The Long-Term Effects of Prenatal Nicotine Exposure on Neurologic Development


  • Jane Blood-Siegfried RN, CPNP,

    Corresponding author
    1. Associate Clinical Professor in the School of Nursing at Duke University in Durham, NC.
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  • Elizabeth K. Rende RN, CPNP, MSN

    1. Pediatric Nurse Practitioner in the Department of Pediatric Neurology at Duke University in Durham, NC, and an instructor for the University of Phoenix.
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Duke University, School of Nursing, Box 3322, Durham, NC 27710. E-mail:


A large body of documented evidence has found that smoking during pregnancy is harmful to both the mother and the fetus. Prenatal exposure to nicotine in various forms alters neurologic development in experimental animals and may increase the risk for neurologic conditions in humans. There is a positive association between maternal smoking and sudden infant death syndrome (SIDS); however, the connection between nicotine addiction, depression, attention disorders, and learning and behavior problems in humans is not straightforward. Nicotine's action on the production and function of neurotransmitters makes it a prime suspect in the pathology of these diseases. Nicotine accentuates neurotransmitter function in adults but desensitizes these functions in prenatally exposed infants and children. This desensitization causes an abnormal response throughout the lifespan. Furthermore, nicotine use by adolescents and adults can alleviate some of the symptoms caused by these neurotransmitter problems while they increase the risk for nicotine addiction. Although nicotine replacement drugs are used by pregnant women, there is no clear indication that they improve outcomes during pregnancy, and they may add to the damage that occurs to the developing neurologic system in the fetus. Understanding the effects of nicotine exposure is important in providing safe care for pregnant women, children, and families and for developing appropriate smoking cessation programs during pregnancy.