2003/12/01 by Kenneth F. Ilett · 82 citations
Medicine · Biochemistry, Genetics and Molecular Biology · Chemistry · #Smoking Behavior and Cessation #Nicotinic Acetylcholine Receptors Study #Breastfeeding Practices and Influences #Cotinine #Nicotine #Medicine #Nicotine patch #Breast milk #Smoking cessation #Physiology #Breast feeding #Animal science #Anesthesia #Obstetrics #Internal medicine #Pediatrics #Chemistry #Biology
paper · doi:10.1016/j.clpt.2003.08.003
published in Clinical Pharmacology & Therapeutics 74(6), 516-524 (Wiley)
openalex publication_date 2003/12/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/29
OBJECTIVE: Our objective was to assess the extent of exposure to nicotine and cotinine in breast-fed infants during maternal smoking and later during maternal use of the nicotine transdermal patch to achieve smoking cessation. METHODS: Fifteen lactating women (mean age, 32 years; mean weight, 72 kg) who were smokers (mean of 17 cigarettes per day) participated in a trial of the nicotine patch to assist in smoking cessation. Serial milk samples were collected from the women over sequential 24-hour periods when they were smoking and when they were stabilized on the 21-mg/d, 14-mg/d, and 7-mg/d nicotine patches. Nicotine and cotinine in milk were quantified by HPLC, and infant dose was calculated. Plasma concentrations of nicotine in the breast-fed infants were assessed, and the infants were also clinically assessed. RESULTS: Nicotine and cotinine concentrations in milk were not significantly different between smoking (mean of 17 cigarettes per day) and the 21-mg/d patch, but concentrations were significantly lower (P <.05) when patients were using the 14-mg/d and 7-mg/d patches than when smoking. There was also a downward trend in absolute infant dose (nicotine equivalents) from smoking or the 21-mg patch through to the 14-mg and 7-mg patches (P <.05 at both 14-mg and 7-mg doses, compared with smoking). Milk intake (shown as median and 25th to 75th percentile) by the breast-fed infants was similar while their mothers were smoking (585 mL/d [507-755 mL/d]) and subsequently when their mothers were using the 21-mg (717 mL/d [504-776 mL/d]), 14-mg (731 mL/d [535-864 mL/d]), and 7-mg (619 mL/d [520-706 mL/d]) patches (chi(2) = 3.19, P =.364). CONCLUSIONS: We conclude that the absolute infant dose of nicotine and its metabolite cotinine decreases by about 70% from when subjects were smoking or using the 21-mg patch to when they were using the 7-mg patch. In addition, use of the nicotine patch had no significant influence on the milk intake by the breast-fed infant. Undertaking maternal smoking cessation with the nicotine patch is, therefore, a safer option than continued smoking.