From the March of Dimes Re: Smoking

[Guest guest]

The March of Dimes is a very reputable organization that I refer to

often in my nursing profession. This was taken from their website @

http://www.marchofdimes.com.

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Babies whose mothers smoked during pregnancy are three times as

likely to die from sudden infant death syndrome (SIDS) as babies of

nonsmokers. I cannot imagine the pain and guilt one would have

feeling that they may have caused their own babies death. The feeling

of losing a baby would be devastating on its own, not to mention if

someone said it was because the Mom smoked.

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Smoking During Pregnancy

Today, about 12 percent of women worldwide smoke cigarettes. In

developed countries, about 15 percent of women smoke, and in

developing countries, about 8 percent smoke, according to the World

Health Organization. In the United States, about 15 to 30 percent of

women smoke, many of them while they are pregnant. This is a major

public health problem because not only can smoking harm a woman's

health, but smoking during pregnancy can lead to serious health

problems in newborns.

Statistics from the United States are compelling. If all pregnant

women in the United States stopped smoking, there would be an

estimated 10 percent reduction in infant deaths, according to the

U.S. Public Health Service. Currently, about 12 percent of women in

the United States smoke during pregnancy.

Cigarette smoke contains more than 2,500 chemicals. It is not known

for certain which of these chemicals are harmful to a developing

baby. However, both nicotine and carbon monoxide are believed to play

a role in causing adverse pregnancy outcomes.

How can smoking harm the newborn?

Smoking nearly doubles a woman's risk of having a low-birthweight

baby. In 2001, 11.9 percent of babies born to smokers in the United

States were of low birthweight, compared to 7.3 percent of babies of

nonsmokers. Low-birthweight babies, who weigh less than 5 1/2 pounds

at birth, face an increased risk of serious health problems during

the newborn period, chronic disabilities (such as cerebral palsy,

mental retardation and learning problems) and even death. These

health consequences can be devastating, inflicting major emotional

and economic costs on families and on communities.

Low birthweight can result from poor intrauterine growth, preterm

delivery or a combination of both. Smoking has long been known to

slow fetal growth. Studies also suggest that smoking increases the

risk of preterm delivery (before 37 weeks of gestation) by at least

20 percent. However, if a woman stops smoking by the end of her first

trimester of pregnancy, she is no more likely to have a low-

birthweight baby than a woman who never smoked. Even if a woman has

not been able to stop smoking in her first or second trimester,

stopping during the third trimester can still improve her baby's

growth. According to the American College of Obstetricians and

Gynecologists, women who stop smoking at any time up to the 30th week

of pregnancy have babies with higher birthweights than women who

smoke throughout pregnancy.

Pregnant women who do not smoke should avoid exposure to other

people's smoke. Studies suggest that regular exposure to secondhand

smoke may reduce fetal growth and, therefore, increase a woman's

chances of having a low-birthweight baby.

Although it has long been known that smoking can increase the risk of

preterm delivery and low birthweight, more recent studies suggest

that smoking also may contribute to certain birth defects, especially

when certain gene-environment interactions are present. One study

found that women who smoked in the early months of pregnancy were 34

percent more likely than non-smoking mothers to have a baby with a

foot deformity called club foot. While nonsmoking women with a family

history of club foot were about six times as likely as women without

a family history of this disorder to have an affected baby, women who

both smoked and had a family history of club foot had a 20-fold

increased risk. Similarly, another study found that babies with a

predisposing gene were at increased risk of developing cleft lip

and/or cleft palate (an opening in the roof of the mouth or the soft

tissue in the back of the mouth) if their mothers smoked during the

first three months of pregnancy.

Can smoking cause pregnancy complications?

Smoking has been associated with a number of pregnancy complications.

Smoking early in pregnancy appears to increase a woman's risk of

having an ectopic pregnancy. In an ectopic pregnancy, the embryo

becomes implanted in a fallopian tube or other abnormal site instead

of the uterus. With the rarest of exceptions, these pregnancies do

not result in the birth of a baby, and the embryo must be removed

surgically or with drug treatment to protect a woman's life. Smoking

also may increase a woman's risk of miscarriage.

Cigarette smoking also appears to double a woman's risk of developing

placental complications (which occur in about 1 percent of

pregnancies). These include placenta previa, a condition in which the

placenta is attached too low in the uterus and covers part or all of

the cervix, and placental abruption, in which the placenta separates

from the uterine wall before delivery. Both can result in a delivery

that jeopardizes the life of mother and baby, although a cesarean

delivery can prevent most deaths. Placental problems contribute to

the slightly increased risk of stillbirth that is associated with

smoking.

Does smoking affect fertility?

Cigarette smoking can cause reproductive problems before a woman even

becomes pregnant. Studies show that women who smoke may have more

trouble conceiving than nonsmokers. A 2000 British study reported

that women who smoked were about 50 percent less likely to conceive

within 12 months than nonsmokers. This study also found that heavy

smoking by the father was associated with delayed conception.

