Smoking during pregnancy

Risks of smoking during pregnancy

The risks of smoking during pregnancy include serious problems for you and your baby.

Smoking risks for you

In addition to the usual dangers of smoking (increased risk of heart disease, stroke, lung cancer, lung disease, and other smoking-related illness), smoking during pregnancy also increases your chances of:

• Abnormal (and potentially catastrophic) bleeding during pregnancy and delivery due to placental problems, such as placental abruption and placenta previa.
• Ectopic pregnancy.
• Preterm premature rupture of membranes (PROM).
• Miscarriage. Tobacco smoke can keep your developing baby from getting enough oxygen.
• Stillbirth. Smoking more than doubles the risk of stillbirth.

Smoking also hurts your chances of getting pregnant. Because of its effects on estrogen and other hormones, smoking lowers a woman's chance of conceiving during any particular cycle by about 40 percent. In men, smoking can damage sperm and contribute to impotence.

Smoking risks for your baby

Tobacco smoke contains chemicals that can harm babies before and after birth. Nicotine and carbon monoxide – two of the most dangerous compounds in cigarette smoke – work together to reduce your baby's supply of oxygen.

Nicotine chokes off oxygen by narrowing blood vessels throughout your body, including the ones in the umbilical cord. It's a little like forcing your baby to breathe through a narrow straw. To make matters worse, the red blood cells that carry oxygen start to pick up molecules of carbon monoxide instead.

Smoking during pregnancy increases your baby's risk of:

• Birth defects, such as cleft lip, cleft palate, and heart defects.
• Preterm birth. Smoking during pregnancy doubles the chances that a baby will be born too early. Babies who are born preterm are at increased risk for complications at birth and long-term impairments, such as vision and hearing problems, respiratory problems, and learning and behavioral impairments.
• Low birth weight. Even babies who are born full-term may be born too small if their mom smoked during pregnancy. Smoking during pregnancy increases the risk of having a low-birth-weight baby by 1.5 to 3.5 times. Low-birth-weight babies may have more trouble feeding and fighting infections, and some are more likely to have long-term health problems, such as diabetes, heart disease, and developmental delays.
• SIDS. The risk of SIDs approximately doubles among infants whose mothers smoked during pregnancy. According to one large analysis of infant birth/death records, 22 percent of SUIDS (sudden unexpected infant deaths) in the United States are directly attributed to maternal smoking during pregnancy. (After birth, too, the chemicals in secondhand smoke increase your baby's risk of SIDS.)

What happens if you smoke in early pregnancy?

Smoking in early pregnancy deprives your developing baby of the oxygen they need to grow and develop – something babies do a lot of early in pregnancy.

Even smoking prior to conception can contribute to serious birth defects. In one long-term study, a mom's smoking before pregnancy was associated with a 40 percent increase in gastroschisis, where the infant’s intestines protrude through a defect in the abdominal wall.

An expecting dad's smoking prior to conception can also be harmful to a baby. One study found that a dad's smoking increased the baby's risk of birth defects including abnormalities of the limbs, heart defects, and neural tube defects such as spina bifida.

If you smoked before you knew you were pregnant, don't panic – just quit. Quitting smoking before 15 weeks of pregnancy offers your baby the most benefits. In one study, pregnant smokers who quit in the first trimester lowered their risk of delivering preterm and small-for-gestational-age babies to a level similar to that of pregnant nonsmokers.

What about light smoking or vaping during pregnancy?

Every cigarette you smoke increases the risks to your pregnancy. A few cigarettes a day are safer than a whole pack, but the difference isn't as great as you might think.

A smoker's body is especially sensitive to the first doses of nicotine each day, and even just one or two cigarettes will significantly tighten blood vessels. There's no safe level of smoking during pregnancy.

E-cigarettes aren't safe during pregnancy, either. We need more research on exactly how vaping affects pregnant women and their babies, but e-cigarettes contain harmful chemicals, such as nicotine, which we know can affect a baby's brain and lungs. In addition, e-cigarettes can be contaminated with other toxic ingredients, such as those included in the flavorings. The American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention warn against vaping for pregnant women.

