Impact of Nicotine Replacement and Electronic Nicotine Delivery Systems on Fetal Brain Development

Maternal tobacco smoking during pregnancy remains a major public health issue. The neurotoxic properties of nicotine are associated with fetal neurodevelopmental disorders and perinatal morbimortality. Recent research has demonstrated the effects of nicotine toxicity on genetic and epigenetic alterations. Smoking cessation strategies including nicotine replacement therapy (NRT) and electronic nicotine delivery systems (ENDS) show lack of clear evidence of effectiveness and safety in pregnant women. Limited trials using randomized controls concluded that the intermittent use formulation of NRT (gum, sprays, inhaler) in pregnant women is safe because the total dose of nicotine delivered to the fetus is less than continuous-use formulations (transdermal patch). Electronic nicotine delivery systems (ENDS) were hyped as a safer alternative during pregnancy. However, refill liquids of ENDS are suspected to be cytotoxic for the fetus. Animal studies revealed the impact of ENDS on neural stem cells, showing a similar risk of pre- and postnatal neurobiological and neurobehavioral disorders to that associated with the exposure to traditional tobacco smoking during early life. There is currently no clear evidence of impact on fetal brain development, but recent research suggests that the current guidelines should be reconsidered. The safety of NRT and ENDS is increasingly being called into question. In this review, we discuss the special features (pharmacodynamics, pharmacokinetics, and metabolism) of nicotine, NRT, and ENDS during pregnancy and postnatal environmental exposure. Further, we assess their impact on pre- and postnatal neurodevelopment.

Download Full-text

Government intervention in the market for electronic nicotine delivery systems (ENDS). The known, the unknown and challenges

Drugs and Alcohol Today ◽

10.1108/dat-02-2020-0006 ◽

2020 ◽

Vol 20 (3) ◽

pp. 283-294

Author(s):

Ayda A. Yurekli ◽

Patricia Kovacevic ◽

Emil Sunley ◽

Karthik Ranganathan

Keyword(s):

Simulation Analysis ◽

Health Impact ◽

Delivery Systems ◽

Economic Research ◽

Electronic Nicotine Delivery Systems ◽

Content Type ◽

The Public ◽

Premature Deaths ◽

Nicotine Delivery ◽

The Impact

Purpose This paper aims to describe the various government measures that regulate the market for novel tobacco harm reduction products (THRPs), with an emphasis on e-cigarettes [electronic nicotine delivery systems (“ENDS”)], and evaluates the public health impact of excise taxes levied on these products. Design/methodology/approach The paper reviews the economic research on the impact ENDS. Using cited evidence, the paper compares the tax treatment of ENDS and cigarettes and provides a simulation of potential lives that can be saved under alternative tax treatment of ENDS. Findings ENDS are considerably less harmful than cigarettes. Imposing the same tax burden on them (per unit of “harm”) as on cigarettes leads to poorer health outcomes. Differential tax treatment of ENDS will encourage more cigarette smokers to switch to ENDS and could save millions of lives worldwide. Research limitations/implications Country experiences with regulatory measures on ENDS are limited to those with high THRP penetration. The paper’s simulation analysis used evidence from a limited number of studies. Rigorous economic analysis is needed to understand how ENDS could save lives and could prevent expected one billion premature deaths by the end of this century. Originality/value The paper uses research evidence in its analysis of the impact that the differential taxation of cigarettes and ENDS would have. It also provides a rough estimate of the number of lives that could be saved if more smokers who are trying to quit can make the switch to ENDS.

Download Full-text

Electronic nicotine delivery systems and/or electronic non-nicotine delivery systems for tobacco smoking cessation or reduction: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2016-012680 ◽

2017 ◽

Vol 7 (2) ◽

pp. e012680 ◽

Cited By ~ 78

Author(s):

Regina El Dib ◽

Erica A Suzumura ◽

Elie A Akl ◽

Huda Gomaa ◽

Arnav Agarwal ◽

...

Keyword(s):

Systematic Review ◽

Smoking Cessation ◽

Tobacco Smoking ◽

Meta Analysis ◽

Delivery Systems ◽

Electronic Nicotine Delivery Systems ◽

Nicotine Delivery

Download Full-text

Use of electronic nicotine delivery systems by pregnant women II: Hair biomarkers for exposures to nicotine and tobacco-specific nitrosamines

Tobacco Induced Diseases ◽

10.18332/tid/105387 ◽

2019 ◽

Vol 17 (June) ◽

Cited By ~ 8

Author(s):

Melissa Clemens ◽

Victor Cardenas ◽

Lori Fischbach ◽

Ruiqi Cen ◽

Eric Siegel ◽

...