Does parents' smoking cause other problems in babies or young

children?

Babies whose mothers smoked during pregnancy are three times as

likely to die from sudden infant death syndrome (SIDS) as babies of

nonsmokers. Babies who are exposed to their parents' cigarette smoke

after birth also may face an increased risk of SIDS; however, recent

studies suggest that exposure to smoke while still in the womb poses

a bigger risk.

Children who are exposed to cigarette smoke before birth also may be

at increased risk of lasting problems, including asthma and autism. A

recent Swedish study found that babies of mothers who smoked in early

pregnancy were 40 percent more likely than babies of nonsmokers to

have autism (a serious developmental disorder characterized by

difficulties communicating with others and mental retardation).

Children of mothers who smoked during pregnancy also may be at

increased risk of learning and behavioral problems, including

impulsive behavior, conduct disorders and attention problems. Studies

also suggest that children whose mothers were regularly exposed to

other people's smoke during pregnancy may be at increased risk of

learning and behavioral problems.

How can a woman protect her baby from the risks associated with

smoking?

The March of Dimes recommends that women stop smoking before they

become pregnant and remain smoke-free throughout pregnancy and after

the baby is born. A woman's health care provider can refer her to a

smoking cessation program that is right for her, or suggest other

ways to help her quit. Even later in pregnancy, a woman can reduce

the risks to her baby by stopping smoking. The fewer cigarettes a

woman smokes, the less likely her baby will be born with smoking-

related problems.

Studies suggest that certain factors make it more likely that a woman

will be successful in her efforts to quit smoking during pregnancy.

These include: attempting to quit in the past, having a partner who

doesn't smoke, getting support from family or other important people

in her life and understanding the harmful effects of smoking.

It is important to stay smoke-free after the baby is born. Both

mother and father should refrain from smoking in the home and should

ask visitors to do the same. Babies who are exposed to smoke suffer

from more respiratory illnesses and ear infections than other babies.

For example, infants whose mothers smoke are 38 percent more likely

to be hospitalized for pneumonia during their first year of life than

babies of nonsmoking mothers. A child exposed to smoking at home

during the first few years of life also is at increased risk of

developing asthma.

Of course, cigarette smoking harms a woman's own health: smokers have

an increased risk of lung and other cancers, heart disease, stroke

and emphysema (a potentially disabling and, sometimes, deadly lung

condition). Quitting smoking will make parents healthier—and better

role models for their children.

Does the March of Dimes fund research on the risks of smoking during

pregnancy?

The March of Dimes has long supported research on the risks of

smoking during pregnancy. In the 1970s, March of Dimes-supported

research suggested that nicotine and carbon monoxide reduce the

supply of oxygen to the baby, perhaps explaining how these chemicals

in cigarette smoke reduce fetal growth. A March of Dimes grantee

recently published a study that may shed light on why some women who

smoke cigarettes during pregnancy have low-birthweight babies and

others do not. The researcher reported that pregnant women who smoke

are more likely to have a premature or low-birthweight baby if two

genes that normally control the body's chemical modification of

components of cigarette smoke are missing or inactive. These findings

could lead to better ways to identify and treat those women at high

risk of having a low-birthweight baby.

What resources are available on the Web for pregnant women and health

care providers?

Smoke-Free Families has information for pregnant smokers and for

prenatal care providers.

The American College of Obstetricians and Gynecologists provides

information to health care providers to assist them as they help

patients stop smoking.

QuitNet is an online resource for people who want to stop smoking.

To order multiple copies of this fact sheet:

Call:

References

American College of Obstetricians and Gynecologists (ACOG). Smoking

Cessation During Pregnancy. ACOG Educational Bulletin, number 260,

September 2000.

Centers for Disease Control and Prevention (CDC). Women and Smoking:

A Report of the Surgeon General—2001. CDC office on Smoking and

Health, Atlanta, GA.

Honein, M. Family History, Maternal Smoking, and Clubfoot: An

Indication of a Geneenvironment Interaction. American Journal of

Epidemiology, volume 152, number 7, October 2000, pages 658–665.

Hull, M.G., et al. Delayed Conception and Active and Passive Smoking.

Fertility and Sterility, volume 72, number 4, October 2000, pages 725–

733.

Hwang, Shih-Jen, et al. Association Study of Transforming Growth

Factor Alpha Taq1 Polymorphism and Oral Clefts: Indication of Gene-

environment Interaction in a Populationbased Sample of Infants with

Birth Defects. American Journal of Epidemiology, volume 141, number

7, 1995, pages 629–636.

Samet, J.M. and Yoon, S.Y. Women and The Tobacco Epidemic: Challenges

for the 21st Century. World Health Organization in Collaboration with

the Institute for Global Tobacco Control, s Hopkins School of

Public Health, 2001.

Wang, X., et al. Maternal Cigarette Smoking, Metabolic Gene

Polymorphism, and Infant Birth Weight. Journal of the American

Medical Association, volume 287, number 2, January 9, 2002, pages 195–

202.

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