Pregnancy & Smoking

It is important to quit smoking if you haven't quit before becoming pregnant. With determination and support, you can be successful.

Did You Know? Approximately 20 to 33% of pregnant women in developed countries smoke during pregnancy.

Why Is Smoking Harmful During Pregnancy?

Smoking increases the risk of:

  • low birth weight delivery;
  • preterm birth;
  • miscarriage; and
  • intrauterine fetal death.

Smoking during pregnancy is also associated with serious conditions that can affect your child during infancy and childhood.

There is some evidence to suggest that smoking habits are linked between generations. Some studies have shown increased rates of smoking in daughters of women who smoked during pregnancy. This indicates that some biologic factor may be determined in utero when a mother smokes during pregnancy.

Why Quit Now?

The smoker who becomes pregnant may think that the harm has already been done and there is no benefit to the baby in quitting during the second or third month of pregnancy. This is not true. A pregnant woman who quits smoking by the twentieth week (fifth month) of pregnancy is likely to have a baby of normal birth weight. Patients are likely to be more determined to quit early in pregnancy and can more easily set a quit date.

All pregnant women who smoke are encouraged to quit, even when they are in their seventh or eighth month of pregnancy.

Did You Know? New behavior patterns, like not smoking, take about six weeks to become established.

How Can I Quit?

Before you attempt to quit smoking, spend some time analyzing when and why you smoke. It is important for you to understand your smoking patterns so you can plan for events and situations that will be tempting or stressful for you. Do you smoke when you are tense or anxious? Do you smoke when you need to energize yourself? Do you smoke when others around you are smoking? Do you smoke when you drink?

When you understand your smoking patterns, you can begin to devise alternate activities. For example, if you smoke with co-workers on work breaks, consider taking walks with other work friends instead. If you smoke when you drink coffee, consider changing to another beverage to break the association.

Plan for times when you will be tempted. Find someone to be your support person during those trying times when you want to have a cigarette. Give yourself positive reinforcement for quitting. Once you have a plan, set a quit date and tell your doctor about it.

Remove all the tobacco and related products from your home, your work, and your car before your quit date. This is an important step in becoming smoke-free.

Consult your doctor for help in setting your quit date, for strategies to stay off cigarettes, and for sources of positive reinforcement as you go through this important process. Some people need more help than others, depending on how much the habit is ingrained and how much they are addicted to nicotine.

How Hard Will it Be for Me to Quit?

The level of difficulty in quitting smoking depends on a number of factors and varies among women. The less you smoke and the more you have tried to quit smoking, the easier it will be. Having a nonsmoking partner, exercising, and having very strong beliefs about the risks of smoking during pregnancy will also make it easier to quit.

The more you smoke, the harder it will be to quit. Women who smoke more than a pack a day and women who consume caffeine may find it more difficult to stop smoking. Women who are depressed or who experience a lot of difficulties in life may also find it more difficult to quit. Patients who are isolated from social support experience more difficulty quitting. Interestingly, no association with alcohol use predicts continued smoking or abstinence.

Additional Aids in Quitting Smoking Available Through Your Caregiver

If you are trying to quit smoking, your doctor may provide monitoring as reinforcement. This may be done with the use of tests that measure expired carbon monoxide or nicotine metabolites.

Is Nicotine Replacement Safe During Pregnancy?

According to smoking cessation clinical practice guidelines published in the Journal of the American Medical Association in 1996, nicotine replacement (by way of the patch-for example, Nicoderm CQ; gum-Nicorette Gum; or an inhaler-Nicotrol Inhaler) should not be used during pregnancy unless the benefits clearly outweigh the risks. The amount of nicotine delivered by the gum or patch is usually substantially less than what you would receive with continued smoking; however, nicotine decreases blood flow to the uterus and is potentially harmful to the developing fetus and placenta, regardless of the method of delivery.

Nicotine gum has been labeled Pregnancy Category C by the Food and Drug Administration. This means that risk to the fetus cannot be ruled out. The nicotine patch has been labeled Pregnancy Category D, meaning that there is positive evidence of risk.

Is Bupropion Safe During Pregnancy?

Bupropion (Zyban) has been helpful for smokers who have difficulty with depressed moods when they stop smoking. It probably acts as an antidepressant, helping with withdrawal symptoms of depressed mood, sleep disturbance, anxiety, and increased appetite. Bupropion is probably as effective as nicotine replacement in helping patients quit smoking. Increased success rates are observed when patients also receive behavioral therapy or guidance.

Unfortunately, there are no data available on the safety of bupropion during pregnancy. However, this drug is marketed as Wellbutrin for treatment of depression and can be used during pregnancy for that indication. Bupropion is labeled as Category B for treatment of depression during pregnancy. Bupropion should not be used by anyone with a history of seizures or eating disorders and should not be used in conjunction with alcohol.

Who Is Most Likely to Restart Smoking?

Unfortunately, women who quit smoking while pregnant often relapse during pregnancy or in the postpartum period. Risk factors for relapse during pregnancy include the following:

  • decreasing, but not actually quitting tobacco;
  • announcing that one has quit before going a week without tobacco;
  • having little confidence in one's ability to remain tobacco-free; and
  • being a heavy smoker.

In addition, women who are not bothered much by nausea and women who have delivered before are more likely to start smoking again.

Whether a woman's family, friends, and co-workers smoke seems to be one of the main predictors of long-term success in smoking cessation. Women who quit smoking during pregnancy need continued support to remain smoke-free during the entire pregnancy. It is important that quitting smoking be perceived as a process and not as a one-time event. If a woman's partner smokes, she is much more likely to relapse. Association with individuals who continue to smoke provides availability of cigarettes and facilitates relapse.

Why Do Women Resume Smoking After Delivery?

Fifty percent of women who stopped smoking during pregnancy will begin smoking again within six months of delivery. Many women view the postpartum period as a time to pursue the activities enjoyed before becoming pregnant-for many, this means returning to smoking. Some women seem particularly concerned with weight loss and stress management and this also contributes to relapse.

Several studies involving pregnancy-specific self-help materials, individual counseling, and physician advice have not shown any improved rates in postpartum relapse.

Reasons Not to Resume Smoking After the Baby Is Born

There is compelling evidence to encourage a woman to remain smoke-free after delivery. Infants and young children have more frequent ear infections and upper respiratory tract infections when there is a smoker in the home. There is evidence to suggest that asthma is more likely to develop in children whose parents smoke.

Additionally, when new mothers continue to smoke, they are less likely to breast-feed, which deprives babies of essential nutrients and protection from infection. Sudden infant death syndrome (SIDS) has been linked to tobacco use in the home.