“…The independent biological effects of prenatal alcohol and nicotine exposure converge at multiple levels including: (1) neurochemical, affecting properties of nicotinic acetylcholine receptors (nAchRs) and other neurotransmitters that affect cardiorespiratory control, sleep, arousal, and other vital functions; [19À22] (2) hormonal, activating neuroendocrine pathways associated with the hypothalamic-pituitary-adrenal axis and homeostatic stress responses; [23À26] and (3) immunological, affecting immune, inflammatory, and infectious responses [27À29]. Maternal smoking and alcohol consumption also have direct effects on the placenta including placental perfusion, weight, and structure [27,28,30]. Whether and to what extent these physiological actions converge in a fetus to adversely affect its development and survival are currently unknown as are the effects of precise timing and amount of the dual exposures.…”