Effects of Transdermal Nicotine or Smoking on Nicotine Concentrations and Maternal-Fetal Hemodynamics
Abstract
OBJECTIVE: To compare nicotine concentrations and fetal middle cerebral artery resistance indices (RIs) during 21-mg transdermal nicotine use with these values during maternal smoking. METHODS: In this randomized, crossover study, participants smoked approximately 20 cigarettes daily and were between 24 and 36 weeks' gestation. Subjects were randomized to transdermal nicotine or to smoking ad libitum for 8 hours. One week later, they crossed over to the other condition. Maternal plasma nicotine concentrations and hemodynamic measurements were obtained before and after the onset of smoking or patch placement. RESULTS: Area under the plasma nicotine concentration-time curve during patch use was similar to continued smoking (93 versus 89 ng-hour/mL, respectively) (P = .77). The mean (standard error [SE] change in the middle cerebral artery RI from baseline to 4 hours later was similar during patch use and smoking: -.002 (0.008) versus -.02 (0.015), respectively (P = .3). The study had greater than 80% power to detect a 25% difference in nicotine concentrations and a change of 2 standard deviations in the middle cerebral artery RI between conditions. An unexpected finding was that of a loss of fetal heart rate (FHR) reactivity in 5/8 tracings after patch placement versus 1/6 tracings after smoking (P = .12). The baseline FHR increased by a mean (SE) of 8 (4) beats per minute with loss of reactivity in the patch condition, compared with a decrease of 3 (3) beats per minute without loss of reactivity (P = .05). CONCLUSION: Eight-hour use of 21-mg transdermal nicotine yields nicotine concentrations and middle cerebral artery RIs similar to those produced by hourly smoking in pregnant smokers.
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In Oncken 1997, there was no significant difference between FVW S:D ratios for each group at baseline.
“No significant difference: between FVW S : D ratios for | each group at baseline.”
From Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis. (2021) · cites this paper as [46]
In Oncken 1997, all changes returned to baseline by 10 minutes.
“All changes returned | to baseline by 10 minutes”
From Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis. (2021) · cites this paper as [46]
In Oncken 1997, there was a significant increase in mean umbilical artery FVW S:D ratio after smokers chewed gum (P < 0.01) and when those who smoked >10/day smoked a cigarette (P < 0.05).
“Significant increase in mean umbilical artery FVW | S : D ratio (indicating possible increased fetal cardiac | contractility) after smokers chewed gum (P < 0.01) | and when those who smoked >10/day smoked | cigarette (P < 0.05)”
From Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis. (2021) · cites this paper as [46]
In Oncken 1997, there was no significant increase in uterine artery FVW S:D ratios.
“but no significant increase in | uterine artery FVW S : D ratios.”
From Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis. (2021) · cites this paper as [46]
In Oncken 1997, there was no significant difference between maternal or fetal heart rates during any study period.
“Between maternal or fetal HRs during any study period”
From Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis. (2021) · cites this paper as [46]
In Oncken 1997, there were significant time effects for systolic blood pressure and maternal heart rate (both P < 0.001) with maximum increases of 5 and 6 mmHg and 10-11 beats/minute 2 hours after baseline measurement in both groups.
“Significant time effects for systolic BP and | maternal HR (both P < 0.001) with max. increases of | 5 and 6 mmHg and 10-11 beats/minute 2 hours | after baseline measurement in both groups.”
From Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis. (2021) · cites this paper as [46]
In Oncken 1997, the change in middle cerebral artery RI from baseline to 4 hours later was similar during patch use and smoking.
“The change in middle cerebral artery RI | from baseline to 4 hours later was similar during | patch use and smoking.”
From Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis. (2021) · cites this paper as [46]
In Oncken 1997, diastolic blood pressure also changed significantly over time in both groups (P = 0.007).
“Diastolic | BP also changed significantly over time in both groups | (P = 0.007).”
From Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis. (2021) · cites this paper as [46]
In Oncken 1997, time effects were significant for the middle cerebral artery RI (P = 0.02) and the uterine artery RI (P = 0.02).
“Time effects | were significant for the middle cerebral artery RI | (P = 0.02) and the uterine artery RI (P = 0.02).”
From Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis. (2021) · cites this paper as [46]
In Oncken 1997, there were no group differences in Doppler measurements of the middle cerebral, umbilical and uterine arteries.
“There were no group | differences in Doppler measurements of the middle | cerebral, umbilical and uterine arteries.”
From Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis. (2021) · cites this paper as [46]
In Oncken 1997, there were no clinically significant adverse effects or pregnancy complications.
“No clinically significant | adverse effects/pregnancy complications”
From Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis. (2021) · cites this paper as [46]
In Oncken 1997, systolic and diastolic blood pressure and maternal heart rate were not significantly different between nicotine patch use and smoking.
“Systolic and diastolic BP and maternal HR not | significantly different between nicotine patch use/ | smoking.”
From Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis. (2021) · cites this paper as [46]
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- Authors
- ONCKEN, C.
- Affiliations
- University of Minnesota (US)
- Corresponding author
- ONCKEN, C
- ORCID
- ONCKEN, C
- Venue
- Obstetrics & Gynecology
- Published
- 1997-10
- Volume
- 90
- Issue
- 4
- Pages
- 569-574
- ISSN
- 0029-7844 (ISSN-L)
- OpenAlex
- W1989920581
- Cited by
- 77
- References
- 19
- Citations by year
- 2024: 1 · 2022: 1 · 2021: 1 · 2020: 2 · 2018: 2 · 2017: 1 · 2016: 3 · 2015: 2 · 2014: 2 · 2013: 1
- FWCI
- 5.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Research Resources (M01RR006192, M01 RR 06192)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- transdermal nicotine, nicotine patch, maternal smoking, pregnancy, fetal hemodynamics, fetal heart rate reactivity, fetal growth restriction
- MeSH terms
- Administration, Cutaneous, Adult, Cerebral Arteries, Female, Fetus, Heart Rate, Fetal, Hemodynamics, Humans, Nicotine, Pregnancy, Smoking, Vascular Resistance, Cross-Over Studies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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