Smoking and Pregnancy

There is a wealth of research that shows us that individuals who smoke tobacco are putting their health at risk from cardiovascular (heart) disease; chronic lung disease; cancer and cerebrovascular disease (stroke). Second-hand smoke puts the health of others at risk too – more than 80% of second-hand smoke is invisible and odourless, so people can still breathe in harmful poisons without being aware they are doing so. This is why the law has changed and why it is now illegal to smoke in vehicles with someone under 18 years present. Both drivers and passengers who breech this law could be fined £50.

Where women smoke during pregnancy, this places their unborn baby’s health at serious risk too. Indeed, smoking in pregnancy is a modifiable yet frequent risk factor for poor infant health outcomes.

We have written this article not to judge or admonish people but to demonstrate why stopping smoking in pregnancy – at any stage, is the best thing you can do to give your baby a healthy start in life.

Why is smoking in pregnancy harmful?

Cigarette tobacco and its smoke contain numerous harmful chemicals – around 4000, plus tar and poisonous gases like Carbon Monoxide. These cross the placenta and restrict the oxygen supply to the developing baby. The harmful effects of tobacco are ‘dose-related’ which means the more cigarettes a woman smokes, the more chemicals and less oxygen that her unborn baby receives. Consequently, where women are able to cut down the number of cigarettes they smoke – even in the latter weeks of pregnancy, the better it is for their baby’s health. If women are able to quit smoking altogether, the harmful effects of tobacco are quickly reversed – Carbon Monoxide and harmful chemicals will soon clear from the body and oxygen saturations (circulating oxygen levels) will improve.

How does smoking affect the unborn baby?

Smoking whilst pregnant is like blowing cigarette smoke in a baby’s face. This is because whenever a pregnant woman smokes a cigarette the poisons from the cigarette fumes cross the placenta (afterbirth) and enter the umbilical cord, and are passed directly into her baby’s bloodstream. The effects can last for up to 15 minutes at a time, which is rather like placing the baby in a smoke-filled room for quarter-of-an-hour. This happens each time a cigarette is smoked. The Carbon Monoxide in tobacco smoke is a dangerous substance that restricts the baby’s supply of oxygen. Oxygen is essential for a baby’s healthy growth and development, so restricting their oxygen supply causes the baby’s heart to pump even harder.

Research shows us that babies whose mothers smoke are:

o Twice as likely to be born preterm (prematurely)

o Three times more likely to be born small/underweight, even when born at term (around their due date)

o More likely to experience placental problems including a condition called ‘placenta praevia’ (low-lying placenta)

How does smoking affect the newborn baby?

Smoking in pregnancy is associated with an increased likelihood of having a preterm birth, with the additional risk that because of their prematurity and poor health, the baby may not survive during the first few months of life. Because nicotine is an addictive substance, newborn babies can go through ‘nicotine withdrawal’ which can make them stressed and irritable. This can make it difficult to stop them crying and settle them.

Babies of smokers have a one in three chance of experiencing serious health problems which have the potential to contribute to their death. They also have a 25% increased risk of dying from SIDS (cot death).

How does smoking affect children?

In the longer term, tobacco use is also associated with neurological, behavioural, and developmental shortfalls in children. Children exposed to passive smoking (second-hand smoke) are at increased risk of needing treatment for ear infections, asthma, bronchitis, pneumonia and meningitis. In 2014 there were 300,000 GP visits and 9,500 UK hospital admissions for children requiring medical treatment as a result of passive smoking.

How does tobacco affect male and female health?

Alongside its association with heart disease, lung disease and stroke, research shows that where the baby’s father smokes this can affect his fertility and, where both partners smoke, this presents doubled health risks. We also know that smoking is linked with poor fertility as well as an increased risk of miscarriage.

Passive smoking (second-hand smoke)

Where a woman’s partner or anyone else living in the household smokes, their second-hand smoke can affect pregnant women and their babies both before and after birth. Studies show that passive smoking is also associated with intrauterine growth retardation (a baby that is smaller than the expected size in pregnancy) and an increased risk of SIDS.

