Pregnant Smoke

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In the late 1990s, a strong push began to discourage smoking. Restrictions on advertising tobacco products and where individuals could smoke began to take effect. Today, nearly all restaurants, bars, parks, schools, and hospital campuses are smoke-free zones. Occasionally, you’ll see people in their cars or outside bars and restaurants smoking, but it’s less likely to see smokers in public than it was 30 years ago.
Naturally, I was intrigued when a CNN reporter reached out to me to discuss the surprising number of women who smoke during pregnancy. According to data from the Centers for Disease Control and Prevention (CDC), as many as 7 percent of women reported that they smoked during their pregnancies in 2016. That’s one in 14 pregnant women.
Pregnant women were asked whether they smoked during any of the trimesters of pregnancy, and, if they did, it was marked on their child’s birth certificate that the mother was a smoker. The data were not tied back to blood samples, infant birth weight, or other physical data – it was all self-reported. This leads me to think that the numbers might be seriously underreported due to the stigma associated with smoking. Assuming that’s the case, doctors must do a better job of supporting women who want to quit smoking and educating them about the short- and long-term health consequences if they don’t – both to them and their babies.
The CDC data showed wide state-by-state variation in reported rates of smoking during pregnancy. West Virginia was the highest at 25.1 percent, and California was the lowest at 1.6 percent. It’s interesting to compare these with data for all adults who smoke because there are some inconsistencies.
In West Virginia, the rates both of pregnant women and all adults who smoke are high. However, in Louisiana, the rate of smoking during pregnancy is less than 7 percent, and the adult smoking rate is almost 23 percent. It makes me curious whether doctors in Louisiana have strong programs to help women quit or whether there is a severe stigma against smoking during pregnancy that has led to extreme underreporting.
Sometimes health questions that lead to answers that are considered unhealthy behaviors, such as smoking during pregnancy, result in a bias of underreporting. Women might be embarrassed to tell their doctors if they smoke or fear repercussions for telling the truth. It’s vital to understand that the doctor is not there to judge you or get you in trouble. 
We’re here to help women have the healthiest pregnancies possible in their unique situations. In our clinic at UT Southwestern, we talk to all pregnant patients about smoking. And if our patients do smoke, we discuss the risks to help them make the best choices for themselves and their babies.
During pregnancy, many women have more frequent contact with doctors than they otherwise would. Doctors should maximize these touchpoints and keep the discussion of quitting at the forefront of prenatal care. Having these conversations gives us a chance to focus on short-term and long-term benefits for patients and their babies. 
Substantial information exists about why smoking during pregnancy is unhealthy for infants and mothers. Risks to the baby include:
● Placental abruption, in which the placenta separates from the wall of the uterus, depriving the developing baby of nutrients and oxygen
● Preterm delivery, or delivery before 40 weeks
Women who smoke during pregnancy are at increased risk for respiratory infections, as well as blood clots, heart attacks, and strokes.
After the baby comes home, infants younger than 2 who live with a smoker are at increased risk of sudden infant death syndrome (SIDS). These children also are more likely to have ear infections and chronic respiratory problems as they grow up, such as:
For mothers, smoking is the No. 1 risk factor for lung cancer (which kills for women annually than breast cancer) and a major risk factor for the three top causes of death of U.S. women: heart disease, cancer, and chronic lower respiratory diseases, such as emphysema and chronic obstructive pulmonary disease (COPD).
The American Congress of Obstetricians and Gynecologists (ACOG) recommends that providers initiate a compassionate intervention with pregnant women who smoke. In other words, we won’t shame patients, and we will help them find a strategy that works in each situation to protect the health of the mother and the baby.
At our clinic, we ask all pregnant women if they smoke and, if they do, how much. We talk about whether they’ve tried to quit in the past and, if so, what has worked and what hasn’t. This base information helps us pull together recommendations regarding each patient’s individual risk and helps us collaborate with them on cutting back or (preferably) quitting altogether. We’ve found, and ACOG has noted, that smoking-cessation programs work better than simply advising women to quit. This could include a number of strategies:
Some women can benefit from medical smoking-cessation therapies, such as nicotine patches or certain antidepressant medications that have been shown to decrease cravings. While these methods avoid exposing the developing baby to secondhand smoke, he or she still will be exposed to nicotine and other chemicals in the medications. Also, some drugs carry a risk for physical or cognitive side effects to the baby. The decision to try one of these strategies must be carefully weighed with a doctor.
In talking to the doctor about smoking, it’s important to remember two points. First, be honest with the doctor. You aren’t our first patient to face quitting, and we aren’t here to judge. Second, patients don’t have to do this on their own. We’re here to help patients have a healthy pregnancy, and if quitting smoking is a barrier, we’ll help them get past it. It isn’t easy, but the possibility of a life without cigarettes both for you as an individual and your family can be terrific motivation. 
If you’re ready to quit smoking before or during pregnancy, request an appointment online or call 214-645-8300.
5323 Harry Hines Blvd.
Dallas, TX 75390
© 2021 The University of Texas Southwestern Medical Center

