Smoking during pregnancy is a significant public health concern as this could lead to many pregnancy complications. Moreover, it can have an impact on the future health and wellbeing of the child.
The incidence of smoking during pregnancy varies in different parts of the world.
In England, it is estimated that 10.4% women smoke during pregnancy.
Smoking is more common in women with:
– Mother’s age 20 years or less
– low socioeconomic status and underprivileged backgrounds
– Poor social and family support
– Mental health conditions
What are the risks?
Smoking is detrimental during entire pregnancy in any quantity, whether sporadic or regular smoking and strongly advisable to avoid during this period.
The risks of smoking during pregnancy are as follows:
– Stillbirth and early neonatal death (One-third of stillbirths and early neonatal deaths could be related to smoking.)
– Preterm birth
– Placental abruption
Babies have an increased risk of:
– Sudden infant death syndrome (SIDS)
– Pneumonia (and other chest infections) and ear infection
– Attention Deficit Hyperactivity Disorder (ADHD)
– Poor academic performance
– Future smoking habits of the children in adulthood
Benefits of smoking cessation during pregnancy
– Reduction in pregnancy and other complications
– Reduction in the risk of stroke, lungs and throat cancer, heart attack
– Financial benefits due to cost-saving for not buying tobacco products.
All the risks of pregnancy complications and future health of the child can be reduced by stopping smoking. Although the earlier smoking is stopped the better, it is never too late to quit smoking.
Why quitting can be difficult?
Quitting smoking could be easier said than done for many and healthcare professionals should take a very supportive approach in the entire journey.
Nicotine in the cigarette smoke has some mood elevation properties, and therefore, produces a temporary feeling of wellbeing.
Chronic use of tobacco causes addiction through a process called ‘dependence’. As a result, trying to stop smoking may cause withdrawal symptoms, such as anxiety and irritability.
However, pregnant women should be reassured that it is absolutely possible to quit smoking as millions have done so.
Relapse after childbirth
Unfortunately, many women who stopped smoking during pregnancy commence smoking again after the childbirth.
Research has shown that only less than one-third of the women who quitted smoking in pregnancy remain smoke-free after one year postpartum. Rest of them start smoking again during this time.
Harmful chemicals in smoking
Cigarette smoke contains several chemicals. The main toxic products are carbon monoxide (CO), tar and nicotine.
Oxygen is carried to the tissues by haemoglobin (Hb) in the red blood cells (RBC), present in our blood. CO attaches to Hb more readily than oxygen.
As a result, there are less Hb carrying oxygen in the system. Therefore, the oxygen supply to the tissues is impaired.
Oxygen is vital for the growth and development of the baby during pregnancy. Therefore, oxygen deficiency leads to growth restriction, miscarriage, stillbirth and other pregnancy complications.
Tar contains many chemicals which are harmful to the fetus (‘fetotoxic’).
Studies have shown that nicotine can activate the nicotine-acetylcholine receptor in the fetal brain. This can disrupt the release and function of the neurotransmitters in the brain.
This is thought to be the cause behind ADHD and learning difficulties seen in the children of the mothers who smoked during pregnancy.
Mental health & smoking
Studies have indicated that the incidence of cigarette smoking both during pregnancy and postnatally are higher among women with mental health conditions compared to women without mental health problems.
Studies have shown that women who had depression, anxiety, or both were more likely to smoke before and during pregnancy and less likely to quit smoking during the prenatal period.
It is estimated that women suffering from depression are four times more likely to be a smoker compared to those without depression.
Carbon Monoxide (CO) monitoring
It is recommended in the UK that all pregnant women (even if they do not give a history of smoking) are offered a CO test at the first Antenatal visit (the ‘booking visit’) and at regular intervals during pregnancy and postpartum.
However, CO levels can be high in passive smoking, lactose intolerance, leakage of CO from home gas appliances, and from the polluted air.
Nicotine Replacement Treatment (NRT)
NRT aims at replacing tobacco smoking with the intake of pure nicotine to avoid withdrawal symptoms of quitting. Gradually, the dose of nicotine is reduced over time.
NRT is safe and licenced to be used during pregnancy.
The use of NRT ensures that the harmful products of smoking (such as CO and the tar) do not enter the body apart from the nicotine.
This is available in various forms such as patches, gum, nasal spray etc. Patches could be particularly helpful in the presence of nausea/ vomiting in pregnancy.
No specific type of NRT is better than the other. You should use whichever suits you the best.
Electronic cigarettes (‘Vaping’)
This is being used increasingly by smokers who are planning to quit or limit smoking.
Electronic cigarettes contain less amount of toxic ingredients than conventional cigarette smoke. Therefore, they are relatively safer than cigarette smoking.
However, they are not entirely risk-free and ideally, they should be avoided in pregnancy too.
It is estimated that in the general population, electronic cigarettes carry about 5% of the risk of tobacco smoking.
Medicines to quit smoking
It is not recommended to use medicines (such as varenicline and bupropion) to be used during pregnancy.
Myths and facts
It is ok to use other forms of tobacco other than a cigarette.
Tobacco products that are chewed (such as Paan, Guthka, Paan Masala and Naswaar) and smoking Shisha are also unsafe in pregnancy.
It’s ok to just cut down rather than quitting it altogether during pregnancy.
There is no safe level or quantity of smoking during pregnancy.
Smoking helps me to relax and reduce stress.
The effect of smoking on mood is temporary. The health risks are huge and long-term.
I smoked in my last pregnancy and did not have any complication.
It is important to remember that every pregnancy is different. Moreover, the long-term impact of smoking during pregnancy (such as effects on the baby’s brain) can only be found many years after the childbirth.
Quitters will put on weight.
A healthy eating habit and regular exercise are the best ways to stay happy and healthy during pregnancy.