Expert Q&A: The Risks of Smoking in Pregnancy

·8-min read

One of the undisputed truths in the world is that smoking is detrimental to health—and that it kills. According to HealthHub, Tobacco use kills 5.4 million people a year worldwide and accounts for one in 10 adult deaths worldwide. Every six seconds, an average of one person dies from it. 

In Singapore, about six Singaporeans die prematurely from smoking-related diseases each day. With this in mind, one would think that people would lay off cigarettes, especially pregnant women. 

Besides, there is clear evidence that maternal smoking is strongly associated with increased risk of adverse effects on pregnancy that can extend into childhood.

risks of smoking while pregnant
risks of smoking while pregnant

Image source: iStock

However, despite known risks to mother and child, some if not many expectant mothers continue to smoke. A study by the International Society for the Prevention of Tobacco Induced Diseases reveals that 15 to 20 per cent of all pregnant women will continue to smoke during pregnancy. 

We speak further with Dr. Fahir Khiard who offers his expert insights and advice on the risks of smoking while pregnant.

Health Effects and Risks of Smoking While Pregnant

When a mother smokes, she and her baby are exposed to a variety of toxic chemicals such as nicotine (used as an insecticide), tar (material for paving roads) and carbon monoxide (a poisonous, odourless and colourless gas)—regardless of whether a cigarette has a filter or not. 

These chemicals are passed from her bloodstream into the baby’s blood.

Effects on Baby 

Carbon monoxide, for instance, reduces oxygen flow to the baby and has been found to hinder the baby’s growth and development. Nicotine, on the other hand, tightens the mother’s blood vessels, reducing the supply of both oxygen and nutrients to the baby.

That said, it is dangerous to smoke anytime during the pregnancy as it can cause tissue damage in the unborn baby—especially in the brain and lungs. The effects of smoking are said to be the most damaging from the fourth month to the ninth month of pregnancy when the baby’s lungs are developing.

Image source: iStock

Smoking during pregnancy also increases the risk of a baby being born with birth defects such as congenital heart defects. Some studies also suggest a link between maternal smoking and cleft lip or palate. 

Babies born by mothers who smoke during pregnancy also face an increased risk of health problems:

  • More likely to be born underweight—one in every five babies born to mothers who smoke during pregnancy has a low birth weight

  • Asthma or breathing problems due to damage to airways 

  • Childhood obesity

  • Sudden Infant Death Syndrome (SIDS)—the sudden and unexplained death of a baby younger than one-year-old

In addition, smoking can affect the health of the unborn baby even in the first trimester. 

Risks of Smoking While Pregnant: Complications

While most pregnancies occur without complications, factors such as cigarette smoking can increase a mother’s risk for complications including: 

  • Maternal blood clots 

Pregnancy is a high-risk period for blood clotting and smoking increases the risks of this even further. The clots can occur in a variety of ways, including especially serious outcomes like pulmonary embolism

  • Pre-eclampsia

It is a complication that affects some women in the second half of pregnancy or immediately after giving birth. The symptoms of pre-eclampsia include hypertension and protein in the urine (which is usually discovered with a urine test).

  • Stillbirth and placental abruption (part of the placenta detaching from the womb wall)

Studies have shown that maternal smoking is significantly associated with a 47 per cent increase in stillbirth risk.

While stillbirths and miscarriages do not directly lead to pregnancy loss, studies have found that women who smoke during pregnancy have a higher chance of pregnancy loss.

In addition, they are 1.23 times more likely to experience pregnancy loss than women who do not smoke. 

Moreover, of the many reasons why maternal smoking is discouraged, one salient reason is that it puts expectant mothers at a higher risk of having a baby well before their due date (read: preterm delivery)—a leading cause of death, disability, and disease among newborns. 

E-cigarettes Equally Harmful For Expectant Mum and Baby

E-cigarettes also contribute to the risks of smoking while pregnant. | Image source: iStock

The use of electronic cigarettes or e-cigarettes has been gaining popularity recently. As such, sufficient research around the safety and negative effects of its use has yet to be established.

