*Article: Smoking cessation in pregnancy
- From: robbb <robbbDICE@xxxxxxxxxxxxxxxxxxxx>
- Date: Tue, 22 Nov 2005 17:56:58 -0500
by Maria Leahy, Rosen Holdings Ltd
Maria Leahy SRN, R.M, Dip Man. MA Marketing, ISO Auditor/Assessor, Cert Health & Safety, CPC, specialised in midwifery for over 16 years at Guys Hospital in South East London. She has experience in helping people quit smoking in many health care sectors. She represented the Midland Health Board (EIRE) on the National Board of STAG (Smoking Target Action Group). Maria is NicoBloc Medical Director at Rosen Holdings Ltd and trains GPs and other professionals in smoking cessation skills.
The risks of smoking in pregnancy are reduced within one hour of giving up. About 30 per cent of women who smoke in the UK continue to smoke during pregnancy. To give up smoking is one of the most important things a person can do for their own health and that of others, and this is particularly true in pregnancy. Low birth weight is associated with higher risks of death and disease in infancy and early childhood. The adverse effects are due mainly to smoking in the second and third trimesters. Therefore, if a woman stops smoking within the first three months of pregnancy, her risk of having a low-weight baby will be similar to that of a non-smoker.
EFFECTS ON THE UNBORN CHILD
Cigarettes affect the mother's circulation, which in turn will affect the baby. In the womb, the baby is totally reliant on the mother to supply oxygen, nourishment and to filter out any dangerous chemicals.
The placenta is the lifeline between mother and baby. When a pregnant woman smokes, oxygen in her blood is replaced by poisonous carbon monoxide. Carbon monoxide robs muscles, brain and body tissues of oxygen, making the baby's heart work harder. If the baby is deprived of oxygen over a long period it will suffer from hypoxia. The most immediate effect is that the baby's movements inside the womb slow down and the heart rate speeds up as the baby tries to get more oxygen. There is a reduction in movements for up to 30 minutes after the mother has smoked a single cigarette.
The placenta supplies the baby with nutrients; smoking increases the chance that the baby will be born smaller than expected. Research suggests that some women see a low birth weight baby as an advantage, but there is much evidence to the contrary. If the baby is smaller at birth it will continue to be smaller throughout its subsequent development. Low birth weight babies are more likely to need intensive care.
The placenta acts as a barrier/filter, but many harmful substances get through to the foetal blood supply. Nicotine, carbon monoxide and other chemicals in tobacco smoke are passed on to the baby. There are 4,000 chemicals in cigarettes of which there are more than 30 known carcinogens. A German study showed traces of nicotine-derived nitrosaminoketon (NNK) in 22 of 31 newborns of mothers who smoked during pregnancy.
NICOTINE IN PREGNANCY
Nicotine has potential adverse effects. Eighty per cent of nicotine is broken down to cotinine by enzymes in the liver. A build-up of cotinine can cause the womb to contract, or go into labour.
Clinical studies have reported that nicotine concentrations in the placenta, amniotic fluid and foetal serum were consistently higher than in maternal serum when measured at various stages throughout pregnancy.
Nicotine alters the smoker's blood pressure, heart rate and metabolism. It moves into the lining of small blood vessels causing narrowing, thus reducing the blood flow to the womb and subsequently to the baby. It can inhibit the production of prostacyclin, a potent vasodilator and inhibitor of platelet aggregation, in arteries. Studies have shown that nicotine increases uterine vascular resistance and reduces uterine blood flow, possibly by an action on catecholamine release. Smoking acutely and chronically reduces placental blood flow in pregnant women, presumably through the effect of nicotine.
There is evidence that nicotine impairs foetal growth and can lead to an increased risk of spontaneous abortion and premature delivery. A likely cause of foetal growth retardation is induction of foetal ischaemia (reduced blood supply) and hypoxia.
RISKS OF SMOKING IN PREGNANCY
The risk of miscarriage is 27 per cent higher;
Perinatal mortality (defined as still-birth or death of an infant within the first week of life) is increased by about one-third in babies of smokers;
The risk of a low birth weight baby (200g) is three times higher; furthermore, the more cigarettes a woman smokes during pregnancy, the greater the probable reduction in birth weight;
There is a 35 per cent increase in cot deaths associated with smoking in
pregnancy; Maternal smoking is associated with a higher risk of children's cancers; Infants of parents who smoke are twice as likely to suffer from serious respiratory infection than the children of
non-smokers. Smoking during pregnancy can also increase the risk of asthma in young children; Maternal smoking in pregnancy has been associated with behaviour and attention deficit disorders.
Mothers who smoked more than ten cigarettes per day were significantly more likely to have an offspring with conduct disorder;
Substance abuse is higher among children of mothers who smoked in pregnancy and also impaired child-rearing behaviour;
On average, smokers have more complications of pregnancy and labour, which can include bleeding during pregnancy, premature detachment of the placenta and premature rupture of the membranes;
Some studies have also revealed a link between smoking and ectopic pregnancy and congenital defects in the offspring of smokers;
There is also evidence that smoking interferes with women's hormonal balance during pregnancy and that this may have long-term consequences on the reproductive organs of her children.
PREVALENCE
Over eight million women smoke in the UK. Research among female smokers shows that 74 per cent would like to stop smoking. Pregnant women who smoke are often highly motivated to quit, especially during early pregnancy, although 23 per cent in the UK continue to smoke.
Many pregnant smokers are still unaware of the detrimental effects or may not contemplate stopping for reasons best known to themselves. Maybe they have many failed attempts behind them; 80 per cent of people who attempt to stop smoking relapse and may have to try four or more times before they manage to quit - that's if they ever try again.
Research has also indicated that women are more emotionally dependent than men on smoking to control unpleasant feelings of stress and anxiety. Setting an abrupt smoking cessation date would merely intensify the stress in pregnancy for mother, baby and family.
The challenge is to deliver smoking cessation services incorporating coping strategies, behaviour modification as well as self-esteem building. The key to effective smoking cessation is to work with smokers to tackle their individual smoking habit. As with any behaviour change, the person has to feel they are in control and the goal achievable for them.
One smoking cessation aid that can safely be used in pregnancy is applied to cigarettes to block the inhalation of nicotine and tar.
Source: http://npa.atalink.co.uk/articles/pharmacy-practice/121
_______________________________________________________________
Great Start Quitline, 1-866-66-START. The toll-free Quitline is available 24 hours a day, 7 days a week, and is managed by the American Cancer Society. The Healthy Mothers Healthy Babies phone line also offers help, 1-800-311-BABY
http://www.smokefreefamilies.org/documents/booklet.pdf
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