Keyword(s):

Pregnant Women ◽

Delivery Systems ◽

Electronic Nicotine Delivery Systems ◽

Nicotine Delivery ◽

Tobacco Specific Nitrosamines

Download Full-text

Applying the Population Health Standard to the Regulation of Electronic Nicotine Delivery Systems

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa190 ◽

2020 ◽

Author(s):

Zachary Cahn ◽

Jeffrey Drope ◽

Clifford E Douglas ◽

Rosemarie Henson ◽

Carla J Berg ◽

...

Keyword(s):

Population Health ◽

Indirect Effects ◽

Delivery Systems ◽

Status Quo ◽

The State ◽

Electronic Nicotine Delivery Systems ◽

Nicotine Delivery ◽

The Status ◽

The Impact ◽

The U.S

Abstract Regulatory authorities have devoted increasing attention and resources to a range of issues surrounding the regulation of novel nicotine and tobacco products. This review highlights the inherent complexity of evaluating prospective policies that pertain to products that heat solutions containing nicotine but not tobacco leaf, sometimes referred to as electronic nicotine delivery systems (ENDS). The U.S. Food and Drug Administration (FDA) is compelled to incorporate a set of public health criteria in their decision-making, collectively referred to as the Population Health Standard. Adherence to this standard is necessary to estimate the impact of prospective ENDS policy decisions on net population harm associated with non-therapeutic nicotine products. For policies that are expected to decrease or increase ENDS use, application of the Population Health Standard requires a comprehensive assessment of the status quo impact of ENDS use on population health. Accordingly, this review first assesses the state of the evidence on the direct harms of ENDS and the indirect effects of ENDS use on smoking, particularly rates of initiation and cessation. After that, the example of flavor restrictions is used to demonstrate the further considerations that are involved in applying the Population Health Standard to a prospective ENDS policy. Implications This narrative review aims to inform regulatory considerations about ends through the prism of the population health standard. More specifically, this review: 1) describes and explains the importance of this approach; 2) provides guidance on evaluating the state of the evidence linking ends to the net population harm associated with non-therapeutic nicotine products; and 3) illustrates how this framework can inform policymaking using the example of flavor restrictions.

Download Full-text

Protein restriction during pregnancy affects maternal liver lipid metabolism and fetal brain lipid composition in the rat

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.00437.2009 ◽

2010 ◽

Vol 298 (2) ◽

pp. E270-E277 ◽

Cited By ~ 36

Author(s):

Nimbe Torres ◽

Claudia J. Bautista ◽

Armando R. Tovar ◽

Guillermo Ordáz ◽

Maricela Rodríguez-Cruz ◽

...

Keyword(s):

Lipid Metabolism ◽

Brain Development ◽

Liver Lipid ◽

Fetal Brain ◽

Protein Restriction ◽

Brain Lipid ◽

Maternal Liver ◽

Fetal Brain Development ◽

Liver Lipid Metabolism ◽

The Impact

Suboptimal developmental environments program offspring to lifelong metabolic problems. The aim of this study was to determine the impact of protein restriction in pregnancy on maternal liver lipid metabolism at 19 days of gestation (dG) and its effect on fetal brain development. Control (C) and restricted (R) mothers were fed with isocaloric diets containing 20 and 10% of casein. At 19 dG, maternal blood and livers and fetal livers and brains were collected. Serum insulin and leptin levels were determinate in mothers. Maternal and fetal liver lipid and fetal brain lipid quantification were performed. Maternal liver and fetal brain fatty acids were quantified by gas chromatography. In mothers, liver desaturase and elongase mRNAs were measured by RT-PCR. Maternal body and liver weights were similar in both groups. However, fat body composition, including liver lipids, was lower in R mothers. A higher fasting insulin at 19 dG in the R group was observed (C = 0.2 ± 0.04 vs. R = 0.9 ± 0.16 ng/ml, P < 0.01) and was inversely related to early growth retardation. Serum leptin in R mothers was significantly higher than that observed in C rats (C = 5 ± 0.1 vs. R = 7 ± 0.7 ng/ml, P < 0.05). In addition, protein restriction significantly reduced gene expression in maternal liver of desaturases and elongases and the concentration of arachidonic (AA) and docosahexanoic (DHA) acids. In fetus from R mothers, a low body weight (C = 3 ± 0.3 vs. R = 2 ± 0.1 g, P < 0.05), as well as liver and brain lipids, including the content of DHA in the brain, was reduced. This study showed that protein restriction during pregnancy may negatively impact normal fetal brain development by changes in maternal lipid metabolism.