However, one thing for sure is that e-cigarettes are not more acceptable than smoking actual ones. 

As a type of electronic nicotine delivery system, e-cigarettes contain nicotine—the addictive drug found in tobacco—as with actual cigarettes, and is equally harmful to mother and baby.

On top of that, e-cigarettes usually contain artificial flavourings that may be harmful to a developing baby.

That said, some expectant mothers may turn to other types of nicotine replacements such as nicotine gum or patches. While they are not ideal for pregnancy, they may be better than smoking cigarettes. 

‘I Smoked Without Knowing I Was Pregnant. What Should I do?’

If you were smoking before you realised you were pregnant, focus on what you can do to improve the situation which is to stop smoking immediately. 

Quitting smoking at any time of the pregnancy is extremely beneficial for the baby, especially if the mother quits before 15 weeks. 

According to research, women who quit smoking at the beginning of their pregnancy reduce their risk compared with that of non‐smokers.

Thankfully, former smokers are not more at risk of miscarriage or stillbirth compared to those who have never smoked before. This tells us that if you are preparing for pregnancy, quitting smoking is extremely important in ensuring a smoother, successful pregnancy.

It is never too late to quit smoking and your doctor can play an important role in helping you quit and discuss the best course of action together. Consulting a doctor would also help to alleviate any worries or anxiety, especially if the mother is having trouble quitting right away. Non-drug treatments like counselling can also be explored. 

risks of smoking while pregnant
risks of smoking while pregnant

Image source: iStock

Ways to Stop Smoking for Good

The journey to quitting smoking can be a tough one but it is not impossible. Here are some ways to quit smoking for good: 

  • Identify what kind of smoker you are, whether it is behavioural, psychological or physical. This will help you choose pharmacological aids (nicotine replacement therapy in the form of patches, gum or lozenges)

  • The mind is more powerful than you think. Come up with a quit plan and set a quit date

  • Limit contact or stay away from people or places that could influence you to smoke (at least for the first few days after quitting)

  • Do NOT purchase more than one packet of cigarettes for home or at work

  • Out of sight out of mind—throw away ashtrays and other smoking-related items such as lighters

  • Get support from family and friends

  • Consider the health benefits for you and your baby when you stay smoke-free

  • Direct your focus to more healthy habits such as learning relaxation techniques to relieve tension and stress

  • Engage in regular exercise

You can also call the Health Promotion Board’s Quit Smoking helpline (1-800-438-2000) to speak to a Quit Advisor, or get the “I Quit” mobile app and join the I-Quit 28-Day journey here. There are also smoking cessation clinics to seek professional help from. 

Risks of smoking while pregnant: secondhand smoke also causes expectant mums and their unborn baby to be at risk. |  Image source: iStock

What Extra Precautions can Pregnant Mothers Take?

Apart from the dangers of smoking during pregnancy, mothers can also be at risk when they inhale secondhand smoke (SHS), and sometimes third-hand smoke (THS).

This can arise from inhaling unwanted smoke from public places or even those from one’s own partner, among other sources. As with smoking, exposure to SHS can harm a developing foetus and may account for complications during pregnancy and birth.

Furthermore, there is no risk-free level of exposure to secondhand smoke and even brief exposure can be harmful to health. The only way to fully protect oneself and loved ones are being in smoke-free environments. 

Here’s what you can do: 

  • Ask people (including your partner) not to smoke around you and your children 

  • Make your home and car smoke-free

  • Choose restaurants and other businesses that are smoke-free

  • Avoiding secondhand smoke exposure not only if you are pregnant, but also if you or your children have respiratory conditions or heart disease

  • Speak to your doctor about the dangers of secondhand smoke

Note: Sitting in a separate area, using ventilation, air conditioning, a fan or opening a window cannot eliminate secondhand smoke exposure. 


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