Smoking and pregnancy factsheet Smoking and pregnancy factsheet
On average, smokers have more complications of pregnancy and labour. This can include bleeding during
pregnancy, placental abruption and premature rupture of membranes.
Passive smoking during childhood increases risk for respiratory infections, asthma and impaired lung growth.
Passive smoking is a cause of lung cancer in adulthood.
Health effects of exposure to environmental tobacco smoke. Report of the Office of Environmental Protection Agency. Smoking and TobaccoControl Monograph 10, National Cancer Institute, 1999. Gilliland FD et al Thorax 2000; 55:271-276
Maternal exposure to passive smoking during pregnancy is an independent risk factor for low birthweight
WHO International Consultation on ETS and Child Health, Geneva: 1999
A study into Sudden Infant Death Syndrome estimated that
the number of deaths from the syndrome could be reduced
smokes, the blood flow through the placenta
by almost two thirds if parents did not smoke
is reduced for about 15 minutes, causing the
Blair, PS, Fleming, PJ, et al 1996. Smoking and the sudden infant deathsyndrome: results from 1993-1995 case-control study for confidential inquiry
Hill, LN, Keinberg, F. 1985 The effect of drugs and
into stillbirths and deaths in infancy. British medical Journal Vol: 313: p 195-198
chemicals on the foetus and the newborn, Mayo ClinicProceedings Vol 59 No 5 p 657-664
Women who smoke are less likely to carry their babies to full
The adverse effects of smoking in pregnancy
term. There is a 26% greater risk that they will miscarry or
are due mainly to smoking in the second and
third trimesters. Therefore, if a woman stops
Poswillo, D and Alberman, E. Effects of smoking on the fetus, neonate and
pregnancy, her risk of having a low-weight
The carbon monoxide contained in inhaled cigarette smoke
baby will be similar to that of a non-smoker.
reduces the oxygen carrying capacity of a fetus. This affects
US Department of health and human services 1990 The
the growth rate of the baby; babies of smoking mothers are
health benefits of giving up smoking. A report of theSurgeon general Rockville, Maryland: USDHHS, 1990.
Royal College of Physicians Nicotine Addiction in BritainLondon: Royal College of Physicians 2000
Infants of parents who smoke are more likely to be admitted
to hospital for bronchitis and pneumonia in the first year of
life. More than 17,000 children under the age of five are
admitted to hospital every year because of the effects of
pregnancy the more likely her child is to
Royal College of Physicians, Nicotine Addiction in Britain London: Royal Collegeof Physicians 2000.
Health effects of exposure to environmental tobacco smoke. Report of theOffice of Environmental Protection Agency. Smoking and Tobacco ControlMonograph 10, National Cancer Institute, 1999.
Prolonged smoking causes discoloration of the fingers and fingernails on the hand used to hold cigarettes.
It also results in discoloured teeth and is a cause of halitosis
Lahmann, C et al Matrix metalloproteinase-1 and skin ageing in smokers. The Lancet 20001; 357:935-6
Women and smoking Men and smoking
Epidemiological studies have found that women
Overall, smoking increases the risk of impotence by
who smoke have up to four times higher risk of
around 50% for men in their 30s and 40s. ASH and
developing cervical cancer than non-smokers and
the British Medical Association have calculated that
increases with duration of smoking. Studies have
around 120,000 UK men in this age group are
now demonstrated biochemical evidence that
needlessly impotent as a result of smoking.
Warning: Smoking Causes Male Sexual Impotence. ASH and theBMA, London, 1999.
Simons, A M et al British Medical Journal 1993;306:1444-48Yang, X. et al International Journal of Cancer 1996;65:338-344
The more a person smokes the greater the risk of
premature wrinkling. Smokers in their 40s often have
as many wrinkles as non-smokers in their 60s, this is
particularly noticeable in those who are underweight
and can cause smokers to look gaunt. Recent research
has shown that the skin ageing effects of smokiing
may be due to increased production of an enzyme
which breaks down collagen in the skin. HEA Smoking and Pregnancy Surveys 1992-1999
Younger pregnant women are more likely to be smokers and women from more economically deprived
backgrounds are three times more likely to smoke than their richer peers.