Download Full-text

The impact of price and tobacco control policies on the demand for electronic nicotine delivery systems

Tobacco Control ◽

10.1136/tobaccocontrol-2013-051515 ◽

2014 ◽

Vol 23 (suppl 3) ◽

pp. iii41-iii47 ◽

Cited By ~ 67

Author(s):

Jidong Huang ◽

John Tauras ◽

Frank J Chaloupka

Keyword(s):

Tobacco Control ◽

Delivery Systems ◽

Control Policies ◽

Electronic Nicotine Delivery Systems ◽

Nicotine Delivery ◽

Tobacco Control Policies ◽

The Impact

Download Full-text

The impact of flavour, device type and warning messages on youth preferences for electronic nicotine delivery systems: evidence from an online discrete choice experiment

Tobacco Control ◽

10.1136/tobaccocontrol-2017-053754 ◽

2017 ◽

Vol 27 (e2) ◽

pp. e152-e159 ◽

Cited By ~ 19

Author(s):

Ce Shang ◽

Jidong Huang ◽

Frank J Chaloupka ◽

Sherry L Emery

Keyword(s):

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Delivery Systems ◽

Electronic Nicotine Delivery Systems ◽

Health Warning ◽

Warning Messages ◽

Nicotine Delivery ◽

Device Type ◽

The Impact

ObjectiveTo examine the impact of flavour, device type and health warning messages on youth preference for electronic nicotine delivery systems (ENDS), and to provide evidence and data to inform the Food and Drug Administration’s potential regulatory actions on ENDS.DesignAn online discrete choice experiment was conducted in September 2015. Each participant was given nine choice sets and asked to choose one out of two alternative ENDS products, with varying characteristics in three attributes (flavour, device type and warning message). The impact of the attributes on the probability of choosing ENDS was analysed using conditional and nested logit regressions, controlling for individual sociodemographic characteristics and current smoking status.Setting and participantsA general population sample of 515 participants (50 ever-users and 465 never-users of ENDS) aged 14–17 years were recruited to complete the experiment using an online panel.ResultsFruit/sweets/beverage flavours significantly increase the probability of choosing ENDS among youth (p<0.01 for never-users and <0.1 for ever-users) and flavour has the most pronounced impact among three attributes. Among never-users, menthol flavour also increases (p<0.05) the probability of choosing ENDS compared with tobacco flavour. Vaping devices that are modifiable, compared with cigarette-like e-cigarettes, increase (p<0.05) the probability of choosing ENDS among adolescent never-users. Warning messages reduce (p<0.01) the probability of choosing ENDS among never-users.Conclusions and relevanceRestricting fruit/sweets/beverage flavours in ENDS, regulating modifiable vaping devices and adopting strong health warning messages may reduce the uptake of ENDS among youth.

Download Full-text

Fluctuation between cigarette smoking and use of electronic nicotine delivery systems: Impact on clozapine concentrations and clinical effect

Mental Health Clinician ◽

10.9740/mhc.2021.11.365 ◽

2021 ◽

Vol 11 (6) ◽

pp. 365-368

Author(s):

Daniel J. Montville ◽

Jaclyn M. Lindsey ◽

Jonathan G. Leung

Keyword(s):

Delivery System ◽

Health Care Professionals ◽

Psychiatric Symptoms ◽

Delivery Systems ◽

Serum Concentrations ◽

Hydrocarbon Production ◽

Electronic Nicotine Delivery Systems ◽

Nicotine Delivery ◽

Polycyclic Aromatic ◽

The Impact

Abstract Unlike with smoking cigarettes, electronic nicotine delivery systems do not cause CYP450 1A2 induction as there is a lack of combustion and polycyclic aromatic hydrocarbon production. Changing to the use of an electronic nicotine delivery system from cigarettes can result in the deinduction of CYP450 1A2 and the increase of certain medication serum concentrations, including clozapine. A case is reported in which the switch from smoking to an electronic nicotine delivery system resulted in increased clozapine serum concentration and constipation, necessitating pharmacologic management. The patient ultimately transitioned back to cigarettes, which resulted in the emergence of psychiatric symptoms. An evaluation of longitudinal serum concentrations and clinical correlation is provided. It is important that patients and health care professionals have knowledge not only about the impact of smoking cigarettes on clozapine metabolism, but also the effects of switching to or from an electronic nicotine delivery system.

Download Full-text