Long-term effects of smoking while pregnant

In addition to possible birth defects, smoking during pregnancy can have long-term effects on your baby's lungs and brain, resulting in:

Breathing issues. If your baby's growth is stunted by your smoking while pregnant, their lungs may not be ready to work on their own, which means they may spend their first days or weeks on a respirator in the NICU.

Even after they're breathing on their own, these babies may have continuing breathing problems because of delayed lung development or other adverse effects of nicotine. Children whose mothers smoked during pregnancy are especially vulnerable to asthma.

If your child is exposed to secondhand smoke, their risk of coughs and chest colds, bronchitis and pneumonia, ear infections, and asthma attacks and wheezing problems are increased.

Learning problems. Smoking during pregnancy can have lifelong effects on your baby's brain. Children of pregnant smokers are at higher risk of learning disorders and behavioral problems, and may have lower IQs.

How to quit smoking while pregnant

The sooner you quit smoking, the better. Just one day after you give up smoking, your baby will get more oxygen. You'll feel better, too.

Tips for quitting

• Get counseling. Pregnant women who have smoking cessation counseling are 40 percent more likely to quit than others. You can call 800-QUIT-NOW (800-784-8669) or 877-44U-QUIT (877-448-7848) to speak to trained counselors.
• Make a plan. Include a starting date (when you'll throw away all of your cigarettes, lighters, and ashtrays), your reasons for quitting, and triggers to watch out for.
• Find other ways to handle your triggers (squeezing a stress ball when you get nervous, for example, or having tea instead of a cigarette after dinner). Take a walk when a craving hits, or grab a piece of gum.
• Fix yourself healthy snacks – such as baby carrots or celery sticks – to reach for instead of a cigarette.
• Wash your clothes, bedding, and towels to remove cigarette smells that may be triggering. You may want to get your car's interior cleaned, too.
• Enlist help. Talk with your partner, friends, and family about your plan for quitting. Ask for support.
• Ask others not to smoke near you or in your house.
• If a craving strikes, try taking ten deep breaths while the craving passes.
• Stay hydrated by drinking plenty of water.
• Reward yourself for milestones you reach (a week or month without smoking, for example). Treat yourself to dinner out, a new book, or a massage or manicure. Incentives work!

Remember when things get rough that over a few weeks your withdrawal symptoms will begin fading and your cravings will become less intense. Hang in there.

If you do relapse, don't punish yourself or give up. It's very common for smokers to try to quit several times before they manage to kick the habit for good.

Additional sources of support:

• Your midwife or doctor can help you find information about local support programs.
• Smokefreewomen offers information on building a smokefree team and asking for help. You can also sign up for Smokefree TXT for a free text message program with daily tips, advice, and encouragement.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) has a free, confidential, national helpline available 24/7 for individuals and families dealing with alcohol, tobacco, and other drug use. It provides referrals to local facilities, support groups, and community-based organizations.
• The BabyCenter Community has a group for pregnant moms who struggle with smoking. Request to join in on the conversation.

Quit-smoking aids for pregnancy

Nicotine replacement products (patches, gums, lozenges, inhalers, or nasal sprays) still contain nicotine, but if you're having trouble quitting, the lowest dose may be helpful to you and less harmful than smoking. Talk with your healthcare provider before using quit-smoking products, though. They can recommend the best product and the best dosage.

Your provider may also recommend an alternative medication that's helpful for smoking cessation and doesn't contain nicotine, such as the antidepressant bupropion (Zyban). Talk with your provider about the pros and cons of this or any medication to help you stop smoking.

Quitting smoking is one big thing you can do to ensure you have a healthy pregnancy and baby. Here are more steps you can take to have a healthy pregnancy.

Learn more:

• Drinking alcohol during pregnancy
• Marijuana during pregnancy: Is it safe?
• Is CBD safe to use while pregnant or breastfeeding?