Smoking in Pregnancy

December 14, 2007
Are you out of your frickin' mind?

The Womb Should Be a Smoke-Free Environment

Forget about lung cancer and heart disease for a moment. I can assure you that smoking causes its share of misery in the specialty of obstetrics as well. An unborn baby is at risk for many complications when the mother-to-be smokes. Everyone wants a perfect baby, but smoking makes all the fuss over birthing methods and drug avoidance trivial. It's still amazing that a quarter of pregnant women smoke during their pregnancies! And it's sad that even after reading this they will still. That's because smoking is a strong addiction, as powerful an addiction as morphine. But smoking is everywhere, traditional, and does not cause sudden damage, which is why it's forgiven on a cigarette-by-cigarette basis. "There's always time to quit...later," says each cigarette as you fill your addiction receptor sites with nicotine, whether it be by taking a drag or getting it any other way. Furthermore, the gum and the patch won't work, since you're still satisfying the addiction. (No one says, "I"m quitting heroin by using a heroin patch.")

Speaking of nicotine receptor sites, this is overly-simplistic, since what I'm talking about is keeping your levels of dopamine up--the "feel-good" neurotransmitter in the brain that stays high when any addiction is satisfied.

Buproprion is an antidepressant that works by keeping the dopamine up, and the brand name of Wellbutrin is now sold as Zyban to help quit smoking, which makes more sense than giving yourself more nicotine in the form of a patch. Insurance won't pay for Zyban, but it will pay for the identical Wellbutrin for "depression," nudge-nudge, wink-wink.

So, what about the baby? Birth Defects From Smoking

Before delivery

The rate of infertility rises with the amount of smoking, as does the miscarriage rate and the ectopic pregnancy rate. These are all bad things to increase your risk of having happen to you. Besides assuring you of your own horrible death at some point in the future, your baby is at great risk here. Growth retardation before birth and decreased intellectual potential after are well-proven. Performance in school can be compromised by the smoking that occurred before the future student was born. I once asked a smoking, pregnant patient of mine, "Why do you keep smoking? Do you want to have a stupid baby?" She responded, "Aw, he's probaby gonna be stupid anyway." Point well made. Premature labor and premature births are a higher risk with smoking pregnant patients.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. And the more an expectant mother smokes, the more this risk rises. Even with survival of the baby, placental abruption is a leading cause of premature delivery, with all of the risks that are associated with it. Premature rupture of membranes is also increased, which likewise pushes a mother into a preterm delivery and risks serious infection to the unborn child. According to Gerald Briggs, B. Pharm, in OB.GYN. News, October 1, 2003:

"5% of all premature births can be attributed to maternal smoking." And "...if all smoking during pregnancy were eliminated, perinatal mortality would be reduced by an estimated 10%."

That's a lot of babies. And you have no special protection that yours wouldn't be one of the ones victimized by your choice to smoke. Additionally, nicotine is a vasoconstrictor, which means it narrows the nutrition- and oxygen-carrying blood vessels to the baby. So each and every drag of a cigarette not only means less oxygen and nutrition to the baby's brain and other organs, but also injures the placenta which is the crucial life-sustaining link between mother and child.

After delivery

There's triple the risk of SIDS (Sudden Infant Death Syndrome) in babies of mothers who smoked not only after delivery, but BEFORE delivery, too. An increased rate of congenital deformities is substantially increased futher with smoking during pregnancy. In other words, there seems to be an additive tendency between family history of deformities (a genetic tendency) and smoking, acting together. Heart defects, limb defects, etc., have all been reported increased over the statistics of family history alone when smoking has been involved. There is also evidence that smoking increases the risk that a child may develop leukemia. Each research year it becomes even more frightening.

Pediatric asthma and the repeated upper respiratory infections (croup) are more likely in a smoking home. 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 no one from the tobacco industry is there to help out the next morning when you have to go to work anyway after a night like that. Allergies in children multiply over those of children not exposed to smoke in the home or in the car. A child gets hit on both sides of his or her birthday, before and after birth. With neonatal intensive care bills often exceeding $4,000 a day for a single premature baby, the costs to our country become unfathomable.

Children just plain lose with smoking.

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. With over 2,000 different chemicals in tobacco smoke, not one of them is nutritious or enriching for you, your baby, your family, your gender, or the generations to come. Just a thought: take the money spent each day on cigarettes, use common financial methods, and then put your child through college when the time comes.

The Babysitter Test:

Don't give your unborn child anything you wouldn't want a babysitter to give him later. If your nanny-cam caught the babysitter getting your baby to take a drag on her cigarette several times with each cigarette she smoked, you would fire her immediately. Why is it O.K. for you to do the same before your baby's born? Don't do what you wouldn't allow a babysitter to do.

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