To the Editor.
—Benowitz1 recently suggested in an intriguing report submitted to the Food and Drug Administration Drugs of Abuse Advisory Committee that nicotine replacement therapy may provide a beneficial aid for pregnant women wishing to cease smoking. In this report, it is stated that "smoking does not appear to increase the risk of teratogenicity."We acknowledge that studies on the independent association of maternal smoking and the occurrence of congenital anomalies have yielded conflicting results.2,3 However, nicotine has been associated with a teratogenic effect on the developing embryo for over three decades.4 Current studies on rat embryos in culture5 and on fetuses of pregnant mice6 continue to support the contention that nicotine acts as a teratogen. We therefore believe that the issue of whether nicotine leads to congenital abnormalities remains uncertain.Altering maternal smoking behavior is one of the major goals of antenatal care,
Seidman DS, Stevenson DK. Nicotine Replacement Therapy During Pregnancy. JAMA. 1992;267(14):1922. doi:10.1001/jama.1992.03480140048027