Effects of Smoking During Pregnancy
Smoking increases the risks of prenatal issues, complicated birth, and a number of peripartum and newborn health issues.
In the U.S., there are an estimated 42 million people (nearly 18% of the total population) who currently smoke 1. Tobacco use is the leading cause of preventable disease, disability and death in the U.S. In fact, smoking accounts for nearly 1 in every 5 deaths each year 2.
Effects of Smoking on a Baby
Cigarette smoke contains thousands of harmful chemicals. When a woman smokes during pregnancy, these toxic chemicals enter her bloodstream and increase the risk of fetal injury. The nicotine and carbon monoxide in cigarettes are especially harmful because they can damage a baby’s developing brain and make it difficult for a baby to get enough oxygen. Nicotine narrows the blood vessels in the umbilical cord, which can result in inadequate levels of oxygen exchange for the developing baby.
Smoking increases the risks of prenatal issues, complicated birth, and a number of peripartum and newborn health issues. Risks include 3,4,5 :
- Roughly 1 in 10 women report that they smoked during the last 3 months of their pregnancy6.
- Approximately 50-60% of women who quit during pregnancy will start again within 1 year after the birth of their child7.
- Low-birth weight.
- Premature birth.
- Ectopic pregnancy.
- Spontaneous abortion.
- Placenta previa.
- Placental abruption.
- Sudden infant death syndrome (SIDS).
When babies are born too early, they are deprived of the safe environment and regular developmental duration they would have otherwise experienced in the womb. The earlier a baby is born, the greater the chance that they will experience health issues. In some cases, premature birth can result in infant death.
Premature babies may experience 8,9:
- Problems with feeding.
- Respiratory distress.
- Cerebral palsy.
- Delays in development.
- Problems with hearing or eyesight.
If a baby is born prematurely, they will often need to be hospitalized for days or even months so that doctors and nurses can safely monitor their progress.
The harmful effects of prenatal exposure to smoking are not limited to childhood. Negative effects can last throughout a child’s lifetime. Studies have found that children who are exposed to tobacco in utero have significantly higher odds of having a learning disability later on 10. Children born to mothers who smoked a pack or more a day during pregnancy are also significantly more likely to be smokers themselves when they grow up 11.
Electronic cigarettes (also referred to as e-cigarettes) are hand-held battery-operated devices that people use to smoke a liquid that is made of nicotine, flavoring, and other chemicals. The battery in the device heats the liquid nicotine to create an aerosol that the smoker then inhales 12.
The use of e-cigarettes has become increasingly popular. According to Forbes, e-cigarette sales generate over $1 billion every year.
People often think that they are safer than tobacco cigarettes, which may lead them to smoke more freely during pregnancy 13. For pregnant women, the chemicals in e-cigarettes can cause adverse effects to their baby.
E-cigarettes contain nicotine—a potent teratogen or, in other words, an agent that can be profoundly harmful to prenatal development 13. Nicotine crosses the placental barrier and studies have found that it can cause a significant amount of damage to the development and well-being of a fetus.
In animal studies, nicotine has been found to cause 14,15:
- Respiratory problems, including impaired lung function and decreased lung size. (This may affect both first- and second-generation offspring.)
- Reduced fertility for female offspring.
Some people turn to e-cigarettes to help them stop smoking tobacco. However, there is no evidence that e-cigarettes are a safe alternative to cigarettes. In fact, to date, no e-cigarette is approved by the FDA for smoking cessation purposes 16. This is due in part to the fact that e-cigarettes are currently unregulated and contain nicotine at varying levels.
If you are pregnant and currently smoking e-cigarettes, talk to your doctor about the risks and benefits of exposing your baby to nicotine during pregnancy.
Dangers of Secondhand Smoke
Secondhand smoke (SHS) refers to the potentially inhaled smoke resulting from another person’s doing it. Just like immediately inhaled cigarette smoke, SHS is a human carcinogen – which means it contains chemicals that cause cancer 17. SHS can cause a number of negative health problems in children and adults.
Exposure to SHS during pregnancy is associated with an increased risk of 18,19:
- Low birth weight.
- Preterm delivery.
Babies who are exposed to SHS after they are born are more likely to die from SIDS compared to babies who are not exposed to cigarette smoke 19.
Babies exposed to SHS also have weaker lungs than other babies, which can increase their risk for other chronic health problems such as asthma, ear infections, bronchitis, and pneumonia 19.
Credit: American Medical Association
Did You Know?
Below are some interesting facts and statistics about smoking during pregnancy:
- Smoking reduces a woman's chances of getting pregnant 20,21,22. Approximately 15% of couples have trouble getting pregnant. One of the causes for this is female infertility. Smoking and secondhand inhalation are risk factors for decreased female fertility 23. In a study on infertile couples, males who smoked had significantly lower sperm quality. Cigarette smoking was associated with reduced sperm density and sperm count 24.
