Smoking as such, is a serious social activity in the
modern world. Luckily a lot of attention
is being paid all over the world against smoking. Smoking during pregnancy,
child birth and post partum is a serious preventable habit. Sadly it happens more often in single young women. They are often
unemployed. This leads to increased neonatal and maternal morbidity and
mortality. Luckily the percentage of women smoking has decreased. In UK 15% of women
smoked in 2006-7 now in 2018 it is about 10% , they are aiming to bring it down
to about 6% . 1 billion men smoke, so you can calculate the risk of passive smoking.
Smoking can interfere with conception itself. Then there is increased risk of an
ectopic pregnancy; meaning pregnancy in the fallopian tube that never grows. This is life threatening, risk of miscarriage,
premature labour, abnormally located placenta, premature separation of placenta,
all these can lead to severe morbidity and mortality. This is not just it; a
lot of these babies are born with many abnormalities, such as deformed limbs,
cleft lip and palate, clubfoot, deformed heart valves, and poor brain
development. Later in life they die of sudden infant death syndrome (SIDS).
They can develop diabetes, become obese, and suffer heart disease. Not only do
they suffer as a child they become very difficult to look after due to autistic
disorders (ADHD) poor at school and at college if they ever get to that point
in life. I hope after reading all this you are already longing to give up cigarettes.
There are three compounds in cigarettes, which are
very harmful. These are carbon monoxide
(CO) tar, and nicotine. Of these CO is most dangerous. The CO that a woman
exhales combines with an iron atom at the cost of oxygen producing carboxyhaemoglobin.
400 -500unit of (PPm unit to measure CO) are exhaled after smoking one cigarette
gives a reading of 3-8% of carboxyhaemoglobin. In non-smokers it is 1%, this
impairs the oxygen delivery to the uterine muscle and fetoplacental area
causing all the problems. At present time in many countries every woman’s PPm
is measured at the time of booking by the midwife, irrespective of the story,
this can pick up even all those who are passive smokers and wanted to hide
their smoking story. The test is explained to women in detail, the machine is
also checked that it is in perfect working order in most places. The women are
explained the problems and referred to clinics for smoking cessation. The test
should be done within a few hours of a cigarette; otherwise it can give a
negative result. Some hospitals refer them with a PPm of 3- others accept a value
of 6-8 to be fool proof. They should keep asking these women on every visit if
they have decided to quit. Maybe repeat the CO test.
Tar
is
the other harmful part. Some of the tar disintegrating material stains woman’s
skin, mucous membranes. These are fetotoxic and teratogenic (causing foetal
abnormalities). Cadmium is a heavy metal in the tar which collects in the
placenta and causes foetal growth restriction, resulting in small feeble babies. There are many other toxins in the tar about
which we do not know or understand. It is believed that tar is very dangerous.
Nicotine
is
the third constituent of a cigarette. It affects the foetus and the placenta. This
binds to the foetal brain resulting in abnormal brain development resulting in
hyperactivity disorders, learning disabilities, cognitive, emotional and
behaviour problems and addiction in later life, including smoking. These babies
and children have poor health, infections, diabetes, obesity health problems even
in adulthood. Nicotine is a very dangerous drug. It is produced by tobacco plants.
It can also be synthetically produced. It is a very dangerous drug initially and
it was classified as a poison. Once a person
gets addicted to it, is very difficult to give it up. In our brain it combines
with acetylcholine receptors and this results in the production of dopamine which
is a happy compound. Normally dopamine
is only produced in the brain when a user feels happy, smoker feels alert, euphoric,
increased concentration, and a person is happy, increased levels of endorphins which
reduce anxiety. When the effect of cigarette finishes the person wants to light
up again and that is how it goes on. Nicotine also stimulates Adrenal gland and
it has its own effects. In the 21st century there is a great effort to get
people to stop smoking, particularly pregnant women. In fact this effort is
paying off. Currently in many countries in the world have pre pregnancy
consultations and the care givers must talk about active or passive smoking and
talk to the women about how good it is to stop smoking even before becoming
pregnant and how smoking can complicate your pregnancy.
The other very important action that is being taken
in many parts of the world is to do a CO test at the time of booking. The
booking midwives are well trained about this and if CO level is high they are
advised to attend a quit clinic .The woman has to be agreeable to this. Do not
force her, but ask her on every visit about smoking cessation. Do not force her. Also arrange for a psychosocial and behaviour
support. One of the big problems for quitting is nicotine dependence. This is
not too bad, as the toxic effect of smoking is CO and TAR. Nicotine replacement
therapy (NRT) is not too bad. They can use Nicobate patches for 16 hours a day
remove it at bedtime. Then there are chewing gums, nasal sprays, mouth sprays,
lozenges and micro tabs. Do not use more than one product without the knowledge
of your caregiver.
The other very popular smoking device is an E-Cigarette
or Vaping.
This does contain some harmful products but in much less
concentration. It is like a hot water that one can smoke. Its safety and
usefulness in pregnancy is not yet proven. It is suggested that in future
pregnant women should be included in research on non smoking research.
Smoking is a serious preventable habit and it will
save babies and mothers.