Pregnant smokers are three times as likely to have a partner who smokes compared with pregnant non-smokers.
A pregnant woman’s motivation and ability to successfully give up smoking is significantly influenced by the
smoking status and support of her partner, family and friends.
Pregnant smokers are more likely to cut down on the amount they smoke rather than give up altogether.
Female smokers are less likely than men to believe they can resist the temptation to smoke in certain situations.
The two situations in which women felt they would not be able to resist smoking are ‘during an emotional
crisis’ and ’when feeling stressed’.
Women are more concerned than men about putting on weight if they try to give up smoking. Twice as many
women than men are motivated to give up for aesthetic and cosmetic reasons, such as the lingering smell of
tobacco smoke and the effects on skin and teeth.
Many pregnant smokers feel labelled by society as ‘uncaring’ and so hide their real smoking habits, often
telling health professionals ‘what they want to hear’ i.e. that they have cut down or given up.
Only one in five women who smoked during pregnancy believed they would give up smoking after the birth.
The majority felt they would continue to smoke, but only away from the baby.
Owen, L, Penn, G. 2000 Smoking and Pregnancy: A survey of knowledge, attitudes and behaviour 1992-1999. HEA London
Evidence from the HEA tracking surveys suggests that advice needs to focus unequivocally on stopping and not to
recommend or condone cutting down, which could discourage people from taking the final step to give up altogether. Smoking cessation interventions with pregnant smokers
Pregnant smokers should receive clear, accurate
and specific information on the risks of smoking
to the fetus and themselves and be advised to
Pregnant smokers should be offered specialist
Clinicians, midwives and other staff who may be
involved in discussing smoking with patients or
clients should receive adequate training to
West, R, McNeill, A, Raw, M. Thorax supplement Dec 2000, vol 55,No 12, p 987-999
Nicotine Replacement Therapy (NRT) in pregnancy
Small studies on the effects of NRT on the fetus have not revealed significant problems although animal studies
have demonstrated impaired development in offspring of mothers given nicotine. However, cigarette smoking as a
source of nicotine is likely to be far more hazardous than nicotine replacement products because cigarette smoke
contains many other toxins including heavy metals and carbon monoxide.
If a pregnant woman is unable to give up smoking without pharmacological support she should be encouraged
to discuss her suitability for NRT with a health care professional and/or referred to the local smoking cessation
service. The recently published NICE guidelines advise that women who are pregnant or breastfeeding should
only use NRT after careful consideration of risks and benefits and if they have been unable to give up smoking
without a cessation aid. (Full guidance available to download at www.nice.org.uk). It is clearly important that
a pregnant woman does not increase her nicotine intake by using NRT while continuing to smoke.
NRT is not a magic cure but correctly used it does at least double the chance of success that is increased
Lambers DS, Clark KE, The maternal and fetal physiological effects of nicotine. Semin Perinatol 1996;20:115-26Lindblad A, Marsal K, Andersson KE. Effect of nicotine on human fetal blood flow. Obstet Gynecol 1988;72(3 Pt 1):371-82National Institute for Clinical Excellence, Guidance on the use of nicotine replacement therapy (NRT) and bupropion for smoking cessation. NICE, London: March 2002West, R, McNeill, A, Raw, M. Thorax supplement Dec 2000, vol 55, No 12, p 987-999
NHS Pregnancy Smoking Helpline 0800 169 9 169
Supporting midwives and other health professionals who are working with pregnant women who smoke.
The NHS Pregnancy Smoking Helpline is a gateway to a range of options to support pregnant women who
seek help to stop smoking at a time of their choosing.
• Lines open 12 midday to 9pm every day. Answerphone out of hours
• Confidential counselling service for pregnant women who want to stop smoking
• Information and self-help materials for pregnant women, their partners and families
• Local service contact details provided
• Flexible call-back service throughout pregnancy and early postnatal period
for their help to compile this factsheet.
C h ild h o o d H e a d a c h e s D o n 't Tak e T h e m L ig h tly B y D r. B ria n A b e ls o n D .C . R N C . Headaches during childhood should be taken seriously. There is a growing body of evidenceshowing that headaches that occur during childhood can set a pattern for headache relateddysfunction throughout a person's adult life. In the United States, it is estimated that more than 45m
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