Indian baby born with 30 times safe level of nicotine for adults in blood

A baby girl whose condition became critical soon after birth was found to have 30 times more nicotine in her blood than is considered safe for adults, according to doctors who treated her in India’s Gujarat state.

She was delivered by Caesarean section on June 20 at a private hospital in Mehsana district of Gujarat on June 20, after her mother reported that she had not felt any movement from her child in two days.

The newborn failed to cry and turned blue, doctors said. She was put on a ventilator and taken to the Arpan Newborn Care Centre, a neonatal hospital in Gujarat's main city of Ahmedabad.

Doctors at the centre initially suspected that the baby suffered from birth asphyxiation – a condition in which a newborn does not get enough oxygen – but her unusual symptoms prompted further tests that found very high levels of nicotine in her body.

The baby had a blood nicotine level of 60 nanograms per millilitre, 30 times the permissible levels for adults, which doctors discovered was the result of her mother's heavy use of chewing tobacco.

“The baby had a flat birth, meaning her heart was beating but she wasn’t breathing adequately, and immediately turned blue because the lungs were not expanding,” Dr Ashish Mehta, senior neonatologist at the centre, told The National.

He said the paediatrician attending the girl's birth put her on a ventilator and placed her in the intensive care unit, but after six hours her blood pressure began to fall.

“We expect this clinical behaviour in a case where the baby is not oxygenated in the womb – what is known as birth asphyxia. The baby will have poor muscle tone and no reflexes. But when we received her, we found that she was in a deeply comatose stage but her reflexes were still all right. We thought this must be something else.”

Dr Mehta said inquiries about the 30-year-old mother's medical history revealed that she was addicted to chewing tobacco and was using it during her pregnancy.

“The doctor just mentioned that there is an asthma medication and the mother is also on gutkha, or tobacco. She had been taking tobacco since school days and was taking 10 to 15 packets of tobacco and rubbing it on her gums. That gave me some clue that tobacco was the culprit for this kind of reaction,” he said.

“There is no mention of such a thing in [medical] literature,” he said, pointing out that studies of substance abuse in pregnant women generally covered addictions to drugs such as cocaine, alcohol and antidepressants.

He said the level of nicotine detected in the newborn was so high that the test was run a second time.

“First time the lab didn't disclose the report because they wanted to recheck the sample. After one hour, we repeated the sample. It was 60 nanograms per millilitre – the adult permissible values less than three 0.3 to three,” Dr Mehat said.

The baby started showing signs of recovery after five days of treatment and was discharged on June 1.

Dr Mehta believes it is the first known case where a foetus was exposed to tobacco.

India accounts for one third of oral cancer cases in the world, and Gujarat has the highest incidence of oral cancer in the country, according to the government-run Gujarat Biotechnology Research Centre.

About 41 per cent of men and 9 per cent of women in the state consumed tobacco in 2020, according to the National Family Health Survey.

“The purpose of highlighting this case is to bring to the notice of parents that they should be careful,” Dr Mehta said.