Smoking In Pregnancy

Cigarette smoking is one of the most dangerous activities encountered during pregnancy. It is also the largest preventable cause of death and illness among American women in general. It is estimated that over 22 million women in this country smoke, and among women of reproductive age (those between the ages of 15-45), almost one-third are smokers.

Over 2,500 chemicals have been identified in cigarette smoke. Most likely, the majority of the adverse effects are attributable to two main ingredients; nicotine and carbon monoxide. During pregnancy, these chemicals decrease the oxygen available to the growing fetus, and increase fetal blood pressure. This leads to several potential problems during pregnancy including increased risk of miscarriage, birth defects, premature delivery, low birth weight, and fetal death. These problems are dose- dependent which means that the more a pregnant woman smokes, the more problems her baby will have.

Mothers who breast feed should be aware that nicotine can reach very high levels in breast milk. Breast-fed infants of smoking mothers do not develop as well as breast-fed infants of non-smoking mothers. In addition, these babies are at twice the risk of death from sudden infant death syndrome (SIDS).

The good news is that if the pregnant mother can quit smoking before the 16th week of pregnancy (the 4th month), many of these potential problems disappear. In fact, most women who smoke will quit when they find out they are pregnant, however, up to 45% do not and continue to put themselves, and their pregnancies at risk.

Nicotine is extremely addictive, similar to the addictive potential of cocaine, but with proper motivation and guidance many people can quit. The backbone of an effective cessation program involves frequent visits with counselors and strong family support. Medications such as nicotine gum or patches are generally not recommended during pregnancy unless prior attempts to quit smoking without medications have failed.

When these medications are used, it should only be under the close supervision of your physician.

References:

Bibliography

1. Williams Obstetrics, 20th Edition, F. Gary Cunningham,M.D. et.al., Appleton & Lange, Stamford, Connecticut, 1997.

2. Smoking In Pregnancy: The Risks And Remedies, R. Nelson, and J. Greenspoon, OBG Management, March 1998, p. 82-86.

3. Smoking and Women’s Health, ACOG Educational Bulletin #240, September 1997.

4. Substance Abuse in Pregnancy, ACOG Technical Bulletin #195, July 1994.