SMOKING IN PREGNANCY

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.