https://www.cdc.gov/tobacco/basic_information/health_effects/pregnancy
Перевести · Smoking during pregnancy can cause tissue damage in the unborn baby, particularly in the lung and brain, and some studies suggests a link between maternal smoking and cleft lip. 1,2 Studies also suggest a relationship between tobacco and miscarriage. Carbon monoxide in tobacco smoke can keep the developing baby from getting enough oxygen.
https://utswmed.org/medblog/smoking-during-pregnancy
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https://en.wikipedia.org/wiki/Smoking_and_pregnancy
According to a study conducted in 2008 by the Pregnancy Risk Assessment Monitoring System (PRAMS) that interviewed people in 26 states in the United States, approximately 13% of people reported smoking during the last three months of pregnancy. Of people who smoked during the last three months of pregnancy, 52% reported smoking five or fewer cigarettes per day, 27% reported smoking six to 10 cigarettes per day, and 21% reported smoking 11 or more cigarettes per …
According to a study conducted in 2008 by the Pregnancy Risk Assessment Monitoring System (PRAMS) that interviewed people in 26 states in the United States, approximately 13% of people reported smoking during the last three months of pregnancy. Of people who smoked during the last three months of pregnancy, 52% reported smoking five or fewer cigarettes per day, 27% reported smoking six to 10 cigarettes per day, and 21% reported smoking 11 or more cigarettes per day.

In the United States, people whose pregnancies were unintended are 30% more likely to smoke during pregnancy than those whose pregnancies were intended.

Effects on ongoing pregnancy
Smoking during pregnancy can lead to a plethora of health risks to both the mother and the fetus.

People who smoke during pregnancy are about twice as likely to experience the following pregnancy complications:
• premature rupture of membranes, which means that the amniotic sac will rupture prematurely, and will induce labour before the baby is fully developed. Although this complication generally has a good prognosis (in Western countries), it causes stress as the premature child may have to stay in the hospital to gain health and strength to be able to sustain life on their own.
• placental abruption, wherein there is premature separation of the placenta from the attachment site. The fetus can be put in distress, and can even die. The mother can lose blood and can have a haemorrhage; they may need a blood transfusion.
• placenta previa, where in the placenta grows in the lowest part of the uterus and covers all or part of the opening to the cervix. Having placenta previa is an economic stress as well because it requires having a caesarean section delivery, which require a longer recovery period in the hospital. There can also be complications, such as maternal hemorrhage.

Premature birth
Some studies show that the probability of premature birth is roughly 1% higher for people who smoke during pregnancy, going from around -1% to 1%.

Implications for the umbilical cord
Smoking can also impair the general development of the placenta, which is problematic because it reduces blood flow to the fetus. When the placenta does not develop fully, the umbilical cord which transfers oxygen and nutrients from the mother's blood to the placenta, cannot transfer enough oxygen and nutrients to the fetus, which will not be able to fully grow and develop. These conditions can result in heavy bleeding during delivery that can endanger mother and baby, although cesarean delivery can prevent most deaths.

Pregnancy-induced hypertension
There is limited evidence that smoking reduces the incidence of pregnancy-induced hypertension, but not when the pregnancy is with multiple babies (i.e. it has no effect on twins, triplets, etc.).

Tic disorders
Other effects of maternal smoking during pregnancy include an increased risk for Tourette syndrome and tic disorders. There is a link between chronic tic disorders, which include Tourette syndrome and other disorders like ADHD and OCD. According to a study published in 2016 in the Journal of the American Academy of Child and Adolescent Psychiatry, there is an especially high risk for children to be born with a chronic tic disorder if their mother is a heavy smoker. Heavy smoking can be defined as ten or more cigarettes each day. With this heavy smoking, researchers have found that there is an increase in risk as high as 66% for the child to have a chronic tic disorder. Maternal smoking during pregnancy is also associated with psychiatric disorders such as ADHD. Concerning the increase risk for Tourette syndrome, there is an increased risk when two or more psychiatric disorders are also existent as maternal smoking leads to a higher chance of having a psychiatric disorder. E. (n.d.). Maternal Smoking Could Lead to an Increased Risk for Tourette Syndrome and Tic Disorders. Retrieved from https://www.elsevier.com/about/press-releases/research-and-journals/maternal-smoking-could-lead-to-an-increased-risk-for-tourette-syndrome-and-tic-disorders

Effects of smoking during pregnancy on the child after birth
Low birth weight
Smoking during pregnancy can result in lower birth weight as well as deformities in the fetus. Smoking nearly doubles the risk of low birthweight babies. In 2004, 11.9% of babies born to smokers had low birthweight as compared to only 7.2% of babies born to nonsmokers. More specifically, infants born to smokers weigh on average 200 grams less than infants born to people who do not smoke.