As mentioned previously, babies who are subjected to ‘passive smoking’ because their parent(s) are smokers are more likely to experience illnesses in the first year of life such as; asthma, bronchitis, pneumonia and meningitis which require admission to hospital. It has been found that more than 17000 children under the age of five are admitted for hospital treatment each year as a result of the effects of passive smoking. Studies also show that the children of smokers are more likely to take up smoking themselves.

Where there are other smokers in a household, this can make it a lot more difficult for pregnant women to quit smoking and, if they do, they are more likely to relapse and start smoking again.

What are the benefits of stopping smoking in pregnancy?

The minute you stop smoking, both you and your baby’s health will begin to benefit immediately. Research shows that stopping smoking in pregnancy is associated with:

o Women having a healthier pregnancy and delivering a healthier baby

o Women having more uncomplicated (problem-free) pregnancies

o Women coping better during labour and birth

o Reduced incidence of having a preterm birth and the neonatal (baby) health problems associated with this, eg needing assistance with breathing; feeding problems, and serious infections such as ‘necrotising enterocolitis’(a serious bowel condition)

o Babies being less likely to be born undernourished and underweight NB. The birth weight of babies whose mothers smoke tends to be around 200g (8 ounces) lighter than the babies of non-smokers

o Reduced risk of SIDS

o Reduced risk of stillbirth.

Smoking relapse

Smoking in pregnancy can cause substantial harm and, while many women quit as soon as they start trying for a baby or discover they are pregnant, others continue to smoke throughout their pregnancy. Equally, many women who quit smoking during pregnancy relapse after their baby has been born. Some of the factors associated with smoking relapse include women reporting that the physiological changes associated with the early postnatal period influence cigarette cravings; also, the stress of caring for a newborn baby, chronic sleep deprivation and the process of adjusting to their new identity of being a mother. Specialist smoking cessation services can provide ongoing support following the baby’s birth, so where women are struggling with nicotine cravings it is important that they speak with their healthcare professional, a pharmacist or stop smoking adviser to ensure they get the help and advice they need.

Quitting or cutting down?

Whilst the adverse effects of smoking on the health of the unborn baby are well known; quitting smoking or even cutting down during pregnancy can prove very difficult for some women, especially during a period in their lives, which can often prove quite stressful. For other women however, becoming pregnant and the desire to protect their unborn baby’s health is often the motivating factor needed for them to stop smoking altogether.

The adverse health affects of smoking during pregnancy are so serious that health services provide numerous opportunities for pregnant women to receive specialist support and advice to help them stop smoking completely, or to cut down during pregnancy. Your midwife and/or GP will be able to provide you with specialist information and the contact details for local smoking cessation support services.

Research shows that people are four times more likely to stop smoking with NHS support. A special one-to-one service is available that is geared towards the specific health needs and concerns of pregnant women who want to quit or cut down on their tobacco use. The service is free and you can register by calling the NHS Smoking Helpline Tel: 0800 123 1044. The Helpline is open Monday to Friday 9.00am -8.00pm and at Weekends from 11.00am – 5.00pm.

Once you have registered, a trained ‘stop smoking’ adviser/counsellor will help you to decide how much ongoing smoking cessation support you might need throughout your pregnancy and following your baby’s birth. The free one-to-one support is available alongside licensed stop smoking medications; these are available for the cost of a prescription.

NB. NHS prescriptions are free during pregnancy and for the first year post birth.

There are other smoking cessation organisations that can also provide specialist information and support:

o SMOKEFREE – offers NHS information on smoking in pregnancy, including additional resources such as a pregnancy support DVD; MP3 downloads; cost calculators and ‘stressbusters’ for the ‘Mind’ and ‘Body. NB. They also offer information specifically for fathers. Available at: www.nhs.uk/smokefree

o Quit – The UK Charity that helps people give up smoking and never start; includes information specifically for young smokers as well as information on smoking in pregnancy. Available at: www.quit.org.uk Tel: 0800 00 22 00

o MiQuit – An NHS funded text message service for pregnant women – provides support, information, encouragement and motivation. Available at: www.miquit.co.uk

The above smoking cessation support services can also offer additional support, information and advice on dealing with stress, weight gain, and the use of nicotine replacement therapy (NRT) – eg patches and chewing gum etc. to help manage cravings.

