Iqmik - A form of smokeless tobacco used by pregnant Alaska natives: Nicotine exposure in their neonates

Objective. To determine the concentration of nicotine and cotinine in maternal blood and neonatal cord blood among pregnant Alaska Native women and to assess the neonates for neurobehavioral effects. Methods. In a nonrandomized, clinical observational pilot trial, 60 pregnant Alaska Native women were enrolled for assessment of Iqmik (a mixture of leaf tobacco and ash) and other tobacco use during pregnancy and at delivery. Neonatal cord blood, nicotine and cotinine concentrations were obtained, and neonatal neurobehavioral effects were assessed using the Lipsitz scale. Results. At delivery, there were 22 subjects who reported using only Iqmik, and 10 who used other tobacco products. Subjects who reported using only Iqmik prior to delivery had higher concentrations of cotinine (167 ± 116 vs. 81 ± 100) in maternal blood (rank sum test, p = 0.036) and higher concentrations of nicotine (8.4 ± 7.3 vs. 4.4 ± 5.1, p = 0.048) and cotinine (153 ± 115 vs. 70 ± 95, p = 0.048) in cord blood compared to subjects who reported using other tobacco products. Neurobehavioral signs as assessed by the Lipsitz score were increased in neonates born to mothers using only Iqmik (3.7 ± 1.8, p = 0.011), or to mothers using other tobacco products (3.4 ± 1.4, p = 0.034) compared to neonates born to women who reported no tobacco use (1.8 ± 1.4). Conclusions. Mothers who use Iqmik and their neonates have higher cotinine concentrations compared to mothers who use cigarettes and/or other forms of tobacco. Neurobehavioral signs occur in neonates born to women who use Iqmik but also in neonates born to mothers who use other forms of tobacco during pregnancy.