Risks of Smoking in Pregnancy

December 14, 2007

Quit Smoking When Pregnant

It was hysterical to see representatives of tobacco companies before the congressional committee claim that smoking is no more habit-forming than eating Twinkies. The whole country tuned in and laughed with me. Clearly the mood of the country is turning, because once again we're doing something now because we have to. With the heightened sensitivities regarding the cost of health care, punitive cigarette taxes are being considered--it's only fair; with the knowledge of the dangers of second-hand smoke, smoke-free environments are being legislated--it's only right; and with no one buying the Twinkie comparison, the government is going after those they accuse of altering nicotine levels in cigarettes to enhance addiction--it's downright scary.

So what is an obstetrician-gynecologist cigarette-bashing for? I can assure you that smoking causes its share of misery in my specialty. Certainly no mother would hire a baby-sitter for her baby who she knew would harm her child. Yet that is what she herself may be doing when she smokes during pregnancy. The unborn baby is at risk for growth retardation before birth and decreased intellectual potential after. Performance in school may be compromised. While pregnant, the smoking mother puts her child at risk for premature separation of the placenta, called abruption, which is a devastating hemorrhaging event that can result in death of the baby and possibly even to the mother. Nicotine is a vasoconstrictor, narrowing the nutrition- and oxygen-carrying blood vessels to the baby. Each drag of a cigarette means less oxygen and nutrition and also damages the placenta which is the crucial link between mother and child.

There is also evidence that smoking increases the risk that a child may develop leukemia. More likely are pediatric asthma and the repeated upper respiratory infections and croup. Spending three hours in an emergency room in the middle of the night, over and over, can get pretty old pretty fast. It's unfair to the child, certainly, and representatives from the tobacco industry are not there with you. A child gets hit on both sides of his or her birthday, before and after birth.

Premature rupture of membranes, premature labor, and premature births are a higher risk with smoking pregnant patients. With neonatal intensive care bills often exceeding $2,000 a day for a single premature baby, the costs to our country become unfathomable. As the tobacco interests' TV commercials speak of an "unfair" tax on cigarettes punishing those least able to pay it, they don't mention that the NICU bills come from children whose parents are least able to pay, as well.

Smoking has been found to be an important risk factor in sudden infant death syndrome (crib death). Allergies in children multiply over those of children not exposed to smoke in the home or in the car. Children just plain lose with smoking, but there are people profiting at their expense.

Gynecologically, smokers have been found to suffer with worse menstrual cramps because of the vascular effects of nicotine. Infertility is increased, a woman's tubal function becoming more sluggish and a man's sperm being altered. Couples spend thousands of dollars on swank infertility surgeries and work-ups, but then jeopardize their efforts by smoking. And now, smoking seems to be a co-factor in cancer of the cervix, nicotine concentrating in the blood of pelvic organs thirty times more than the rest of the body. In spite of all this, 26% of women of reproductive age choose to smoke, and nearly a third of them continue to do so during pregnancy. But I feel it may not be entirely their fault.

The Battle To Quit Smoking When Pregnant

Smoking is a very tough addiction. When I talk with internists and perinatalogists I hear smoking referred to as being as addictive as heroin and cocaine. Or Twinkies? Let's all take inventory here.

Is there one single thing good about smoking? Yes. But only to those who prosper from it. The rest are being duped and killed and made to suffer. "We all have to go sometime," is the phrase I hear when I suggest to a patient she quit. This is true. But it's not that we all have to go sometime, it's the way we go when we smoke. Death by smoking is a bad, bad way to go. It's slow. And unfairly, it makes everyone in the whole family stop their lives while they hover over chest surgeries, chemotherapies, and the gasping for air from emphysema. It goes on and on, but the toll on the rest of the family is seldom discussed. And of course, there's the bill. And representatives from the tobacco industry are not there.

Quitting is nearly impossible. The cigarettes do the talking when people discuss quitting. "I can't quit right now. I have other things going on. I have to take one thing at a time."

The cigarettes speak these words.

"I'll try again in a few weeks." Again, the cigarettes talking. Try again tomorrow, and then again the following day. Try every single day of the rest of your life if you have to, but don't try every few weeks or months. "I just can't quit. I'm too nervous," or, "I'll just start cutting back."

Pure nico-speak. The cigarettes write the scripts, and the smoker learns his or her lines well. It's like that cartoon where there's a little devil on someone's shoulder whispering bad guidance. Addiction always takes on a life of its own, being personified and offering a false symbiotic relationship. With over 2,000 different chemicals in tobacco smoke, not one of them is nutritious or enriching for you, your baby, your family, or your gender. Twinkies have far fewer chemicals. Well, I think so, anyway. I'll have to talk about Twinkies another time, maybe when people start going through twenty or forty or sixty of them a day.

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