrome?. Pediatrics, 123(3), e406–e410.