Tips for Quitting

If your partner also uses tobacco, pregnancy can be a good opportunity for both of you to stop smoking and to support each other. Studies have shown that where people stop smoking completely as opposed to cutting down gradually, they are more likely to succeed in quitting smoking; this is because it appears to lessen the nicotine cravings that are often reported. Other tips include the following:

o Work out how much money you will be saving and think about what you could do with the extra cash – you’ll be amazed!

o Decide on a date to stop smoking completely and adhere to it. NB. You will need to think of a time that suits you best eg a weekend when you will be socialising could be harder than during a working week

o Give your partner, friends and family advance notice so they can support you along the way

o Get rid of any cigarettes you have sitting around the house, in your handbag or in the car – do this the day before your quit date

o Think about the triggers that make you want to light-up and forward plan if you know there are going to be times where you will be tempted to smoke

o Use all the NHS support services that are available to you – they want to help you quit

o Take things a day at a time and give yourself a treat for succeeding!

Nicotine replacement therapy (NRT)

Extra support to stop smoking is available in the form of nicotine replacement therapy (NRT). It works by giving the individual nicotine instead of lighting-up a cigarette, so helps to combat the cravings.

The research evidence on the effectiveness of NRT in helping women quit smoking during pregnancy is however, inconclusive. The best research study showed no evidence of its effectiveness in smoking cessation or that NRT affected babies’ birth weights. However, because NRT contains only nicotine without the numerous harmful chemicals found in cigarettes, they are a preferable option to continuing to use tobacco.

NRT can be used during pregnancy; particularly, by women who find they are unable to stop smoking without it. The use of ‘stop smoking’ tablets such as ‘Champix’ or ‘Zyban’ are however, not recommended for use in pregnancy.

A GP or an NHS stop smoking adviser can prescribe NRT for use in pregnancy. Alternatively, NRT can be purchased over-the-counter without needing a prescription from any pharmacy.

NRT is available in a variety of forms, as:

Nicotine patches
Chewing gum
Nasal spray
Lozenges
Microtabs
Nasal spray
Mouth spray
As an inhalator.

However, it is recommended that women always speak with their midwife, GP, a pharmacist, or a specialist stop smoking adviser before they start to use any of these products. Pregnant women should also always follow the information/guidance that comes with the product. For example, NRT patches should be used for no more than 16 hours in any 24 hour period – the best way to adhere to this guidance is to remove the patch just before bed time. However, if women are suffering from pregnancy-related nausea and/or vomiting they should not use NRT patches and should consider another form of NRT instead.

Similarly, pregnant women are advised to avoid liquorice-flavoured nicotine products. While there is no known risk associated with small amounts of liquorice flavouring, the manufacturers do advise caution. This caution is based on evidence-based information on the adverse effects associated with excessive amounts of liquorice root. Therefore, pregnant women are advised to choose an alternative flavour such as, mint or fruit flavoured NRT.

The use of E-Cigarettes

Whilst rates of smoking during pregnancy have decreased slowly in recent years, the rapidly growing popularity of electronic cigarettes (e-cigarettes) may lead to increased nicotine use during pregnancy, and an increased rate of babies being born with complications including intrauterine growth retardation and the problems associated with premature birth. E-cigarettes are not completely risk free and the vapour may contain toxins; however, these are at much lower levels than found in cigarette fumes which makes them a safer alternative to smoking cigarettes.

It is recommended that pregnant women speak with their midwife, GP or a specialist ‘stop smoking’ adviser before using e-cigarettes during pregnancy. This is because little is known about the possible risks of e-cigarette vapours to unborn babies, so your healthcare professional/stop smoking adviser will always recommend that you try NRT in the first instance to help ease nicotine withdrawal.

And finally…

Protecting your baby from tobacco smoke is one of the best things you can do to give your child the healthiest start in life. Because health professionals are very aware of the harmful effects of smoking on the unborn baby, there can be a lot of pressure to stop smoking when you become pregnant. Some women can feel very anxious about admitting that they smoke/are continuing to smoke while pregnant and are very concerned about the reactions of their midwife/GP. However, your healthcare professionals are not there to judge you – they understand that smoking can help to ease stress and anxiety, and that a cigarette provides a brief ‘time out’ from the pressures of every day living. They will want to help you as best they can and can make sure that you receive all the support, advice and information that you need to quit smoking or cut down.

Remember – It is never too late to stop smoking!

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