In Utero Exposure to Black Bull Chewing Tobacco and Neonatal Nicotine Withdrawal: A Review of the Literature

Abstract

Among the indigenous people of the Yukon-Kuskokwim Delta area of Alaska, a homemade moist chewing tobacco known as Black Bull or “iq’mik” is widely used. Intake of various tobacco products is reported to be more than 80 percent in pregnant women throughout this area, with up to 60 percent of the pregnant women admitting to regular use of Black Bull. High levels of nicotine, cotinine, heavy metals, and other chemicals are known to pass to the fetus. Neonatal exposure to maternal tobacco use has been studied for the past three decades and has been shown to cause neonatal passive addiction and subsequent withdrawal symptoms. The intensified exposure and withdrawal experienced by infants passively subjected to Black Bull warrant further study.