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Prevention - Effects of Maternal Cigarette Smoking

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Published On: January 9, 2002          Updated On: January 09, 2002
© Terence T. Gorski, 2001

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The Effects of Maternal Cigarette Smoking
By Terence T. Gorski
September 9, 2002

This article is the lecture outline that I prepared for the conference The World's Greatest baby Shower to be held in Hernando County Florida.  This presentation is designed to explain in simple and easy to understand language why pregnant woman should quit smoking during pregnancy, what it means to be addicted smoking, and how they can get help if they can't quit smoking even though they know that they should.

1.    Cigarette smoking is inherently dangerous to all people including men, women, and the unborn children of women who smoke.  

2.   All pregnant women are at risk of harming their unborn babies to some degree if they keep smoking cigarettes during pregnancy.  

3.   There are two common set of problems that result from maternal smoking during pregnancy:  

A.   The first set of problems is immediate.  Pregnant women who smoke are at greater risk of having their baby born with a low-birth-weight that puts them at greater risk of miscarriage, premature births, birthing complications, and early infancy (neonatal) illness.

    Maternal cigarette smoking is the single largest modifiable risk factor associated with reduced birth weight or increased risk of low-birth-weight infants in developed countries.  (Kramer 1998, 1987)

B.   The second set of problems is long-term.  Pregnant women who smoke are more likely to have children who developing learning disabilities, attention deficit disorders, and mental retardation latter in life.

3.    Many pregnant woman do, in fact, cause harm to their unborn babies by continuing to smoke during their pregnancy.  This harm shows up most clearly in the statistics related to low-birth-rate infants.

A.    In the United States, 65% of all infant deaths occur among low-birth-weight infants who weigh less than 2500 g;  (Guyer et al 1999)

B.    Low-birth-weight infants infants account for 7.6% of all live-born infants.  (Guyer et al 1999)

C.   Maternal smoking during pregnancy is one of a number of environmental and genetic factors may play a role producing low-birth-weight infants.  (Wang et al 2002, 1995) 

D.   Scientific studies have shown that maternal cigarette smoking during pregnancy is associated with reduced birth weight or increased risk of low-birth-weight infants.  (Wang et al 2002)

4.    The amount of damage to the unborn baby by smoking during pregnancy will depend upon three factors:  

A.   The first factor is the stage of pregnancy during which the woman smokes.  Smoking in the earlier stages of pregnancy, especially the first trimester, produces a greater risk than smoking during the latter stages of pregnancy.  

B.   The second factor is the number of cigarettes smoked per episode of and the frequency of smoking  episodes during each stage of the pregnancy.  The risk of damaging the unborn child goes up as number of cigarettes smoked and the frequency of smoking goes up.  

C.   The third factor is the level of toxicity of both the the substances in cigarette smoke that are directly inhaled chemicals and the intermediary substances produced during the metabolism of the the inhaled toxic substances.  Let me explain what this means.  

(1)  The body has a two step process for metabolizing (breaking down) the toxic substances in cigarette smoke so they can be excreted from the body.  

During the first step, which researchers call a metabolic activation process, the body produces intermediate substances that can be broken down by and excreted from the body.  This is done by converting the inhaled toxins into new chemical structures that are then connected with other molecules.  These intermediate substances may be more harmful than the original toxic substances from which they are produced.  (National Research Council, 1983)

During the second step, which researcher call the detoxification process,  the intermediate substances produced in the first step are transformed into substances that can be excreted from the body.  (Timbrell 1991)

(2)   As the level of toxicity of the substances produced at each of these steps increases,  the risk of physical harm the bodies of both the smoking mother and the unborn baby also increases.  (Bartsch et al 2000; Brunnemann & Hoffmann 1991)

(3)  The level of toxicity of these intermediary substances is influenced by the pregnant woman's genetic predisposition.  (Wang et 2002)

       In other words, even though all pregnant women who smoke and their unborn children are at risk, some women women have a genetically genetically higher risk of damage than others.  

       The problems is that there is currently no way of identifying these genetic risk factors.  The methods used in this research are so expensive and time consuming that they cannot be used in routine medical practice.

5.    In spite of these risks, many women continue to smoke during their pregnancy.   

A.    In 1997, 13.2% of US women reported smoking cigarettes during pregnancy. (Guyer et al 1999)  

B.    The actual number of women who keep smoking during pregnancy is probably higher than this.   This figure is based upon unconfirmed self-reports.  Since many women know that it can be harmful to their unborn babies to smoke during pregnancy, it is unlikely that all women responding to the survey who continued to smoke would honestly report it.

6.    There are three primary reasons why pregnant women continue to smoke.

A.   They don't know or don't really believe that smoking can damage "their" unborn baby.  Not knowing that smoking can damage an unborn baby is extremely rare.  Most women know that smoking can be harmful to their unborn baby.  They learn this from their health care providers, from the media, and from the warning labels on every pack of cigarettes.  Not believing it can happen to "my baby" is a lot more common.  Many women just believe they're immune and their smoking can't harm "their" baby.  They believe that kind of thing only happens to other people.

B.    They don't care.  They know that smoking can be harmful to their unborn child but they don't care enough about what happens to the child to quit.  This is also rare, but it does occur in immature and self-centered women who "accidentally" get pregnant and resent the baby for interfering with their life plans.

C.   They're addicted and can't quite even though they want to.  This is the most common reason.  Many women know that smoking can be harmfully to their unborn babies.  They also care about and would do anything to want to protect their unborn child from harm.  So they make up their mind to quite, they try to stop, but feel overwhelming cravings or urges to start smoking again.  They start to feel so bad when they're not smoking that they can't stand it.  So, in a moment of desperation, they start smoking again.  Then they feel regret -- they're guilty,  ashamed, and afraid of what might happen to their baby.  So they try to quite again.  Many women go through this cycle of quitting, relapsing, and regretting over and over again during their pregnancy.  They never stop to think that they might be addicted to cigarettes.

