Tobacco

INFORMATION FOR WOMEN WHO ARE THINKING OF USING, ARE USING, OR HAVE USED TOBACCO DURING PREGNANCY OR BREASTFEEDING

The information provided below is for readers based in the United States of America. Readers outside of the United States of America should seek the information from local sources.

What is tobacco?

Tobacco is a plant that is cultivated for its leaves, which are processed for use in tobacco products, such as cigarettes and cigars which are smoked, although other preparations of tobacco are chewed. Tobacco use leads to addiction, because tobacco contains nicotine, an extremely addictive drug. Smoking is currently on the decline in the United States, while rates in Europe vary strikingly between countries; 38 percent of Belgians maintain the deadly habit compared with only 7 percent of people in Sweden, the latter country boasting a smoking rate much lower than any US state.

Tobacco addiction is a long-term disorder characterized by a persistent, uncontrollable desire to get nicotine into your body, usually by smoking. Use of tobacco varies greatly around the world. Even when anticipating pregnancy, after becoming pregnant, or after giving birth, women often have trouble quitting. Reports from the US Centers for Disease Control and Prevention suggest that the rate of smoking cessation is very high during pregnancy, a time when the percentage of smokers drops, yet 10 percent of US pregnant women report smoking during at least the last 3 months of pregnancy.

Is there a safe amount of tobacco that I can smoke during pregnancy?

No. In fact, there is evidence that maternal exposure even to second hand smoke (SHS, smoke from somebody else who is smoking) is associated with preterm birth.

Can tobacco use make it harder for me to get pregnant?

Yes, tobacco can decrease fertility, thereby making conception less likely. Additionally, tobacco increases the likelihood of spontaneous abortion soon after implantation, leading to early pregnancy loss, sometimes before you even know that you’re pregnant.

Can tobacco cause a miscarriage?

Yes. Maternal tobacco use increases the risk of spontaneous abortion (miscarriage).

Can tobacco smoking during my pregnancy cause a birth defect?

Tobacco use by the mother has been linked to congenital birth defects, as well as problems with the placenta and premature birth.

Are there long-term consequences to my baby from my tobacco use?

Babies born to smoking mothers are likely to have a low birth weight and have an elevated risk of sudden infant death syndrome (SIDS). Maternal smoking also puts the baby at risk for conditions that strike later in life such as obesity, type 2 diabetes mellitus, psychiatric disorders, and having a tobacco addiction.

I just found out I am 6 weeks pregnant and last weekend smoked tobacco. Will my baby have a problem?

Although studies suggest that low levels of tobacco exposure, even levels associated with SHS, are associated with preterm birth, evidence suggests that the risk is the product of repeated exposures. Thus, if you smoked once, your baby is probably not at elevated risk, even if that one episode of smoking occurred six weeks into pregnancy, a very critical point in development. On the other hand, if you smoked repeatedly (a more common scenario), the risk would be significant, even if that repeated smoking took place prior to pregnancy.

Is binge smoking tobacco on only some days of the week as risky as smoking tobacco everyday but at lower amounts?

The nature of the risk differs between these two scenarios. Continuous maternal tobacco use puts the baby at risk of low birth weight, SIDS, and later in life obesity, type 2 diabetes mellitus, psychiatric disorders, and tobacco addiction. Although binge smoking is generally not studied in pregnant women, this behavior can result in carbon monoxide poisoning and nicotine toxicity, disrupting oxygen delivery to the developing baby and blood supply of the womb, respectively, putting you at severe risk of early pregnancy loss.

Is it ok to smoke some tobacco after the first trimester?

No. Risk of SIDS and long-term effects is elevated for maternal smoking occurring at any point in the pregnancy. To help prevent this situation, several medications are available to help you stop smoking. One approach is nicotine replacement therapy, which supplies you with nicotine at gradually decreasing doses, so that you won’t crave it from cigarettes. Other drugs used to fight nicotine addiction are bupropion, varenicline, nortriptyline, and clonidine.  Additionally, numerous non-drug therapies are available. The simplest one is quitting “cold turkey” stopping without any assistance, but this is also the most difficult pathway for many smokers. Other approaches include psychotherapy, cognitive behavioral therapy, telephone counseling, brief intervention, patient education, and various drug and non-drug combinations.

Can a baby go through withdrawal after birth?

Yes. This is called neonatal nicotine withdrawal syndrome. The more that you smoke, and the later into pregnancy you smoke, the more likely it is to happen.

How will I know if tobacco has hurt my baby?

You wouldn’t know for certain, as effects of maternal smoking are a matter of risks and probabilities. If you are a smoker and your newborn dies of SIDS, for instance, it’s very likely that smoking was the reason. If you smoked at the beginning of pregnancy and then quit and the birth weight of your newborn is a little bit low, it would be very difficult to tell whether if was because of the smoking.

Is there any hope for a baby who has been exposed to tobacco throughout pregnancy?

Effects of maternal smoking are a matter of risks and probabilities, and so a neonate born to a smoker can be perfectly healthy. However, if you do smoke, you’re stacking the cards against your child.

Can I smoke tobacco while breastfeeding?

Nicotine from tobacco smoking concentrates in breast milk, turning the lactating breast into a nicotine delivery device. Under no circumstance should a mother breastfeed if she has failed to quit smoking.

What if the father of the baby smokes tobacco?

Studies on the effects of paternal smoking on outcomes such as spontaneous abortion (miscarriage) and congenital birth defects have been limited and have yielded conflicting results. However, maternal exposure to SHS from a smoking partner is indeed harmful, as is neonatal SHS exposure from a smoking parent.

Resources for tobacco addiction in pregnancy:

For more information about smoking during pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446] or check the following links:

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General information

It is very common for women to worry about having a miscarriage or giving birth to a child with a birth defect while they are pregnant. Many decisions that women make about their health during pregnancy are made with these concerns in mind.

For many women these concerns are very real. As many as 1 in 5 pregnancies end in a miscarriage, and 1 in 33 babies are born with a birth defect. These rates are considered the background population risk, which means they do not take into consideration anything about the health of the mom, the medications she is taking, or the family history of the mom or the baby’s dad. A number of different things can increase these risks, including taking certain medications during pregnancy.

It is known that most medications, including over-the-counter medications, taken during pregnancy do get passed on to the baby. Fortunately, most medicines are not harmful to the baby and can be safely taken during pregnancy. But there are some that are known to be harmful to a baby’s normal development and growth, especially when they are taken during certain times of the pregnancy. Because of this, it is important to talk with your doctor or midwife about any medications you are taking, ideally before you even try to get pregnant.

If a doctor other than the one caring for your pregnancy recommends that you start a new medicine while you are pregnant, it is important that you let them know you are pregnant.

If you do need to take a new medication while pregnant, it is important to discuss the possible risks the medicine may pose on your pregnancy with your doctor or midwife. They can help you understand the benefits and the risks of taking the medicine.

Ultimately, the decision to start, stop, or change medications during pregnancy is up to you to make, along with input from your doctor or midwife. If you do take medications during pregnancy, be sure to keep track of all the medications you are taking.


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