For the healthiest possible pregnancy, most midwives and doctors will advise women to give up smoking. Smoking-related disease, including lung cancer, is the biggest single killer in Britain each year. The anti-smoking lobby won a substantial victory when in August 1992 the British Medical Association and the Department of Health agreed to classify smoking as a cause of death. This meant that doctors could put smoking on a death certificate without recourse to a coroner. It will also mean that more accurate figures for death due to smoking should be able to be compiled.
In the past few years, a consensus has been reached about smoking. Don’t do it if you’re expecting a baby. Tobacco companies, by law, now have to state the dangers, all official pregnancy advice recommends not smoking. The grim figures are these: babies of smokers are, on average, 200-250g lighter at birth; there is a third greater risk of stillbirth and perinatal death and a 25 percent higher chance of miscarriage.
The Back to Sleep Campaign was launched in 1992 and has been extremely successful in reducing the rate of cot death in Britain. Babies of smokers are not only twice as likely to be born prematurely but are also three times more likely to succumb to sudden infant death syndrome (SIDS), as cot death is officially known.
The problems do not stop at birth. Babies of women who smoke are twice as likely to suffer from serious respiratory infections. Smoking during pregnancy can also increase the risk of asthma, and hospital admissions for asthma in children under four have more than doubled since 1979. Professor Jean Golding, professor of pediatrics at Bristol University, believes that smoking during pregnancy is one of the factors causing this asthma epidemic.
Our research shows that smoking in pregnancy has a major impact on the development of babies, making them more likely to suffer from wheeziness and to develop asthma.
Some sources suggest that babies of smokers are more likely to have a cleft lip or palate as well as disorders of the limbs, genitals and urinary system. Babies are particularly vulnerable to smoking during the first three months of pregnancy, so if a woman can give up during this time, she will have a better chance of producing a healthy child. Cutting down does not seem to have the same beneficial effect.
Studies show that, if you give up during the first three months of pregnancy, your risk of placenta problems, such as placenta praevia, goes down significantly and so does your risk of stillbirth and having a low-birthweight baby. Stopping smoking also lowers your baby’s chances of being ill after the birth: in one study, only 8.8 per cent of babies whose mothers had stopped smoking in pregnancy needed hospital attention during the first month of life compared with 11.4 per cent of babies whose mothers had carried on smoking.
In 2000, 35 per cent of women smoked before becoming pregnant and 20 per cent continued to smoke throughout their pregnancy. Of pregnant women who stopped smoking, 20 per cent gave up before conceiving, 73 per cent gave up once their pregnancies were confirmed and seven per cent gave up later in pregnancy.8 All the women I interviewed who continued to smoke did feel guilty about the effect it might be having, but at the same time they protested, like Pam, that cigarettes were part of their characters, emotional supports that they were unwilling to forgo. Pam found that even though the midwives and doctors didn’t actually tell her to stop, peer group pressure was persistent. She was smoking no more than five cigarettes a day, but friends considered they had the right to express their disapproval. Because Pam was 41 and it was her first pregnancy, she felt the unspoken comment ‘at your age’ lay behind the criticism.
That outsiders have no right to criticize a woman’s choice for her own body, regardless of whether it is harboring a baby or not, was undisputed by those who continued to smoke. The arguments are less straightforward when a partner – who will also be assuming parental responsibility after the birth – objects.
Carrie is a blogger at the highly successful site Mommy Edition where she writes exclusively about topics on breastfeeding and baby care.