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| |    Smoking and Pregnancy by Marjorie Greenfield, M.D. reviewed by Robert Needlman, M.D., F.A.A.P. To nonsmokers, it's obvious that pregnant women should not smoke. But for smokers, the prospect of quitting can be so dreadful that many try to ignore the evidence of danger. The dangers are quite real, however, and all parents deserve information and support to protect their children from what is an avoidable health risk. The evidence against smoking in pregnancy Many complications of pregnancy are more likely to occur in smokers. While any smoking is bad, going through less than a half pack a day is definitely better than a heavier habit. Miscarriage, placental abruption, premature rupture of the membranes, premature birth, and low birth weight have all been shown to be more prevalent in the pregnancies of heavy smokers. If you quit smoking by 16 weeks gestation, you can avert many of these complications; and some can still be prevented even if you wait until close to the end of your pregnancy to stop smoking. Exposure to secondhand smoke in the home poses a real risk as well. And on top of all that, if a parent smokes, her child is more likely to become a smoker. The emotional repercussions of this can be great: Smokers who have these smoking-related complications have to deal with the bad outcomes plus guilt over having contributed to the suffering of their families. Placental problems Smoking causes vascular disease, which affects the blood flow through the placenta. The placentas of smokers look older than they should, because the blood vessels are calcified and partially obstructed. The complication of placental abruption (where the placenta separates from the wall of the uterus while the baby still needs the nutrients and oxygen) is more common in smokers. Abruption can lead to vaginal bleeding in late pregnancy, premature birth, fetal distress, and even fetal death. Effects of nicotine Nicotine causes spasm of the arteries, including those that send blood to the placenta. This diminishes the baby's oxygen and nutrient supplies, which can result in smaller (or underweight) babies. Effects of carbon monoxide Because carbon monoxide substitutes for oxygen in the blood during smoking, some fetuses may try to compensate for this deprivation by making extra red blood cells to carry more oxygen. In rare instances, their blood gets too thick from the proliferation of these cells and cuts off the blood supply to vital organs, with fatal results. (I saw the baby of a two-pack-a-day smoker die after birth from this effect.) Long-term effects on the baby Unfortunately, smoking limits the nutrition that a baby can receive. This can be particularly detrimental during late pregnancy, when the baby's brain is developing rapidly. There is also a growing body of evidence that nicotine has a direct damaging effect on developing nerve cells. In animals, even small doses of nicotine injected into the mother during pregnancy resulted in brain malformations, poor functioning, and learning problems. (No one knows what effects the hundreds of other chemicals in cigarette smoke have on a fetus, but they can't be good.) Research shows that humans exposed to nicotine during pregnancy are also more likely to show learning and behavioral problems years later. Babies who are born prematurely or too small for their gestational age can end up struggling with learning problems their whole lives. You may never know if your child's complication was caused specifically by your smoking or by something else unrelated to it. But why chance feelings of guilt if a complication does develop and your cigarette habit may have played a role? Breaking the habit If it were easy to give up cigarettes, few adults would smoke. Many people who quit smoking successfully tried and failed numerous times before they became nonsmokers. If you have tried to quit in the past, take heart: It may take a few falls off the wagon before you are successful. You are not a failure as long as you try. Many women who could not quit at other times in their lives are able to quit in pregnancy because they feel responsible for the good of their baby, even if they couldn't accomplish it for their own health. In pregnancy you can quit cold turkey, or you can slowly decrease the number of cigarettes you have each day over a few weeks; you also can take bupropion (Zyban), a medication that helps to take the edge off cravings. Using nicotine replacement therapy (like the patch or gum) in pregnancy is controversial. It's hard to prescribe a medication for a pregnant woman that clearly is not safe for her fetus. In reality, however, it is safer than smoking, and the goal would be to get off the replacement within a few weeks too. All in all, if nicotine replacement is the only way that a mother-to-be can quit, it is probably better than her continuing to smoke. For specific ideas on how to quit, talk to your practitioner. You also may want to check out an excellent article on how to give up cigarettes at http://rex.nci.nih.gov/NCI_Pub_Interface/Clearing_the_Air/clearing.html.
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