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Pregnancy Timeline by SemestersDevelopmental TimelineFertilizationFirst TrimesterSecond TrimesterThird TrimesterFirst Thin Layer of Skin AppearsEnd of Embryonic PeriodEnd of Embryonic PeriodFemale Reproductive SystemBeginning Cerebral HemispheresA Four Chambered HeartFirst Detectable Brain WavesThe Appearance of SomitesBasic Brain Structure in PlaceHeartbeat can be detectedHeartbeat can be detectedFinger and toe prints appearFinger and toe prints appearFetal sexual organs visibleBrown fat surrounds lymphatic systemBone marrow starts making blood cellsBone marrow starts making blood cellsInner Ear Bones HardenSensory brain waves begin to activateSensory brain waves begin to activateFetal liver is producing blood cellsBrain convolutions beginBrain convolutions beginImmune system beginningWhite fat begins to be madeHead may position into pelvisWhite fat begins to be madePeriod of rapid brain growthFull TermHead may position into pelvisImmune system beginningLungs begin to produce surfactant
CLICK ON weeks 0 - 40 and follow along every 2 weeks of fetal development


Pregnant nicotine exposure higher than reported

More women may be smoking and/or exposed to nicotine during pregnancy than previously thought, says a new study from Cincinnati Children's Hospital in collaboration with Cradle Cincinnati.

The study reveals a significant gap between the number of local, pregnant mothers who report smoking during pregnancy and the number who test positive for nicotine exposure.

"This is extremely important new information for us as we work to better understand risk factors for preterm birth," said Jim Greenberg, MD, director of the Perinatal Institute at Cincinnati Children's and senior author of the study. "We have long suspected that smoking during pregnancy is under-reported, but now we know just how many women struggle to quit smoking when they are pregnant."

The study, published online in the Journal of Perinatology, detected high-level nicotine exposure for 16.5 percent of women in the study and low-level exposure for an additional 7.5 percent. Only 8.6 percent, however, admitted to using cigarettes.

The study suggests that tools researchers use to estimate nicotine exposure do not accurately capture all smoking means, including e-cigarettes.

Researchers studied 708 women who gave birth at a single maternity hospital in southwest Ohio between March 2014 and August 2015. Birth records in Ohio include those women who self-report last trimester cigarette smoking. But also in southwest Ohio, all maternity centers collect maternal urine samples for drug testing to catch increases in prenatal exposure to opioids. Cotinine is a metabolized byproduct of tobacco exposure measured in urine and in blood. Centers were therefore able to detect nicotine exposure in urine alone.

"Studies show that smoking increases the risk of preterm birth by over 25 percent. It is also a proven risk factor for sudden infant deaths (SIDS) and birth defects. All three of the leading causes of infant death are negatively affected by tobacco use. To learn the true size of the battle we are fighting is an important first step."

Todd Portune, Hamilton County Commissioner and chair of Cradle Cincinnati.

The study highlighted the importance of public health efforts to decrease tobacco and e-cigarette particularly among pregnant minority women. African American women previously self-reported tobacco use rates of 7.9 percent, but the number rose to 21.1 percent after measurement of cotinine.

Added Dr. Greenberg: "The public health community has long assumed targeted campaigns toward minority women were not needed because we've relied on self-reported data. This new information suggests that approach is profoundly incorrect. New support needs to be offered to a population that's too often ignored when it comes to anti-smoking efforts."

Centers for Disease Control and Prevention
The CDC advises smoking can make it harder for a woman to become pregnant and can affect her baby's health before and after birth as it increases risk for the following:

• Preterm (early) delivery
• Stillbirth (death of the baby before birth)
• Low birth weight
• Sudden infant death syndrome (SIDS or crib death)
• Ectopic pregnancy
• Orofacial clefts in infants

The study also revealed an additional 7.5 percent of women, not minorities, also tested positive for secondhand smoke during pregnancy, bringing total smoke exposure up to nearly one in four women.

Anyone trying to quit smoking during pregnancy can call 1-800-QUIT-NOW to receive personalized support to help them quit during the crucial months of pregnancy — when all systems of a fetus are developing.

The objective of this study was to evaluate the prevalence of late pregnancy nicotine exposures, including secondhand smoke exposures, and to evaluate the associated risk of exposure to drugs of abuse.

Study Design: The study was a retrospective single-center cohort analysis of more than 18 months. We compared self-reported smoking status from vital birth records with mass spectrometry laboratory results of maternal urine using a chi-square test. Logistic regression estimated adjusted odds for detection of drugs of abuse based on nicotine detection.

Results: Compared with 8.6% self-reporting cigarette use, mass spectrometry detected high-level nicotine exposures for 16.5% of 708 women (P<0.001) and an additional 7.5% with low-level exposures. We identified an increased likelihood of exposure to drugs of abuse, presented as adjusted odds ratios, (95% confidence interval (CI), for both low-level (5.69, CI: 2.09 to 15.46) and high-level (13.93, CI: 7.06 to 27.49) nicotine exposures.

Conclusion: Improved measurement tactics are critically needed to capture late pregnancy primary and passive nicotine exposures from all potential sources.

The study was funded by the Amgis Foundation of Medina, NY.

About Cincinnati Children's
Cincinnati Children's, a non-profit, pediatric, academic medical center established in 1883, is internationally recognized for improving child health and transforming delivery of care through fully integrated, globally recognized research, education and innovation. It is one of the top three recipients of pediatric research grants from the National Institutes of Health, ranked third in the nation among all Honor Roll hospitals in U.S. News and World Report's Best Children's Hospitals, and a research and teaching affiliate of the University of Cincinnati's College of Medicine. Its patient population includes the eight-county primary service area covering parts of Ohio, Kentucky and Indiana. A destination for children with complex medical conditions, it also served patients from all 50 states and nearly 70 countries during the past year. Additional information can be found at http://www.cincinnatichildrens.org. Connect on the Cincinnati Children's blog, via Facebook and on Twitter.

About Cradle Cincinnati
Cradle Cincinnati, launched in June of 2013, is a partnership between Hamilton County, the City of Cincinnati, UC Health, Cincinnati Children's Hospital Medical Center, The Christ Hospital, TriHealth, Mercy Health, Hamilton County Public Health, the Cincinnati Health Department, the UC College of Nursing, the United Way, Interact for Health, the Greater Cincinnati Foundation, and the Greater Cincinnati Health Council.

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Jul 21, 2016   Fetal Timeline   Maternal Timeline   News   News Archive   

Maternal urine samples collected to monitor possible opioid use reveal more pregnant women
than expected are being exposed to e-cigarettes, cigarette smoke - or are smoking themselves.
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