Smoking and Baby Poop

Telltale metabolites in meconium.

Attention pregnant smokers: You can run, but you can’t hide. A chemical analysis of your baby’s first official poop can establish whether your infant has suffered from prenatal exposure to tobacco smoke. The higher the levels of tobacco metabolites, the more likely the mother was an active smoker.

The authors of a study published in Environmental Health found that nicotine and assorted tobacco metabolites were easily detectable in an infant’s meconium, the black, tar-like substance that comprises the first stools from newborns. In a study of 337 babies, tobacco metabolite concentrations were higher in active smokers than in non-smoking women exposed to second-hand smoke only.

The researchers say the meconium method is not superior to other methods of measurements, but suggest it may be a useful adjunct in estimating “gestational exposure to other environmental toxicants that exhibit more variability during pregnancy, especially non-persistent compounds like bisphenol A and phthalates.”

One striking aspect of the study is that the researchers found nicotine and cotinine—a common nicotine metabolite--in most of the meconium samples analyzed. 80% of the samples contained nicotine. So it is not a question of exposure, it’s a question of the degree of exposure. Should we be concerned about the lower levels of exposure registered from second-hand smoke? Apparently so, since “meconium tobacco smoke metabolites were inversely associated with birth weight,” according to Joe M. Braun and coworkers. Braun suggested that additional biomarkers for tobacco exposure were important, based on his belief that tobacco smoke exposure during pregnancy is under-reported.

This looks like a potentially useful tool for epidemiological studies that enroll women and infants at birth. More studies of this kind are needed, because prenatal tobacco smoke exposure is increasingly implicated in “adverse infant and childhood health outcomes.”

Graphics Credit: http://www.youquittwoquit.com/

Life After Cigarettes: Book Review

Why Women Smoke.

Women are different from men. Well, maybe you already knew that.  But did you know that women smoke differently than men, and quit smoking differently than men?

Dr. Joseph Califano, the U.S. Secretary of Health, Education, and Welfare under President Jimmy Carter, once said that even though he gained thirty pounds when he quit cigarettes, he did not then appreciate the importance to women of the link between smoking cessation and weight gain. As Dr. Cynthia Pomerleau, formerly the director of the Nicotine Research Laboratory at the University of Michigan and now Research Professor Emerita in the Department of Psychiatry, remarks in her new book, Life After Cigarettes: “If we’d had a woman HEW Secretary at that time, and she had stopped smoking, I’m sure a thirty-pound weight gain would have grabbed her attention!”

In her book, Dr. Pomerleau makes clear that the challenges of quitting smoking are even greater for women than they are for men. She is refreshingly frank: “Face it; There are definitely some plusses to smoking. If there weren’t, you wouldn’t have done it, and neither would anyone else.”

For women, one of the primary pluses is, and has always been, weight control.  Pomerleau offers up the image of smoking ballerinas, women performing in a business where gaining two pounds can mean the loss of a job. Models, gymnasts, and ice skaters have also looked to cigarettes for help with weight control.

When women quit smoking, here are the facts of the matter: They will begin gaining weight almost the minute they quit—as much as three pounds in the first week—and will stabilize within three to six months. The average weight gain for women, writes Pomerleau, is ten pounds, with a quarter of female quitters gaining five pounds or less, and about a quarter gaining more than 15 pounds.  And the longer women smoke, the harder it is to battle the weight gain when they eventually quit.

The problem, Pomerleau discovered when screening patients for her Nicotine Research Lab, was that 75 per cent of the women who wanted to quit smoking said that they were unwilling to gain more than five pounds while doing so. 40 per cent of the women responded that they were unwilling to gain ANY pounds in pursuit of tobacco abstinence.

In an email exchange with Addiction Inbox, Professor Pomerleau was kind enough to expand on her message.  

When I asked her about reports that the dopamine D2 receptor gene has been implicated in both weight gain and smoking, she responded:

“In a laboratory study of food reward in smokers attempting to quit, Caryn Lerman and colleagues found that carriers of the DRD2 A1 minor allele exhibited significant increases in the rewarding value of food following abstinence from smoking, and that higher levels of food reward after quitting predicted a significant increase in weight by 6-month follow-up in participants receiving placebo.  Both effects were attenuated in participants receiving bupropion, leading them to conclude that bupropion’s efficacy in attenuating abstinence-induced weight gain may be attributable, in part, to decreasing food reward.  How well these findings will hold up to further scrutiny in larger samples remains to be seen.”

On smoking and bulimia: “As I’m sure you’re aware, the question of ‘self-medication’ is a complicated one, but it seems likely that some women ‘use’ nicotine to hold the symptoms of bulimia in check; when they quit, the underlying predisposition reemerges – which helps to explain why these women may be more prone to larger weight gain than other quitting smokers.” 

On smoking as a weight management tool: “Using a variety of different measures, it’s probably safe to say that around 40% of women qualify as serious weight-control smokers.  (The proportion is much lower in men.)  By the way, though findings are mixed, these women don’t necessarily fare worse than other women when they quit, even if they do gain weight; the real challenge is bringing them to the point of even considering quitting.”

And finally, when I asked Professor Pomerleau about the role of primary care physicians in promoting smoking cessation, she noted that she was “concerned about possible attempts to downplay the amount of weight quitters can expect to gain or to overstate the ease with which it can be avoided – which can backfire and lead to relapse when the needle on the scale begins to creep up.  I personally think it’s better to be realistic about the likelihood of weight gain after quitting and to concentrate on keeping it in the 5-10 pound range (approximately one unit of BMI and less than a dress size) – something that is in fact an achievable goal for most women.”

Photo Credit: http://www.mapleplaceventures.com/

Female Smokers and Menstruation

Better to quit after ovulation, study finds.

Women stand a better chance of successfully quitting smoking if they stop during the later phase of their monthly menstrual cycle, according to new research conducted at the University of Minnesota and published in the May 2008 edition of the journal Addiction.

Sharon Allen and co-workers discovered that women who quit smoking right before they start to ovulate--the so-called follicular stage--relapsed more often than women who quit during the "luteal" stage, defined as the two weeks between ovulation and the start of a new cycle. In the study, 86 percent of women who gave up smoking during the follicular phase relapsed during the first 30 days, compared to 66 per cent of women who quit during the later luteal phase.

"Our findings support an important role for ovarian hormones in nicotine addiction and smoking cessation," the authors wrote.

The ebb and flow of estrogen and progesterone during the menstrual cycle can have a direct effect on mood, as evidenced by the well-documented premenstrual syndrome, or PMS. In addition to mood factors, the researchers suggested that female hormones might play a role in the speed with which nicotine is metabolized.

The study of 200 female smokers was conducted by the Tobacco Use Research Center at the University of Minnesota. Earlier work by the group, published in Nicotine & Tobacco Research, had established a strong suspicion that "withdrawal symptomatology in short-term smoking cessation in women is increased in the late luteal phase when pre-menstrual symptomatology is the highest." The group concluded that "it seems prudent to recommend that women quit during the follicular phase of their cycle."

In short, the work suggests that female smokers would be well advised not to inaugurate a quit attempt in the ten days preceding ovulation.

Photo Credit: MedGadget

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