Smoking During Pregnancy

Smoking is a major public health problem. Smokers face an increased risk of lung cancer, other lung diseases, and cardiovascular and other disorders.  According to the World Health Organization (WHO), globally 1.1 billion people smoke. Each year tobacco causes some five million premature deaths.  If current smoking patterns continue, it will cause some 10 million deaths each year by 2020. Half the people that smoke today; that is about 650 million people will eventually be killed by tobacco. According to these figures, smoking will claim more lives than HIV, tuberculosis, motor vehicle accidents, suicide and homicide combined.

South Africa became one of the first countries in the world to ban smoking in public places in 2000 when it introduced its Tobacco Products Control Amendment Act. The act put a serious dent in the smoking culture in South Africa, as it prohibited smoking in restaurants, pubs, shopping centres and offices where there was no separate, enclosed smoking room. Having said all that, the smoking habits continue. According to the Tobacco Institute of Southern Africa, there were some 7.7 million tobacco users in South Africa last year (2011), lighting up some 27 billion cigarettes.
 

Maternal smoking during pregnancy remains a serious public health problem. Smoking is known to have an effect on babies before they are born. Cigarette smoke contains more than 2,500 chemicals. It is not known for certain which of these chemicals are harmful to the developing baby, but both nicotine and carbon monoxide play a role in causing adverse pregnancy outcomes. 

Nicotine, carbon monoxide and other chemicals in tobacco smoke are passed on to the baby through the placenta. Nicotine increases a baby's heart rate and breathing movements. Some of the chemicals passed to through the mother's blood are known to cause cancer.Women who smoke during pregnancy could be more likely to have a child with high-functioning autism, say researcher Professor Amy Kalkbrenner from the University of Wisconsin-Milwaukee. The dangers of smoking during pregnancy include premature birth, certain birth defects and infant death. Smoking makes it harder for a woman to get pregnant.

Women who smoke during pregnancy are more likely than other women to have a miscarriage.

• Smoking can cause problems with the placenta—the source of the baby's food and oxygen during pregnancy. For example, the placenta can separate from the womb too early, causing bleeding, which is dangerous to the mother and baby.
• Smoking during pregnancy can cause a baby to be born too early or to have low birth weight—making it more likely the baby will be sick and have to stay in the hospital longer. A few babies may even die.
• Smoking during and after pregnancy is a risk factor of Sudden Infant Death Syndrome (SIDS), deaths among babies of no immediately obvious cause.
• Babies born to women who smoke are more likely to have certain birth defects, like a cleft lip or cleft palate.
• Stillbirth.

In South Africa, less than 10% of women of European, Indian, and African descent smoke. However, an alarming 46% of women of Khoi women smoke and continue to smoke throughout pregnancy. Most women are aware that smoking is harmful, but do not understand the potential severity of the harm. Research done at Tygerberg Hospital in Cape Town found that smoking during pregnancy was associated with an 8% increase in pre-term delivery and a three-fold increase in abruption placentae - a complication during pregnancy in which the placenta (which feeds the unborn child) prematurely separates from the wall of the uterus. These two conditions are the most common causes of death in unborn and newborn babies.

Cape Town is experiencing a devastating level of methamphetamine use, with an estimated 7% of the adult population reporting the use of this drug. A study conducted among pregnant women attending an antenatal clinic at the Tygerberg Hospital in Cape Town has found that 10 percent of the mothers were abusing the drug methamphetamine or “tik” as it is known in Western Cape.

Most midwives would love to educate their patients about the risks of smoking during pregnancy. Most midwives are confident about discussing smoking during pregnancy with the women. In fact they would love to receiving training in smoking cessation counseling.

Source:

World Health Organization: http://www.who.int/mediacentre/factsheets/fs339/en/index.html