- Smoking during pregnancy can increase the risk of tissue damage in an unborn baby: Studies show that maternal smoking can cause tissue damage in the baby’s lungs, brain, and increase the risk of the baby having a cleft lip 25,26.
- Nicotine passes freely into breast milk: The amount of nicotine transferred through breast milk is more than double the amount transferred through placenta 27. However, breastfeeding is beneficial to a baby’s health and even if a woman smokes, she will be encouraged to breastfeed vs. use formula, as evidence shows the milk itself still provides protection against respiratory illness 27.
Quitting Smoking While Pregnant
Quitting smoking during pregnancy is one of the most important steps a woman can take to improve her health. It will help you feel better and provide a healthier environment for your baby.
Keep in mind that many people try to quit multiple times before they are successful. It is difficult to quit smoking, and you are not a failure if you “slip.” The important thing is to keep trying.
Benefits of Quitting for Mothers
Mothers who quit smoking will get numerous health benefits. If you quit smoking, you’re likely to experience 17:
- Reduced likelihood of developing heart disease, stroke, lung cancer, chronic lung disease, and other smoke-related diseases.
- Increased levels energy.
- Increased ease of breathing.
- Better financial prospects, as money previously put toward cigarettes will be available for other expenses.
- A sense of peace about the choices you made for yourself and your baby.
If you are in the process of quitting smoking, below are some useful strategies to help you handle cravings and avoid triggers 28.
- Engage in physical activity, such as walking, jogging, running, swimming, or dancing.
- Practice deep breathing at least once a day. Take long, slow breaths to center yourself.
- Talk to friends and loved ones.
- Write down your thoughts and feelings in a journal or blog.
- Remind yourself that you are not a smoker—identity is powerful, and identifying yourself as a nonsmoker can help you quit and stay tobacco-free.
- Spend time with people who don’t smoke.
- Ask others not to do it in front of you.
- Establish a “smoke-free” zone in the car or house.
- Identify triggers, such as people or stressful situations that cause you to want to smoke. Avoiding these triggers can help you stay drug-free.
- Redirect your focus and attention when a trigger makes you want to smoke: immediately go for a walk, listen to music, call a friend, or brush your teeth.
- Reduce stress in your life, such as work stress or personal stress.
- Eat a healthy diet, drink plenty of water, and get at least 8 hours of sleep each night.
When you stop smoking, your baby will be able to get more oxygen. Quitting will also reduce the risk that your baby is born prematurely.
Some women may feel guilty or ashamed about their smoking. But every mother wants the best for her child. Try not to let fear stand in the way of getting help. There are numerous resources available for individuals looking to quit. For example, this virtual clinic is free for those looking for help to stop smoking. You can also call 1-800-44U-QUIT, a national quitline for pregnant women seeking to end their tobacco use.
If you are abusing any other substances like alcohol that may also cause potential harm during your pregnancy, reach out to us today at 1-888-744-0069Who Answers?. You and your baby deserve to be healthy.
Are Nicotine Replacement Therapies Safe During Pregnancy?
While nicotine replacement therapy (NRT) is shown to be highly effective in non-pregnant individuals, there is not evidence to determine whether or not NRT is safe and effective for use among pregnant smokers 29. More data is needed to determine whether or not NRT is safe to use during pregnancy given that there is conflicting and inconclusive evidence in the research community regarding its use 30.
Gynecologists may recommend nicotine replacement therapy only after a woman has tried behavioral therapy interventions and they have failed 31. A doctor should first discuss the risks and benefits of nicotine replacement therapy before prescribing it to a pregnant patient.
Below are a few facts about these medications 30,31:
- Varenicline acts on the brain’s nicotine receptors.
- Bupropion is an antidepressant.
- Both of these medications are transferred through breast milk.
- The U.S. Food and Drug Administration recently added warnings on these products because they increase the risk of psychiatric symptoms and suicide.
There is currently not enough evidence to conclude whether any of these medications are safe to use during pregnancy.
Mothers can breastfeed while being on nicotine replacement therapy as long as the dose is less than the number of cigarettes usually smoked. Women should first consult their doctor before breastfeeding and using nicotine replacement therapy, since a baby can be exposed to nicotine through a mother’s breast milk. Additionally, the FDA discourages lactating women from using other smoking cessation pharmacotherapies such as bupropion or varenicline 32.
Handling Nicotine Withdrawal
An addiction to tobacco can have both physiologic and psychological components, potentially compounding the difficulty in quitting.
In order to quit smoking, a physician may recommend any of the following cessation techniques 33:
- Cognitive and behavioral therapy.
- Motivational interviewing and talk therapy.
- Alternative or nontraditional treatments and therapies like hypnosis, meditation, and acupuncture.
- Pharmacologic therapy.
The acute nicotine withdrawal syndrome has a number of unpleasant associated symptoms. These are normal and will last a few days to a few weeks.
Symptoms of withdrawal may include 10:
- Negative moods.
- Urges to smoke.
- Difficulty concentrating.
