Smoking in pregnancy.

My inspiration for this article

A family member of mine is about to start her first cycle of IVF, and is still smoking.  After having a discussion about the topic, she seemed unware of the extent that smoking could effect her fertility, pregnancy and

unborn baby.  Although she plans to quit in the new year (after she starts IVF) I felt inspired to find her some information on smoking in pregnancy to help her motivation to quit.  I have also just found out that the hospital where I work has just applied a policy to educate all smoking parents about the effect that passive smoking has on the childs health and illness, so I also need some background information and research to support my educating attempts.  Here is a summary of the research, and hopefully it might inspire some smoking mothers or mother- to- be to quit.

Smoking and fertility

If you are a smoker, and plan to become pregnant, it is recommended that you quit 6 months before trying for a baby.  In females, cigarette smoking damages tubal motility (the ability of the fallopian tubes to transport the egg to the place of fertilization) and also effects implantation of the embryo.  Smoking reduces blood flow to the reproductive organs.  Toxins in cigarette smoke can affect the early stages of embryo development.  Cigarette smoking has been shown to damage egg quality, decrease the ability of the egg to be fertilized and increase the chance of miscarriage.  Smokers and passive non smokers take longer to conceive than non smokers.

Various articles quote a 20-40% reduction in a woman’s fertility if she smokes.  Smoking during IVF treatment lessens the chance of success, due to the effects on implantation and early miscarriage.  One study also found that there was a 45 % decrease in the number of eggs aspirated at IVF egg collection in a smoker compared to a non smoker.  It seems silly to waste time, money and emotion on IVF treatment, if you are not going to do everything in your power to make it successful.  Aspiring parents are highly encouraged to quit before starting IVF.

Smoking in pregnancy

Birth weight

Cigarette smoke contains over 2000 components and chemicals.  The most harmful of these are thought to be nicotine, carbon monoxide and cyanide.  These substances cross the placenta and restrict the baby’s growth.  Babies of smoking mothers are on average 200g lighter than non smokers due to the negative effects of the cigarette toxins reducing the nutrients and oxygen to the baby.  Low birth weight babies are more likely to be ill after birth.

Asthma

Low birth weight and pre-term delivery increases the risk of developing asthma.  One study states that there is a link between maternal smoking and the development of asthma in the first 7 years of life (Jaakkola and Gissler, 2004, p137).  There is also an increased risk of respiratory illness such as croup, bronchiolitis, pneumonia and also ear infections.  Continued exposure to passive smoking after pregnancy also leads to more severe and more frequent asthmatic episodes.

SIDS

There is no denying the evidence that smoking during and after pregnancy increases the chance of your baby dying of SIDS or cot death.  This is a good reason not to start smoking again after pregnancy.

Congenital Abnormalities

Babies have an increased risk of genetic abnormalities when exposed to cigarette chemicals in pregnancy.  There is an increased chance of cleft lip, cleft palate, bowel problems, eyes and vision problems, ears and hearing and spinal cord issues.

Heart defects

Women who smoke during pregnancy are more likely to give birth to a baby with congenital heart defects, according to a news release from the Centre for Disease Control and Prevention (AORN, 2008, p349).  This includes septal heart defects (hole in the heart), obstructive defects (blood is blocked and can’t flow freely from one side of the heart) and lower heart chamber circulation deficits.

Childhood cancer

More studies need to be done in this area.  One study stated that there has been no significant link between maternal (mum) smoking and childhood leukaemia, but there is a link between paternal (dad) smoking and leukaemia.  One article stated that children of smokers have a greater chance of developing cancer than children of non smokers.

Behavioural problems

An article published by picket et al (2008, p.21) summarized a study which found that quitting smoking during pregnancy reduces a mother’s chance of giving birth to a baby with problem behaviour.  Smoking is associated with low positive mood in a child and lower levels of easy temperament, meaning that a child of a smoker is more likely to be highly strung and difficult to manage.  A child that has been exposed to maternal smoking has a higher risk of developing autism (Passive Smoking: The Impact on children, 2006).  Sleep issues are also attributed to maternal smoking.

Intelligence

Smoking during pregnancy negatively effects language development, learning and memory and cognitive scores (Martin et al., 2008, p.272), general intelligence and academic skills (Gilman et.al, 2008, p.448).

 

Effects on the mum to be

Smoking during pregnancy causes an increased risk of:

-increased heart rate and blood pressure- possibly increasing the risk of pre-eclampsia and eclampsia

-depressed nervous system.   

-chest infections

-blood clotting disorders

-ectopic pregnancy

-stillbirth

-bleeding during pregnancy

-polyhydraminos (too much amniotic fluid)

-thrush

-urinary tract infections

-vomiting requiring hospitalization

-premature birth

-maternal mental health issues

The more the woman smokes, the higher the risk of complications.

Good reasons to quit

If the health of your child is not enough, consider the financial burden of having an ill child in hospital and not being able to work.  Can you afford to travel to get a heart defect fixed (not all hospitals offer specialized paediatric heart surgeons)?  Do you have enough sick leave to spend the final months in a hospital bed because of smoking related complications, or who will look after your other kids?  Do you want your child to struggle at school because of learning difficulties and recurrent ear infections (can’t hear what the teacher is saying) or sick days and missing school.

Smoking is an addiction, and it takes a lot of courage and will power to quit.  But what better motivation than the health and life of your baby.  Use all the supports you have available to you- Quit line, be honest with your midwife, get support from your partner and family.  Quitting, as hard as it is, will make all the difference in the world to your baby.  A list of tips to help you stop smoking can be found at http://health.ninemsn.com.au/article.aspx?id=58689

References

“Tips for Quitting Smoking in Pregnancy”, 28th December 2008, http://health.ninemsn.com.au/article.aspx?id=58689

“Smoking During Pregnancy”, Jane Palmer (27th Nov, 2000), 28th December, 2008, http://www.pregnancy.com.au/smoking_during_pregnancy.htm

“Smoking and Fertility”, 28th December, 2008, http://www.menstruation.com.au/fertility/smoking.html

“Fact sheets: Smoking and Fertility”, 28th December, 2008, http://www.monashivf.com/default.asp?action=article&ID=21861

“How Does Smoking Effect Conception and Fertility”, 28th December, 2008, http://wish2conceive.com/smoking-fertility.htm

Jaakkola and Gissler, 2004, “Maternal Smoking in Pregnancy, Fetal Development, and Childhood Asthma”, American Journal of Public Health, Jan, vol. 94, no. 1, pp136-140.

Gilman, Breslau, Subramanian, Hitsman, Koenen, 2008, “Social Factors, Psychopathology, and Maternal Smoking During Pregnancy”, American Journal or Public Health, Mar, vol. 98, no.3, pp448-453

Pickett, Wood, Adamson, 2008, “Quitting Smoking in Pregnancy Benefits Baby’s Temprament”, Contemporary OB/GYN, vol. 53, no. 5, p.21.

Author unknown, 2008 ,“Smoking While Pregnant May Cause Infant Heart Defects”, AORN Journal, vol. 88, no.3, p349.

Martin, McNamara, Milot, Bloch, Hair, Halle, 2008, “Correlates of Smoking Before, During and After Pregnancy”, American Journal of Health Behaviour, vol.32, no.3, pp272-82.

“Passive Smoking”, 28th December 2008, http://www.chw.edu.au/parents/factsheets/passive_smoking.htm?print

“Passive Smoking: The Impact on Children” (april 2006) 28th December 2008, http://old.ash.org.uk/html/passive/html/kidsbrief.html