The effects of smoking during pregnancy on the mother and child.

Even though people are well aware that smoking is detrimental to their health and that with each cigarette that they smoke they risk developing any one of a number of serious illnesses, they still continue to smoke.

Some do so even after suffering from a smoking-related illness and subsequently being cured from it.

Nicotine is an extremely powerful and addictive drug.

Bearing this in mind, female smokers who immediately give up smoking as soon as they find out that they are pregnant should be strongly commended for doing so, as they aim to protect the health of their unborn child.
Obviously to a mother, her child is the most important and precious thing in the world. But for the child, isn't it also important for him or her to have a healthy mother, who will not die an early death through developing a preventable smoke-related illness?

In the majority of developed countries, around 20% of women smoke and although nowadays more and more people in general are quitting the habit, it is the women of childbearing age who are finding it the hardest to give up.

Statistics show that a third of women who are of childbearing age regularly smoke, or in other words are smokers.

Out of the 20% of women who do smoke, between 20 - 30% of them smoked throughout their pregnancy, with more than 50% of them smoking over half a packet of cigarettes a day.

Research suggests that if all pregnant women gave up smoking, the number of stillbirths and cot deaths could be reduced by around 10%.

Not only that, but the risks of numerous other smoke-related complications and illnesses before, during and after birth, would also be greatly reduced.

By smoking throughout pregnancy, the health of the mother and the child are at risk. Smoking could also be the cause health problems later on in life for both mother and child as well.

Despite the fact that generally the number of smokers has declined, the number of heavy smokers has practically doubled in the last 10 years, and more so in women than in men. This statistic is of particular interest because it has been proven that the more cigarettes a woman smokes throughout her pregnancy, the more the unborn child will be affected or harmed.

If a mother smokes whilst she is expecting, there is no doubt that the unborn child will be harmed in some way through exposure to tobacco smoke. How seriously depends on how many cigarettes the mother smokes.

Not only could the correct development of the baby's body be at risk, but so could the development of its brain and its health. These problems could have a lifetime impact on the child, possibly staying with him well into adulthood.

Smoking can also complicate the pregnancy, labour, birth and feeding of the child.

If a mother reduces the number of cigarettes she smokes to one or two a day, then the risk of any complications or harm to the baby are lessoned. However, even smoking those one or two cigarettes means that the baby is still being exposed to harmful chemicals, poisons and toxins.

After the birth of their child, around half of the mothers who gave up smoking during their pregnancy, took up the habit again within a few weeks, days or even hours of giving birth.

A child's health may also suffer from passive smoking in the home. Passive smoking can lead to respiratory problems such as asthma and also ear infections amongst other conditions (See section on passive smoking).

Effects on the foetus

When a woman continues to smoke throughout her pregnancy, her unborn baby is affected from the first instant.

Tobacco smoke contains more than 4000 harmful chemicals, of which a number of them are known carcinogens in humans, whilst others are highly toxic and poisonous.

The chemicals that most affect the foetus and its healthy development are nicotine, tar and carbon monoxide, although arsenic, ammonia, hydrogen cyanide, formaldehyde and creosote are in no way good for the baby to inhale either.

When an expecting mother inhales tobacco smoke from a cigarette, some of the chemicals are exhaled immediately and leave the body, but others stay in the body and make their way into the placenta. The unborn child, as well as inhaling the mainstream smoke that the mother breathes in from the cigarette, which stays in her body, it may also inhale any secondhand smoke that is in the air. This would mean that the growing foetus would be negatively affected by two different types of smoke.

Once the baby is born, it would no longer be affected by the mainstream smoke that the mother inhales, however if the mother continues to smoke, the child will suffer the effects of secondhand smoke and become a passive smoker itself.

The unborn child in the womb relies on the mother for its food, nutrients and oxygen in order to develop and grow healthily before the birth. The placenta is the tissue that connects the foetus to its mother and from where it receives all it needs for its correct development whilst it is in the mother's womb.

