Pregnant Smoke
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Health Effects of Smoking and Secondhand Smoke on Pregnancies
Health Effects of Smoking and Secondhand Smoke on Babies
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Robyn Horsager-Boehrer, M.D.
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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 .
More in:
Your Pregnancy Matters
Pediatrics;
Your Pregnancy Matters
Women's Health;
Your Pregnancy Matters
Mental Health;
Your Pregnancy Matters
Pediatrics;
Your Pregnancy Matters
Women's Health;
Your Pregnancy Matters
Mental Health;
Your Pregnancy Matters
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or 214-645-8300
or 817-882-2700
5323 Harry Hines Blvd.
Dallas, TX 75390
© 2021 The University of Texas Southwestern Medical Center
Member of Southwestern Health Resources
https://www.cdc.gov/tobacco/basic_information/health_effects/pregnancy/index.htm
https://utswmed.org/medblog/smoking-during-pregnancy/
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Pregnant Smoke
