Tobacoo and Nicotine in Pregnancy

QUICK FACTS:

• A study in 2016 showed that 7.2% of women reported smoking at any point during pregnancy in the United States1

  • Utah had a rate of 3%

• Electronic Nicotine Delivery Systems (ENDS)/ Electronic cigarettes contain less toxins than cigarettes, but may cause developmental harm based on data from animal studies2

• Tobacco can cause harm through decreased oxygenation, altered development, and exposure to toxins

• The most well studied effect of tobacco use is low birth weight. 

POSSIBLE RISKS:

Risks to the pregnancy:

• Modestly increased chance of miscarriage

• Nearly 50% increase in stillbirth3

• Increased chance of pregnancy complications and birth complications

  • Preterm labor

  • Placental abruption

  • Preterm premature rupture of membranes

• 1.5 to 3.5 times Increased chance of Low Birth Weight Infant4

• Decreased risk of preeclampsia5

Risks after birth:

• Neurobehavioral effects (effects on the brain that may impact behavior)6,7

  • Higher stress response

  • More excitable brain (irritable, restless)

  • Increased muscle tone

  • Behavioral problems (conduct disorders, ADHD)8-11

  • Tourette’s syndrome or Tic disorders12

• There is no good evidence that prenatal nicotine exposure causes neonatal withdrawal syndrome.

• Sudden Unexpected Infant Death (also called SIDS)13

  • Risk of SIDS is much lower if infant is not exposed to cigarette smoke after birth

• 4 times increased chance of Diabetes as young adult if exposed to heavy smoking14

• Unclear evidence of cognitive problems 

• Increased chance of asthma15

WHAT TO LOOK FOR:

• Risk is minimal after a successful pregnancy and birth.

• After birth you can look for irritability, restlessness and increased muscle tone, however the only treatment is to help them feel comfortable 

• Stay aware of the child’s behavior but behavioral disturbances may or may not be related to tobacco exposure

WHAT TO DO:

• Talk to your pediatrician about any concerns you may have

• Once you have a healthy baby, there are likely no major issues to be worried about from tobacco exposure 

1. Drake P, Driscoll AK, Mathews TJ. Cigarette smoking during pregnancy: United States, 2016. NCHS Data Brief, no 305. Hyattsville, MD: National Center for Health Statistics. 2018.
2. Larcombe AN. Early-life exposure to electronic cigarettes: cause for concern. Lancet Respir Med. 2019 Nov;7(11):985-992. doi: 10.1016/S2213-2600(19)30189-4. Epub 2019 May 31. PMID: 31160239.
3. Pineles BL, Hsu S, Park E, Samet JM. Systematic Review and Meta-Analyses of Perinatal Death and Maternal Exposure to Tobacco Smoke During Pregnancy. Am J Epidemiol. 2016 Jul 15;184(2):87-97. doi: 10.1093/aje/kwv301. Epub 2016 Jul 1. PMID: 27370789; PMCID: PMC4945701.
4. Pereira PP, Da Mata FA, Figueiredo AC, de Andrade KR, Pereira MG. Maternal Active Smoking During Pregnancy and Low Birth Weight in the Americas: A Systematic Review and Meta-analysis. Nicotine Tob Res. 2017 May 1;19(5):497-505. doi: 10.1093/ntr/ntw228. PMID: 28403455.
5. Castles A, Adams EK, Melvin CL, Kelsch C, Boulton ML. Effects of smoking during pregnancy. Five meta-analyses. Am J Prev Med. 1999 Apr;16(3):208-15. doi: 10.1016/s0749-3797(98)00089-0. PMID: 10198660.
6. Law KL, Stroud LR, LaGasse LL, Niaura R, Liu J, Lester BM. Smoking during pregnancy and newborn neurobehavior. Pediatrics. 2003 Jun;111(6 Pt 1):1318-23. doi: 10.1542/peds.111.6.1318. PMID: 12777547.
7. Haslinger C, Bamert H, Rauh M, Burkhardt T, Schäffer L. Effect of maternal smoking on stress physiology in healthy neonates. J Perinatol. 2018 Feb;38(2):132-136. doi: 10.1038/jp.2017.172. Epub 2017 Nov 9. PMID: 29120451.
8. Weissman MM, Warner V, Wickramaratne PJ, Kandel DB. Maternal smoking during pregnancy and psychopathology in offspring followed to adulthood. J Am Acad Child Adolesc Psychiatry. 1999 Jul;38(7):892-9. doi: 10.1097/00004583-199907000-00020. PMID: 10405508.
9. Wakschlag LS, Lahey BB, Loeber R, Green SM, Gordon RA, Leventhal BL. Maternal smoking during pregnancy and the risk of conduct disorder in boys. Arch Gen Psychiatry. 1997 Jul;54(7):670-6. doi: 10.1001/archpsyc.1997.01830190098010. PMID: 9236551.
10. Linnet KM, Wisborg K, Obel C, Secher NJ, Thomsen PH, Agerbo E, Henriksen TB. Smoking during pregnancy and the risk for hyperkinetic disorder in offspring. Pediatrics. 2005 Aug;116(2):462-7. doi: 10.1542/peds.2004-2054. PMID: 16061604.
11. Thapar A, Fowler T, Rice F, Scourfield J, van den Bree M, Thomas H, Harold G, Hay D. Maternal smoking during pregnancy and attention deficit hyperactivity disorder symptoms in offspring. Am J Psychiatry. 2003 Nov;160(11):1985-9. doi: 10.1176/appi.ajp.160.11.1985. PMID: 14594745.
12. Browne HA, Modabbernia A, Buxbaum JD, Hansen SN, Schendel DE, Parner ET, Reichenberg A, Grice DE. Prenatal Maternal Smoking and Increased Risk for Tourette Syndrome and Chronic Tic Disorders. J Am Acad Child Adolesc Psychiatry. 2016 Sep;55(9):784-91. doi: 10.1016/j.jaac.2016.06.010. Epub 2016 Jul 21. PMID: 27566119.
13. Anderson TM, Lavista Ferres JM, Ren SY, Moon RY, Goldstein RD, Ramirez JM, Mitchell EA. Maternal Smoking Before and During Pregnancy and the Risk of Sudden Unexpected Infant Death. Pediatrics. 2019 Apr;143(4):e20183325. doi: 10.1542/peds.2018-3325. Epub 2019 Mar 11. PMID: 30858347; PMCID: PMC6564075.
14. Montgomery SM, Ekbom A. Smoking during pregnancy and diabetes mellitus in a British longitudinal birth cohort. BMJ. 2002 Jan 5;324(7328):26-7. doi: 10.1136/bmj.324.7328.26. PMID: 11777801; PMCID: PMC61655.
15. Skorge TD, Eagan TM, Eide GE, Gulsvik A, Bakke PS. The adult incidence of asthma and respiratory symptoms by passive smoking in uterus or in childhood. Am J Respir Crit Care Med. 2005 Jul 1;172(1):61-6. doi: 10.1164/rccm.200409-1158OC. Epub 2005 Apr 1. PMID: 15805186.
16. Burke H, Leonardi-Bee J, Hashim A, Pine-Abata H, Chen Y, Cook DG, Britton JR, McKeever TM. Prenatal and passive smoke exposure and incidence of asthma and wheeze: systematic review and meta-analysis. Pediatrics. 2012 Apr;129(4):735-44. doi: 10.1542/peds.2011-2196. Epub 2012 Mar 19. PMID: 22430451.