The nicotine in cigarette smoke constricts the blood vessels in the placenta and carbon monoxide, which is poisonous, enters the fetus' bloodstream, replacing some of the valuable oxygen molecules carried by hemoglobin in the red blood cells. Moreover, because the fetus cannot breathe the smoke out, it has to wait for the placenta to clear it. These effects account for the fact that, on average, babies born to smoking mothers are usually born too early and have a low birth weight (less than 2.5 kilograms or 5.5 pounds), making it more likely the baby will become ill or die.

Premature and low birth weight babies face an increased risk of serious health problems as newborns have chronic lifelong disabilities such as cerebral palsy (a set of motor conditions causing physical disabilities), intellectual disabilities and learning problems.

Sudden infant death syndrome
Sudden infant death syndrome (SIDS) is the sudden death of an infant that is unexplainable by the infant's history. The death also remains unexplainable upon autopsy. Infants exposed to smoke, both during pregnancy and after birth, are found to be more at risk of SIDS due to the increased levels of nicotine often found in SIDS cases. Infants exposed to smoke during pregnancy are up to three times more likely to die of SIDS than children born to non-smoking mothers.

Other birth defects
Smoking can also cause other birth defects, reduced birth circumference, altered brainstem development, altered lung structure, and cerebral palsy. Recently the U.S. Public Health Service reported that if all pregnant women in the United States stopped smoking, there would be an estimated 11% reduction in stillbirths and a 5% reduction in newborn deaths.

Future obesity
A recent study has proposed that maternal smoking during pregnancy can lead to future teenage obesity. While no significant differences could be found between young teenagers with smoking mothers as compared to young teenagers with nonsmoking mothers, older teenagers with smoking mothers were found to have on average 26% more body fat and 33% more abdominal fat than similar aged teenagers with non-smoking mothers. This increase in body fat may result from the effects of smoking during pregnancy, which is thought to impact fetal genetic programming in relation to obesity. While the exact mechanism for this difference is currently unknown, studies conducted on animals have indicated that nicotine may affect brain functions that deal with eating impulses and energy metabolism. These differences appear to have a significant effect on the maintenance of a healthy, normal weight. As a result of this alteration to brain function, teenage obesity can in turn lead to a variety of health problems including diabetes (a condition in which the affected individual's blood glucose level is too high and the body is unable to regulate it), hypertension (high blood pressure), and cardiovascular disease (any affliction related to the heart but most commonly the thickening of arteries due to excess fat build-up).

Future smoking habits
Studies indicate that smoking during pregnancy increases the likelihood of offspring beginning to smoke at an early age.

Quitting during pregnancy
Quitting smoking at any point during pregnancy is more beneficial than continuing to smoke throughout the entire nine months of pregnancy, especially if it is done within the first trimester (within the first 12 weeks of pregnancy). A recent study suggests, however, that people who smoke at any time during the first trimester put their fetus at a higher risk for birth defects, particularly congenital heart defects (structural defects in the heart of an infant that can hinder blood flow) than people who have never smoked. That risk only continues to increase the longer into the pregnancy a person smokes, as well as the larger number of cigarettes she is smoking. This continued increase in risk throughout pregnancy means that it can still be beneficial for a pregnant person to quit smoking for the remainder of their gestation period.

There are many resources to help pregnant people quit smoking such as counseling and drug therapies. For non-pregnant smokers, an often-recommended aid to quitting smoking is through the use of nicotine replacement therapy in the form of patches, gum, inhalers, lozenges, sprays or sublingual tablets (tablets which are placed under the tongue). However, it is important to note that the use of nicotine replacement therapies (NRTs) is questionable for pregnant people as these treatments still deliver nicotine to the child. For some pregnant smokers, NRT might still be the most beneficial and helpful solution to quit smoking. It is important that smokers talk to doctor to determine the best course of action on an individual basis.
https://www.nhs.uk/pregnancy/keeping-well/stop-smoking
Перевести · Every cigarette you smoke contains over 4,000 chemicals, so smoking when you are pregnant harms your unborn baby. Cigarettes can restrict the essential oxygen supply to your baby. As a result, their heart must beat harder every time you smoke. Benefits of stopping smoking in pregnancy. Stopping smoking …
https://women.smokefree.gov/pregnancy-motherhood/quitting-while-pregnant/myths-about...
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https://www.cdc.gov/nchs/products/databriefs/db305.htm
Key Findings
Prevalence of Cigarette Smoking During Pregnancy Varied by State.
Women Aged 20–24 Were Most Likely to Smoke Cigarettes During pregnancy.
Summary
Definitions
Data Source and Methods
About The Authors
References
Suggested Citation
Prevalence of smoking was highest among women aged 20–24 (10.7%), followed by women aged 15–19 (8.5%) and 25–29 (8.2%) (Figure 2).
The prevalence of smoking during pregnancy increased for mothers under age 15 through those aged 20–24, and then declined with increasing maternal age.
Smoking during pregnancy was least prevale…
Prevalence of smoking was highest among women aged 20–24 (10.7%), followed by women aged 15–19 (8.5%) and 25–29 (8.2%) (Figure 2).
The prevalence o
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