We have discussed tobacco on some previous occasions, because it is extremely bad for your health, particularly during pregnancy. It’s time to discuss smoking again to keep perspective, as it is still the most preventable cause of death and, even in the context of the COVID-19 pandemic, is still one of the worst things that you can do while you are pregnant. Smoking is currently on the decline in the United States, while rates in Europe vary strikingly between countries. But many people still smoke, including many pregnant women.
Tobacco is a plant that is cultivated for its leaves, which are processed for use in tobacco products, such as cigarettes and cigars, which are smoked, although other preparations of tobacco are chewed. Tobacco use leads to addiction, because tobacco contains nicotine, an extremely addictive drug. Tobacco addiction is a long-term disorder characterized by a persistent, uncontrollable desire to get nicotine into your body, usually by smoking. Use of tobacco varies greatly around the world. Even when anticipating pregnancy, after becoming pregnant, or after giving birth, women often have trouble quitting. Reports from the US Centers for Disease Control and Prevention suggest that the rate of smoking cessation is very high during pregnancy, a time when the percentage of smokers drops, yet 10 percent of US pregnant women report smoking during at least the last 3 months of pregnancy.
One thing that tobacco can do when you are not pregnant is to decrease fertility, thereby making conception less likely. Additionally, tobacco increases the likelihood of spontaneous abortion soon after implantation, leading to early pregnancy loss, sometimes before you even know that you’re pregnant. Then there are issues for your fetus once you are pregnant. Maternal tobacco use increases the risk of spontaneous abortion (miscarriage), plus it has been linked congenital birth defects, as well as problems with the placenta and premature birth. Neonates born to smoking mothers are likely to have a low birth weight and have an elevated risk of sudden infant death syndrome. Maternal smoking also puts the baby at risk for conditions that strike later in life such as obesity, type 2 diabetes mellitus, psychiatric disorders, and having a tobacco addiction herself.
Although studies suggest that low levels of tobacco exposure, even levels associated with second hand smoke are associated with preterm birth, evidence suggests that the risk is the product of repeated exposures. Thus, if you smoked once, your baby is probably not at elevated risk, even if that one episode of smoking occurred six weeks into pregnancy, a very critical point in development. On the other hand, if you smoked repeatedly (a more common scenario), the risk would be significant, even if that repeated smoking took place prior to pregnancy. Binge smoking has not been studied much in pregnant women, but this behavior can result in carbon monoxide poisoning and nicotine toxicity, disrupting oxygen delivery to the fetus and blood supply of the womb, respectively, putting you at severe risk of early pregnancy loss.
Risk of sudden infant death syndrome and long-term effects is elevated for maternal smoking occurring at any point in the pregnancy. To help prevent this situation, however, several medications are available to help you stop smoking. One approach is nicotine replacement therapy, which supplies you with nicotine at gradually decreasing doses, so that you won’t crave it from cigarettes. Other drugs to fight nicotine addiction are bupropion, varenicline, nortriptyline, and clonidine. Additionally, numerous non-drug therapies are available. The simplest one is quitting “cold turkey” stopping without any assistance, but this is also the most difficult pathway for many smokers. Other approaches include psychotherapy, cognitive behavioral therapy, telephone counseling, brief intervention, patient education, and various drug and non-drug combinations.
Another issue related to maternal smoking is that your fetus can actually become addicted to nicotine. Then, after birth deprives the newborn of the nicotine from the mother’s blood, the newborn can develop problems similar to those of drug withdrawal in adults. This is called neonatal nicotine withdrawal syndrome. The more that you smoke, and the later into pregnancy that you smoke, the more likely it is to occur. As for breast feeding, nicotine from tobacco smoking concentrates in breast milk, turning the lactating breast into a nicotine delivery device. If you have failed to quit smoking, do not breast feed. You’d be doing more harm than good. Infant formula is better for a newborn than nicotine-infested breastmilk.
Now let’s discuss the issue of the father smoking. Studies on the effects of paternal smoking on outcomes, such as spontaneous abortion (miscarriage) and congenital birth defects, have been limited and have yielded conflicting results. However, maternal exposure to second hand smoke from a smoking partner is quite harmful, as is neonatal second hand exposure from a smoking parent.