In the late 1990s, a strong push began to discourage smoking. Restrictions on advertising tobacco products and where individuals could smoke began to take effect. Today, nearly all restaurants, bars, parks, schools, and hospital campuses are smoke-free zones. Occasionally, you’ll see people in their cars or outside bars and restaurants smoking, but it’s less likely to see smokers in public than it was 30 years ago.
Naturally, I was intrigued when a CNN reporter reached out to me to discuss the surprising number of women who smoke during pregnancy. According to data from the Centers for Disease Control and Prevention (CDC), as many as 7 percent of women reported that they smoked during their pregnancies in 2016. That’s one in 14 pregnant women.
Pregnant women were asked whether they smoked during any of the trimesters of pregnancy, and, if they did, it was marked on their child’s birth certificate that the mother was a smoker. The data were not tied back to blood samples, infant birth weight, or other physical data – it was all self-reported. This leads me to think that the numbers might be seriously underreported due to the stigma associated with smoking. Assuming that’s the case, doctors must do a better job of supporting women who want to quit smoking and educating them about the short- and long-term health consequences if they don’t – both to them and their babies.
Pregnant smokers vs. all adult smokers
The CDC data showed wide state-by-state variation in reported rates of smoking during pregnancy. West Virginia was the highest at 25.1 percent, and California was the lowest at 1.6 percent. It’s interesting to compare these with data for all adults who smoke because there are some inconsistencies.
In West Virginia, the rates both of pregnant women and all adults who smoke are high. However, in Louisiana, the rate of smoking during pregnancy is less than 7 percent, and the adult smoking rate is almost 23 percent. It makes me curious whether doctors in Louisiana have strong programs to help women quit or whether there is a severe stigma against smoking during pregnancy that has led to extreme underreporting.
Sometimes health questions that lead to answers that are considered unhealthy behaviors, such as smoking during pregnancy, result in a bias of underreporting. Women might be embarrassed to tell their doctors if they smoke or fear repercussions for telling the truth. It’s vital to understand that the doctor is not there to judge you or get you in trouble.
We’re here to help women have the healthiest pregnancies possible in their unique situations. In our clinic at UT Southwestern, we talk to all pregnant patients about smoking. And if our patients do smoke, we discuss the risks to help them make the best choices for themselves and their babies.
Smoking-related health risks for moms and babies
During pregnancy, many women have more frequent contact with doctors than they otherwise would. Doctors should maximize these touchpoints and keep the discussion of quitting at the forefront of prenatal care. Having these conversations gives us a chance to focus on short-term and long-term benefits for patients and their babies.
Short-term health risks
Substantial information exists about why smoking during pregnancy is unhealthy for infants and mothers. Risks to the baby include:
- Low birth weight
- Placental abruption, in which the placenta separates from the wall of the uterus, depriving the developing baby of nutrients and oxygen
- Preterm delivery, or delivery before 40 weeks
Women who smoke during pregnancy are at increased risk for respiratory infections, as well as blood clots, heart attacks, and strokes.
Long-term health risks
After the baby comes home, infants younger than 2 who live with a smoker are at increased risk of sudden infant death syndrome (SIDS). These children also are more likely to have ear infections and chronic respiratory problems as they grow up, such as:
For mothers, smoking is the No. 1 risk factor for lung cancer (which kills for women annually than breast cancer) and a major risk factor for the three top causes of death of U.S. women: heart disease, cancer, and chronic lower respiratory diseases, such as emphysema and chronic obstructive pulmonary disease (COPD).
How we help women who want to quit smoking
The American Congress of Obstetricians and Gynecologists (ACOG) recommends that providers initiate a compassionate intervention with pregnant women who smoke. In other words, we won’t shame patients, and we will help them find a strategy that works in each situation to protect the health of the mother and the baby.
At our clinic, we ask all pregnant women if they smoke and, if they do, how much. We talk about whether they’ve tried to quit in the past and, if so, what has worked and what hasn’t. This base information helps us pull together recommendations regarding each patient’s individual risk and helps us collaborate with them on cutting back or (preferably) quitting altogether. We’ve found, and ACOG has noted, that smoking-cessation programs work better than simply advising women to quit. This could include a number of strategies:
- Online support communities
- Telephone quitlines
- Text message support
Some women can benefit from medical smoking-cessation therapies, such as nicotine patches or certain antidepressant medications that have been shown to decrease cravings. While these methods avoid exposing the developing baby to secondhand smoke, he or she still will be exposed to nicotine and other chemicals in the medications. Also, some drugs carry a risk for physical or cognitive side effects to the baby. The decision to try one of these strategies must be carefully weighed with a doctor.
In talking to the doctor about smoking, it’s important to remember two points. First, be honest with the doctor. You aren’t our first patient to face quitting, and we aren’t here to judge. Second, patients don’t have to do this on their own. We’re here to help patients have a healthy pregnancy, and if quitting smoking is a barrier, we’ll help them get past it. It isn’t easy, but the possibility of a life without cigarettes both for you as an individual and your family can be terrific motivation.