On smoking several things happen. Firstly, there is a reduced supply of oxygen, due to the increase of nicotine and carbon monoxide in the mother's bloodstream. This means that there is less oxygen available to the baby, as the harmful substances replace it. The baby will begin to move slower after the mother has smoked a cigarette and the baby's heart will have to work faster, as it tries to breathe in more oxygen. Consequently, its breathing and movement will be altered. In other words it will suffer unnecessary stress.

As well as a reduced amount of oxygen, the nicotine constricts the blood vessels in the mother's side of the placenta, thus preventing the blood supply, oxygen and the necessary amount of nutrients and food from reaching the baby, which will result in the slow growth of the foetus.

As a result the foetus will not develop or grow as well as it should and this can lead to the birth of a low-weight baby and all the risks and complications that this could entail. A low-weight baby is more likely to be placed in intensive care once it has been born.

Not only this, once the mother has given birth, she will cut off the supply of nicotine to her child and shortly the baby will begin to suffer the effects of nicotine withdrawal.

Even if the mother does not smoke but the baby is exposed to passive smoking from the father, the growth and development of the foetus can be affected.

Effects on the mother and the pregnancy

Smoking throughout pregnancy does affect both mother and child and can lead to complications that could have been prevented had the mother stopped smoking.

Fortunately some mothers suddenly develop a strong distaste for smoking when they become pregnant and are easily able to give up smoking for the nine-month period or longer.

If you quit smoking within the first 3 months of being pregnant, you are greatly increasing the probability of giving birth to a normal and healthy baby.

Below is a list of possible pregnancy complications that have been associated with women who smoke:
  • Ectopic pregnancy - this can be life-threatening for the mother and can lead to difficulties in becoming pregnant again. In an ectopic pregnancy, the egg usually becomes implanted in one of the fallopian tubes and begins to grow there. In the majority of cases, this type of pregnancy will never result in the live birth of a child, as there is not enough room for the baby to grow fully, and the cells must be removed as soon as the ectopic pregnancy is diagnosed by either an injection of drugs or by surgery.
  • Foetal death - this is when the baby is still a foetus (less than 28 weeks) and dies in the uterus. Maternal smoking has been linked to the death of 5 - 10% of all foetal and neonatal deaths.
  • Stillbirth and death of the baby in the first week - this risk is increased by a third if the mother smokes.
  • Miscarriage - the risk of suffering a miscarriage is increased by 25% for a smoker.
  • Placenta previa - the placenta lies extremely low in the uterus and block or covers the opening of the cervix. This can result in a difficult delivery and puts the mother's and baby's life at risk.
  • Early detachment of the placenta from the wall of the uterus before delivery, which could result in heavy bleeding.
  • Increase of heart rate and blood pressure in the mother due to the effects of the nicotine.
  • Blood clots
  • Vomiting
  • Vaginal bleeding
  • Thrush
  • Urinary tract infections
  • Premature rupture of the membranes, which may lead to a premature birth as well as infection.
  • Lack of necessary vitamins and folic acid.
  • Decreased lung function of the developing baby, caused by the nicotine that crosses the placenta to the foetus and alters the cells of the unborn child's developing lungs.
  • Premature birth, which could result in a low-weight baby. Full-term babies are healthier and stronger. Going into labour prematurely is twice as common in smokers than it is in non-smokers. The risks are even higher if the mother is still smoking throughout the latter half of her pregnancy.
  • Respiratory problems in the mother.
  • Less energy and therefore tiring more easily and less able to cope well with the pregnancy.
Remember, the more cigarettes you smoke throughout your pregnancy, the greater the risks of harm to the foetus, complications with the pregnancy and harm to your health.

Effects smoking has on the birth

Smoking does not actually affect whether you have an easy birth or not. However, there are still certain risks you are taking by continuing to smoke throughout your pregnancy.

Smoking does not actually affect whether you have an easy birth or not. However, there are still certain risks you are taking by continuing to smoke throughout your pregnancy.

