NICOTINE POISONING IN PREGNANCY

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(Date of issue: June 2018, Version: 1.2)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

Summary

Nicotine is an alkaloid obtained from the dried leaves of the tobacco plant, present in cigarettes, nicotine replacement therapy (gum, patches, inhalers, nasal sprays), traditional herbal remedies and insecticides.

Nicotine is highly toxic by ingestion, inhalation and skin contact.  The fatal dose of nicotine has been estimated to be as little as 40mg in an adult, however ingestion of just a few milligrams can cause severe symptoms. There are no reported cases that specifically describe nicotine poisoning during human pregnancy.

There is a wealth of data concerning fetal effects of tobacco exposure during pregnancy, however nicotine is one of many harmful components of cigarette smoke and the dose of nicotine delivered via smoking is lower than in a poisoning scenario.  Please consult the specific UKTIS documents on tobacco and nicotine replacement therapy in pregnancy for further details.

Following nicotine poisoning in a pregnant patient, maternal toxicity is likely to be a major determinant of fetal risk.  Given that chronic low-level nicotine exposure is associated with adverse fetal effects, it is possible that nicotine poisoning in the absence of severe maternal symptoms may also be associated with a teratogenic effect.  Given the paucity of data regarding exposure in this context, it is not possible to predict the likelihood of an adverse effect on fetal development.  In all cases of nicotine poisoning in pregnancy, extended maternal and fetal monitoring may be warranted.  Discussion with UKTIS is recommended in all cases.

This document is regularly reviewed and updated. Only use full UKTIS monographs downloaded directly from TOXBASE.org to be sure you are using the most up-to-date version. The summaries of these monographs are openly available on UKTIS.org.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.