Born Under a Cloud: Neurophysiological Consequences of Maternal Smoking on Neonatal Sleep and EEG Patterns

Sleep is a fundamental physiological process critical for central nervous system maturation and optimal cognitive development. It is known that nicotine, as a psychoactive substance, alters central signaling pathways and sleep physiology. Therefore, smoke exposure during pregnancy and breastfeeding is believed to negatively impact the newborn’s sleep architecture. In this study, we investigated the effects of indirect prenatal and postnatal nicotine exposure on sleep architecture and quantitative EEG characteristics in 28 newborns (≥37 weeks postmenstrual age), including 14 newborns born to mothers who smoked, and 14 newborns born to non-smoking mothers. Each newborn underwent a three-hour observational sleep assessment and a 64-channel EEG recording. We compared the duration of sleep stages and quantitative EEG parameters between the two groups. Newborns of smoking mothers spent a greater proportion of time in wakefulness and drowsiness and a reduced proportion in quiet sleep. Quantitative EEG analysis revealed that these newborns exhibited increased power in the theta and alpha frequency bands, decreased power in the delta frequency band, elevated spectral edge frequency (SEF 90), reduced global brain network efficiency in the alpha frequency band, and diminished fronto-temporal connectivity in the right hemisphere within the delta frequency band. Our findings indicate that maternal smoking alters sleep patterns and brain activity in newborns, which could potentially have a long-term influence on central nervous system development in infancy and childhood. • Neonatal exposure to nicotine disrupts early sleep architecture and brain function, which reflects in quantitative EEG measures and sleep-wake cycling. • High-density EEG seems to detect the influence of maternal smoking on brain connectivity and network characteristics in newborns. • Changes such as reduced quiet sleep and altered EEG patterns in newborns exposed to nicotine may indicate early neurophysiological dysfunction, potentially elevating the risk of cognitive, behavioral, and developmental difficulties later in life.