Evidence has shown that women who smoke whilst they are pregnant have a 25% higher risk of giving birth to a stillborn baby. The more cigarettes that are smoked, the higher the risk.

There is an 82% chance of giving birth to a baby with a lower birth weight. Many mothers wrongly believe that giving birth to a lighter baby will mean an easier birth, however this is by no means the case. Giving birth to a low-weight baby can bring with it no end of complications and health problems for the child.

Low-weight babies can be expected to have severe health problems such as breathing disorders, bronchitis and ear infections especially in the first two years of their life.

They are more likely to be admitted into intensive care after being born and could even face being disabled. Some may even die shortly after birth.

According to statistics, 20 - 30% of the babies who are born with a low birth weight do so because their mother smoked throughout pregnancy. Giving birth to a low-weight baby may have long-lasting negative effects on the child's growth and development. A premature birth can also result in a low birth weight baby and smoking increases this risk by around 30%.

Low-weight babies usually weigh around 250g less than a normal and healthy baby. Newborns who weigh in at less than 5½ pounds could suffer from birth defects such as a cleft lip or a cleft palate. This is more likely if the mother smokes over 20 cigarettes a day. They could even be born with severe disabilities like cerebral palsy or they could have problems with their spinal cord, ears or eyes.

Low birth weight in a baby is caused by a restricted supply of oxygen, nutrients and food to the baby, which in turn hinders the correct development and growth of the foetus. This is all caused by smoking and the effects of the poisonous gases and chemicals found in the tobacco smoke that the mother inhales into her body and passes on to her baby.

What is more, all of these potential risks can be avoided simply by giving up smoking.

SIDS (Sudden Infant Death Syndrome) otherwise known as "cot death" is when an apparently normal and healthy baby dies suddenly whilst sleeping.

When an expectant mother smokes during her pregnancy the risk of her baby dying from cot death is twice as high as that of a non-smoking mother. The risk may be increased even more if the mother is a heavy smoker.

There is also a risk of cot death when the baby is exposed to passive smoking at home, especially if both parents smoke (see section on passive smoking).

Smoking and breastfeeding

Many women who give up smoking for the duration of their pregnancy, start again almost immediately after the birth of their child.

If the mother decides to smoke and breastfeed her child, the baby can still be affected by the harmful effects of tobacco and other chemicals in the mother's bloodstream. The chemicals from the tobacco smoke enter the mother's breast milk and will therefore be passed into the baby upon feeding.

Breast milk will normally contain whatever is in the mother's body. Without a doubt, the more cigarettes the mother smokes, the higher the concentration of harmful substances is passed onto the child.

The amount of nicotine that is passed on to the baby depends on how many cigarettes the mother smokes, when she smokes in relation to feeding and the amount of time in between cigarettes. Nicotine is actually naturally present in breast milk and the baby will in fact, inhale more nicotine from breathing in the smoky air in a room rather than from the intake of the breast milk itself.

The baby may possibly suffer symptoms of vomiting, stomach cramps or diarrhoea if the mother is a heavy smoker and smoking more than 20 cigarettes a day may also reduce the mother's supply of breast milk. Nicotine reduces the amount of prolactin, which is a hormone that is needed in order to breastfeed. Mothers that smoke usually breastfeed for a shorter length of time overall.

Many children who have parents and especially mothers who smoke, may suffer severe breathing problems such as asthma, wheezing or bronchitis as they are growing up. Studies have shown that breastfeeding may reduce the severity of any of these illnesses.

Some studies do suggest however, that it is better for the child if the mother smokes and breastfeeds rather than smokes and bottle feeds. Obviously, the ideal would be not to smoke at all. However, if you do smoke and breastfeed, try to smoke after feeding rather than before, in a room that is separate from the baby, as this will reduce the amount of nicotine in the milk and the milk will taste much better. Research has discovered that a mother's breast milk contains the strongest flavour of tobacco between 30 - 60 minutes after smoking a cigarette.

Maternal smoking and the health of your child

If you smoke throughout your pregnancy and continue to smoke after the baby has been born, your child will be exposed to secondhand smoke throughout its childhood. This will lead to adverse effects on its health.

