Tobacco Addiction


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 addiction during pregnancy?

Tobacco addiction is a long-term disorder that is characterized by an uncontrollable or difficult-to-control desire to get the drug nicotine from tobacco into the body, usually by way of smoking. Since smoking is a drug addiction, it can be very difficult for a smoker to quit the habit, even when preparing for pregnancy, after becoming pregnant, or after giving birth, despite knowing that tobacco use during pregnancy, or during breastfeeding, leads to dire consequences for the developing baby or nursing infant.

How common is tobacco addiction during pregnancy?

Use of tobacco varies greatly around the world, and even between regions and cities in North America, Europe, and other developed areas. Smoking is currently on the decline in the United States, having dropped from 21 percent to 15 percent of the US population between the years 2005 2015, but that 15 percent amounts to about 45 million people in the US alone. In the European Union, the rates of people smoking varies strikingly between countries, with 38 percent of Belgians maintaining 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. Rates in certain other countries are strikingly high, China being an example where men smoke much more than women, but non-smoking women are thus exposed to secondhand smoke. 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.

How is tobacco addiction during pregnancy diagnosed?

Diagnosis is based 100 percent on your medical history.

Does smoking cause problems during pregnancy?

Yes, in addition to damaging the lungs, dramatically elevating the risk of life-threatening lung and heart disease in the future, smoking stresses your body in several ways. For one thing, it intoxicates you with carbon monoxide, a gas that sticks to the hemoglobin in your red blood cells 240 times more powerfully than oxygen sticks to it. It also sticks dozens of times more tightly than oxygen to various molecules that are similar to hemoglobin (other types of globins) that normally transport and store oxygen inside various types of cells. Once stuck to these globin molecules, the carbon monoxide does not detach, unless you were to spend several hours inside a special pressure chamber that is used to rescue people after smoke inhalation from fires. Such chambers are not used for smokers, but being exposed to carbon monoxide gradually, your red blood cells merely become less efficient at carrying oxygen through the body, as do the oxygen-carrying molecules in your muscles, liver, brains, and other organs. With your ability to deliver oxygen to tissues diminished, your heart must move blood faster and you must breathe more quickly, and so activities that dont strain non-smokers require an extra physical effort on your part. With the extra physical burden of carrying a developing child and the need to deliver oxygen to it, your heart and lungs must work still harder. All in all, smoking makes pregnancy more difficult than it would be otherwise. On top of this, in the long-term, smoking dramatically raises the risk for emphysema, lung cancer, heart disease, strokes, and a host of other conditions.

Does smoking during pregnancy cause problems for the baby?

Smoking increases the risk of spontaneous abortion (miscarriage), problems with the placenta, premature birth, low birth weight, and congenital birth defects. Babies born to smoking mothers have a higher risk of sudden infant death syndrome (SIDS). It 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.

What to consider about taking medications when you are pregnant or breastfeeding:

  • The risks to yourself and your baby if you do not treat the tobacco addiction
  • The risks and benefits of each medication you use when you are pregnant
  • The risks and benefits of each medication you use when you are breastfeeding

What should I know about using medication to treat tobacco addiction during pregnancy?

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 wont crave it from cigarettes. Other drugs to fight nicotine addiction are bupropion, varenicline, nortriptyline, and clonidine.

Who should NOT stop taking medication for tobacco addiction during pregnancy?

Anyone who is making progress on medication to treat tobacco addiction should continue, because the consequences of smoking while pregnant are dire for the developing baby.

What should I know about choosing a medication for my tobacco addiction during pregnancy?

Of the medication options listed above for treating tobacco addiction, every one of them has raised some concern that it could affect the baby negatively. In the cases of bupropion and varenicline, health care specialists are awaiting studies to determine whether these drugs should be recommended during pregnancy. Furthermore, nicotine replacement therapy is controversial as nicotine is toxic to the developing baby, but then the baby will be exposed to nicotine anyway if the mother does not quit smoking. Generally, all available treatments are safer for the baby than maternal smoking.

It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.

You may find Pregistrys expert reports about the individual medications used to treat tobacco addiction here. Additional information can also be found in the sources listed at the end of this report.

What should I know about taking a medication for my tobacco addiction when I am breastfeeding?

Concerns about medications entering breastmilk and affecting a nursing infant vary from medication to medication. What is very clear, however, is that smoking concentrates nicotine from tobacco, turning the lactating breast into a nicotine delivery device. Under no circumstance should a mother breastfeed, if she has failed to quit smoking.

What alternative therapies besides medications can I use to treat my tobacco addiction during pregnancy?

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.

What can I do for myself and my baby when I have tobacco addiction during pregnancy?

Work with your physician to do all that is possible to quit smoking. Leave no stone unturned.

Resources for tobacco addiction in pregnancy:

For more informatio
n about smoking during pregnancy, contact (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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