Women who smoke during pregnancy are encouraged to stop smoking and seek help. Although physicians recommend quitting smoking before 15 weeks of gestation for the greatest benefits to the baby and the mother, quitting at any point is beneficial 34.
Additional Resources to Help You Quit
If you are addicted to smoking and looking for ways to quit, below are a few resources designed to help you.
Additionally, extra cessation therapy is offered to pregnant women under the Affordable Care Act, or ObamaCare.35. This includes free counseling and medication – as approved by a doctor 36.
Quitting smoking can be challenging. But there are more resources than ever to help you quit.
If you’re struggling with substance addiction, don’t wait to get help. Our treatment placement specialists at 1-888-744-0069Who Answers? can help you find the care you need to quit today and become as healthy as possible for yourself and your child.
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2 Centers for Disease Control and Prevention. (2016). Current Cigarette Smoking Among Adults in the United States.
3 Pineles, B. L., Park, E., & Samet, J. M. (2014). Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. American journal of epidemiology, 179(7), 807-823.
4 Centers for Disease and Control. (2015). Highlights: Impact on Unborn Babies, Infants, Children, and Adolescents.
5 Cnattingius, S. (2004). The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes.Nicotine & Tobacco Research, 6(Suppl 2), S125-S140.
6 Centers for Disease Control and Prevention (2016). How Does Smoking During Pregnancy Harm My Health and My Baby?
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9 Been JV, Lugtenberg MJ, Smets E, van Schayck CP, Kramer BW, Mommers M, Sheikh A. (2014). Preterm Birth and Childhood Wheezing Disorders: A Systematic Review and Meta-Analysis. PLOS Medicine.
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11 Buka, S. L., Shenassa, E. D., & Niaura, R. (2003). Elevated risk of tobacco dependence among offspring of mothers who smoked during pregnancy: a 30-year prospective study. American Journal of Psychiatry, 160(11), 1978-1984.
12 Centers for Disease Control and Prevention (2016). E-Cigarettes and Pregnancy.
13 Baeza-Loya, S., Viswanath, H., Carter, A., Molfese, D. L., Velasquez, K. M., Baldwin, P. R., ... & De La Garza, R. (2014). Perceptions about e-cigarette safety may lead to e-smoking during pregnancy. Bulletin of the Menninger Clinic, 78(3), 243.
14 England, L. J., Bunnell, R. E., Pechacek, T. F., Tong, V. T., & McAfee, T. A. (2015). Nicotine and the developing human: a neglected element in the electronic cigarette debate. American journal of preventive medicine, 49(2), 286-293.
15 Petrik, J. J., Gerstein, H. C., Cesta, C. E., Kellenberger, L. D., Alfaidy, N., & Holloway, A. C. (2009). Effects of rosiglitazone on ovarian function and fertility in animals with reduced fertility following fetal and neonatal exposure to nicotine. Endocrine, 36(2), 281-290.
16 Siu, A. L. (2015). Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: US Preventive Services Task Force Recommendation Statement. Annals of internal medicine, 163(8), 622-634.
17 World Health Organization, & International Agency for Research on Cancer. (2004). Tobacco smoke and involuntary smoking(Vol. 83). Iarc.
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19 Centers for Disease Control and Prevention. (2016). Health Effects of Secondhand Smoke.
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21 U.S. Department of Health and Human Services. (2010). A Report of the Surgeon General: Highlights: Overview of Finding Regarding Reproductive Health.
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24 Künzle, R., Mueller, M. D., Hänggi, W., Birkhäuser, M. H., Drescher, H., & Bersinger, N. A. (2003). Semen quality of male smokers and nonsmokers in infertile couples. Fertility and sterility, 79(2), 287-291.
25 Leslie, E. J., & Marazita, M. L. (2013). Genetics of cleft lip and cleft palate. In American Journal of Medical Genetics Part C: Seminars in Medical Genetics (Vol. 163, No. 4, pp. 246-258).
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27 Massachusetts General Hospital. (2007). Smoking While Breastfeeding: What Are the Risks.
28 American College of Obstetricians and Gynecologists. (2011). Smoking Cessation During Pregnancy.
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30 Pfizer Labs. (2010). Chantix® (varenicline) tablets: highlights of prescribing information.
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32 Sachs, H. C., Frattarelli, D. A., Galinkin, J. L., Green, T. P., Johnson, T., Neville, K., ... & Van den Anker, J. (2013). The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics,132(3), e796-e809.
33 American College of Obstetricians and Gynecologists. (2015). Smoking Cessation During Pregnancy: Committee Opinion.
34 England, L. J., Kendrick, J. S., Wilson, H. G., Merritt, R. K., Gargiullo, P. M., & Zahniser, S. C. (2001). Effects of smoking reduction during pregnancy on the birth weight of term infants. American Journal of Epidemiology, 154(8), 694-701.
35 ObamaCare. (n.d.). ObamaCare and Smokers.
36 Substance Abuse and Mental Health Services Administration. (n.d.). How the Affordable Care Act Affects Tobacco Use and Control.