August 26, 2010

Smoking and Reproductive Outcomes, Cigarette Smoking Among Pregnant Women

Smoking and Reproductive Outcomes, Cigarette Smoking Among Pregnant Women

Women smokers, like men smokers, are at increased risk of cancer, cardiovascular disease, and pulmonary disease, but women smokers also experience unique risks related to menstrual and reproductive function.

Women who smoke have increased risk beginning delay and for major and secondary infertility.

Smoking during pregnancy remains a major public health problem despite increased knowledge of the adverse health effects of smoking during pregnancy. Although the occurrence of smoking during pregnancy has declined steadily in recent years, substantial numbers of pregnant women continue to smoke, and only about one-third of women who stop smoking during pregnancy are still abstinent one year after the delivery.

Women who smoke may have a modest increase in risks for ectopic pregnancy and spontaneous. abortion.

Smoking during pregnancy is associated with increased risk for premature break of membranes, abruptio placentae (placenta separation from the uterus), and placenta previal (abnormal location of the placenta, which can cause massive hemorrhaging during delivery; smoking is also associated with a modest increase in risk for preterm delivery.

Infants born to women who smoke during pregnancy have a lower average birth weight and are more likely to be small for gestational age than infants born to women who do not smoke. Low birth weight is associated with increased risk for neonatal, perinatal, and infant morbidity and mortality. The longer the mother smokes during pregnancy, the greater the effect on the infant’s birth weight.
The risk for perinatal mortality, both stillbirths and neonatal deaths, and the risk for sudden infant death syndrome (SIDS) are higher for the offspring of women who smoke during pregnancy.

Women who smoke are less likely to breast-feed their infants than are women who do not.

Environmental Tobacco Smoke and Reproductive Outcomes

Infants born to women who are exposed to environmental tobacco smoke (ETS) during pregnancy may have a small decrement in birth weight and a slightly increased risk for intrauterine growth retardation than infants born to women who are not exposed to ETS.

Smoking Prevalence and Smoking Cessation during Pregnancy

Despite increased knowledge of the adverse health effects of smoking during pregnancy, estimates of women smoking during pregnancy range from 12% (based on birth certificate data) up to 22% (based on survey data). However, smoking during pregnancy appears to have decreased from 1989 through 1998.
Eliminating maternal smoking may lead to a 10% reduction in all infant deaths and a 12% reduction in deaths from perinatal conditions.

Women who quit smoking before or during pregnancy reduce the risk for adverse reproductive outcomes, including difficulties in becoming pregnant, infertility, premature rupture of membranes, preterm delivery, and low birth weight.
Most relevant studies suggest that infants of women who stop smoking by the first trimester have weight and body measurements comparable with those of nonsmokers’ infants. Studies also suggest that smoking in the third trimester is particularly detrimental.
Women are more likely to stop smoking during pregnancy, both spontaneously and with assistance, than at other times in their lives. Using pregnancy-specific programs can increase smoking cessation rates, which benefits infant health and is cost effective. However, only one-third of women who stop smoking during pregnancy are still abstinent 1 year after the delivery.

Programs that encourage women to stop smoking before, during, and after pregnancy — and not to take up smoking ever again — deserve high priority for two reasons: during pregnancy women are highly motivated to stop smoking, and they still have many remaining years of potential life.

Despite increased knowledge of the adverse health effects of smoking during pregnancy, survey data suggest that a substantial number of pregnant women and girls smoke. Cigarette smoking during pregnancy declined from 19.5% in 1989 to 12.9% in 1998.

Smoking prevalence during pregnancy differs by age and by race and ethnicity. In 1998, smoking prevalence during pregnancy was consistently highest among young adult women aged 18 through 24 (17.1%) and lowest among women aged 25 through 49 (10.5%).

Smoking during pregnancy declined among women of all racial/ethnic populations. From 1989 to 1998, smoking among American Indian or Alaska Native pregnant women decreased from 23.0% to 20.2%; among pregnant white women from 21.7% to 16.2%; African American pregnant women from 17.2% to 9.6%; Hispanic pregnant women from 8.0% to 4.0%; and Asian American or Pacific Islander pregnant women from 5.7% to 3.1%.

In 1998, there was nearly a 12-fold difference among pregnant women who smoke—ranging from 25.5 percent among mothers with 9-11 years of education to 2.2 percent among mothers with 16 or more years of education.