7.    Cigarettes Are Addictive:  Many pregnant women continue to smoke during pregnancy because they are addicted to smoking cigarettes.

A.   Tobacco smoke contains contains addictive substances that are inhaled with each puff.  These substances are addictive because they can create ...

(1)   A need to smoke cigarettes in order to feel and function normally, 

(2)  An inability to stop or stay stopped in spite of a strong desire to quite based upon accurate knowledge of the adverse effects smoking can have on both the mother and the unborn baby. 

B.   Unfortunately, cigarette manufacturers have a good job in two areas:

(1)  Creating ways of manufacturing cigarettes that make them highly addictive, and

(2)  Convincing people, especially smokers, of the "big lie"  --- "normal people" can't get addicted to cigarettes.   What makes cigarettes addictive?   There are a number of things

C.   Cigarette smoking can and often does become an addiction that is more powerful than addiction to alcohol, narcotics, and even cocaine.  

D.   The primary addictive substance in cigarette smoke is nicotine.

E.    Nicotine is a mind-altering drug that produces a fast-acting low-grade stimulant high that quickly wears off.  Let's break this complicated sentence into some easy to understand parts.

(1)   Nicotine mood altering -- it causes people to "get high".  When people "get high" they experience a change in mood or emotion as a result of using a drug.  

(2)  Nicotine is a mind altering drug.  It changes people's mood and emotions by changing the chemical processes that occur in the brain.

(3)  Nicotine is a stimulant drug that is similar to caffeine, amphetamine, and cocaine.  As a stimulant drug, nicotine changes brain chemistry in way that gives people a feeling of increased energy.  At very high does it can people jittery.

(4)   When people get  a "stimulant high", the  drug effect gives them a sense of increased energy.  

(5)   When people use get a fast-acting high, the drug works quickly by producing its mood altering effect in a short period of time.  

(6)   When a drug high "quickly wears off",  the drug effect tends to last for only a brief moment.  So if you want to keep feeling the way the drug makes you feel, you have to keep taking more of the drug each time its effect starts to wear off.     

F.    Nicotine Tolerance:  People who develop a tolerance to nicotene need to keep smoking more in order to get the same mood-altering and mind-altering effect

(1)   Most cigarette smokers will remember the days when each puff of a cigarette quickly gave them smoker a small shot of energy that lasted for a short period of time.  

(2)   Addicted smokers will tell you that they had to take more puffs, over a shorter period of time, while inhaling more deeply in order to keep getting the same feeling.  

(3)  This is because people who smoke regularly and heavily  can develop tolerance to the effects of nicotine.

(6)  When people develop tolerance means that they have to take more puffs, more quickly, and inhale more deeply to get the same energizing effect that they once were able to get with fewer puffs, taken more slowly, while inhaling less deeply.  

G.   Nicotine Withdrawal:  People can experience nicotine withdrawal when they try to stop smoking cigarettes.  These withdrawal symptoms get progressively worse over a period of five to seven days and quickly go away when people start smoking again.  The symptoms of nicotine withdrawal are:

(1)   Strong cravings for cigarettes and often for sugar and sweets.  (A craving is a strong irrational urge to start smoking again even though you don't want to),  

(2)  Depressed mood, 

(3)  Insomnia (inability to sleep restfully), 

(4)  Feeling irritable, frustrated, and anger for no apparent reason, 

(5)  Feeling anxious or scared for no apparent reason, 

(6)  Having difficulty concentrating.  

H.   Depression & Smoking:   Addicted smokers who stop smoking for period of several weeks often find themselves developing serious problems with depression.  This is may be caused by the tendency of heavy smoking to inhibit the production of serotonin and other naturally occurring brain chemicals that have antidepressant effects.


Brunnemann K, Hoffmann D.  Analytical studies on tobacco-specific N-nitrosamines in tobacco and tobacco smoke.  Crit Rev Toxicol.  1991;21:235-240. MEDLINE   

Bartsch H, Nair U, Risch A, et al.  Genetic polymorphism of CYP genes, alone or in combination, as a risk modifier of tobacco-related cancers.  Cancer Epidemiol Biomarkers Prev.  2000;9:3-28.  MEDLINE  

Guyer B, Hoyert DL, Martin JA, et al., Annual summary of vital statistics1998., Pediatrics. 1999;104:1229-1246. MEDLINE

Kramer MS.  Socioeconomic determinants of intrauterine growth retardation.  Eur J Clin Nutr.  1998; 52(suppl 1):S29-S33. MEDLINE

Kramer MS. Intrauterine growth and gestational duration determinants. Pediatrics. 1987;80:502-511.  MEDLINE

National Research Council.  Polycyclic Aromatic Hydrocarbons: Evaluation of Sources and Effects. Washington, DC: National Academy Press; 1983: 197-262.  

Timbrell J.  Principles of Biochemical Toxicology.  2nd ed. Washington, DC: Taylor & Francis; 1991.  

Wang X, Zuckerman B, Coffman GA, Corwin MJ.; Familial aggregation of low birth weight among whites and blacks in the United States. N Engl J Med. 1995; 333:1744-1749. MEDLINE

Wang, Xiaobin; Zuckerman, Barry; Pearson, Colleen; Kaufman, Gary; Chen, Changzhong; Wang, Guoying; Niu, Tianhua; Bauchner, Howard; Xu, Xiping; Maternal Cigarette Smoking, Metabolic Gene Polymorphism, and Infant Birth Weight, JAMA. January 9, 2002; 287:195-202


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