Pregnancy and Smoking

Smoking increases the risk of:

• low birth weight delivery
• preterm birth (before 37 weeks)
• miscarriage
• intrauterine fetal death (stillbirth)
• cleft palate and other birth defects
• respiratory issues

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

• sudden infant death syndrome (SIDS)
• learning disabilities
• behavioral problems
• asthma attacks
• frequent infections

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. In other words, smoking during pregnancy puts your baby at risk of becoming a smoker when they grow up.

The smoker who becomes pregnant may think that the harm has already been done and that there’s no benefit to the baby in quitting during the second or third month of pregnancy.This isn’t true. According to Smokefree Women, quitting during any stage of pregnancy decreases the risk for lung defects and low birth rate. Also, 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’re in their seventh or eighth month of pregnancy.

Before you attempt to quit smoking, spend some time analyzing when and why you smoke. It’s 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’ll 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’re addicted to nicotine.

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. Those who are isolated from social support experience more difficulty quitting. Interestingly, no association with alcohol use predicts continued smoking or abstinence.

If you’re 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.

Smoking cessation aids, such as nicotine replacements, are commonly used by people looking to quit. Examples include a nicotine patch, gum, or inhaler. However, these aids shouldn’t 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. Such concerns are outlined by the American Congress of Obstetricians and Gynecologists (ACOG), who also state that there is no clinical evidence to show that these products really help pregnant women quit smoking for good.

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

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. 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. Still, there is a high risk of transmission of the drug to breast milk.

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
• being a heavy smoker

In addition, if you’re not bothered much by nausea and have delivered before, you’re 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’s important that quitting smoking be perceived as a process and not as a one-time event. If your partner smokes you’re much more likely to relapse. Continued association with individuals who smoke can mean easy availability of cigarettes and increased chances of relapse.

The CDC estimates that more than 50 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.

Unfortunately, self-help materials, individual counseling, and physician advice have not shown any improved rates in postpartum relapse. It’s important to have a coach or someone in your life to help motivate you to stay tobacco-free.

There’s compelling evidence to remain smoke-free after delivery. Studies show that if you smoke more than 10 cigarettes per day, the amount of milk you produce decreases and the make-up of your milk changes. Also, women who smoke are more likely to think that their milk supply isn’t good enough and may be less motivated to breastfeed. Also, babies who’ve been breastfed by mothers who smoke tend to be more colicky and cry more, which may encourage early weaning.

Additionally, infants and young children have more frequent ear infections and upper respiratory tract infections when there’s a smoker in the home. There’s also evidence to suggest that asthma is more likely to develop in children whose parents smoke.