Babies who have one or two parents who smoke are twice as likely to suffer from breathing disorders such as bronchitis or asthma, especially during the first two years of their life. They may suffer from more colds, coughs, wheezing and are still at risk of dying from SIDS.

Children exposed to environmental tobacco smoke will be more vulnerable to infections and illnesses and will visit the doctor more often than a child who has not been exposed.

More worryingly, the latest research has found that smoking whilst being pregnant, not only affects the health and growth of the child, but is also associated with hyperactivity, behaviour disorders and poor results at school.

As a child, there is an increased risk that the child will go through puberty at an earlier age and as an adult, the risks are higher for suffering a stroke, heart disease, high blood pressure or from developing a from of diabetes.

Smoking mothers and hyperactive children

Scientists have gradually become aware of an increase in the number of hyperactive children being born over the last thirty years, which seemed to coincide with an increase in smoking and above all, heavy smoking in women. This had led them to investigate further in order to find out whether there is a link between the two.

Investigations conducted by the Psychology Department of a Canadian University have uncovered a possible link between heavy maternal smoking and hyperactive (ADHD) children.

Although a very small number of children were observed, it was found that the mothers of these "hyperkinetic" children who were being treated with Ritalin, smoked on average 14 cigarettes a day whilst they were pregnant and increased this amount to 23 cigarettes a day after giving birth.

In comparison, mothers of "normal" children only smoked 6 cigarettes during pregnancy and 8 after giving birth.

The reason for the hyperactivity is found in the fact that high levels of carbon monoxide in the foetus, which were double the levels of the mother, were concentrating in the foetus, depriving it of necessary oxygen and consequently severely damaging and altering the unborn child's central nervous system.

Maternal smoking and poor school results

Several studies were carried out in a number of different countries where thousands children were observed over time and subsequently tested on their reading, maths, language skills and ability to process and carry out auditory tasks and information.

Three different groups were studied:
  • a) children of active smoking mothers who smoked throughout pregnancy
  • b) children exposed to passive smoking at home
  • c) children whose parents didn't smoke at all
The childrens' abilities were evaluated when they reached the age of 11 and the results showed that the children belonging to mothers who smoked were on average shorter in height and several months behind the other two groups in their reading, maths and general schoolwork ability.

Likewise, performance in auditory processing tasks was also lower in the maternal smoking group.

Furthermore, findings also showed that the children in the passive smoking group performed better than the children whose mothers actively smoked, but not as well as the children in the smoke free group.

Child behaviour disorders linked to maternal smoking

Finally, researchers have discovered that women who smoke throughout pregnancy are significantly more likely to have children who possess severe behaviour disorders. These disorders such as anxiety, disobedience or anger problems become apparent as the child becomes older.

The children that displayed the greatest behaviour problems belonged to mothers who smoked more than 20 cigarettes a day during their pregnancy.

The benefits of giving up smoking

Becoming pregnant is an excellent reason to give up smoking for good.

There is more than enough evidence to prove that smoking whilst pregnant has adverse effects on your child's development; physically, emotionally and mentally.

The sooner you quit smoking the better, although it is never too late. Even if you are nearing the end of your pregnancy, your child's health and growth will benefit from no longer being exposed to the harmful substances that tobacco smoke contains.

If you really find it impossible to give up smoking, then, at least try to limit the number of cigarettes you smoke to less than 5 a day if possible.

If you give up smoking within the first few weeks of your pregnancy, you have every chance of giving birth to a completely normal and healthy baby.

If you need help to give up smoking, you should consult your doctor, midwife or health professional.

Ideally, it is best for pregnant women to quit without the use of any Nicotine Replacement Treatments (NRT's), such as patches or gum, as the baby will still be exposed to concentrations of nicotine, which will in turn adversely affect the developing foetus.

Strength and willpower together with counselling from a professional and support from family and friends will be the best way to give up smoking if you are expecting a child.

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