SMOKING IN PREGNANCY

Dr Catherine Angell

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Physiology of smokingWhy do people enjoy smoking?

Dopamine • feelings of pleasure and satisfaction

Adrenaline• increased heart rate, blood pressure, respiration • release of glucose from the liver• raised blood sugar and appetite suppression

Norepinephrine• increased concentration, sharpness and arousal

Seratonin• calming, pain-killing, sedative effect

Nicotine is unique in the change in effect achieved by different doses

Physiology of smoking

Smoking has particular healthimplications for women

Infertility/delayed conceptionEarlier menopauseOsteoporosisCervical cancerBreast cancer (Odiase, 2009)

Heart attack/stroke if using oral contraceptives

PUBLIC HEALTH ISSUE

Smoking during pregnancy

Researching risk of pregnancy smoking is problematic because

Smoking habits related to social group• Poverty• Less educated• General health• Delay in seeking health care• Other risk factors ; diet, alcohol, medication, drugs• Less likely to breastfeed

Women may be reluctant to disclose level of smokingExposure to passive smoking

(Jarvis and Wardle, 1999)

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Risks to the woman of smoking during pregnancy

Ectopic pregnancyMiscarriagePlacenta praeviaUrinary tract infectionsPlacental abruptionPre-term labourPremature rupture of membranesHaemorrhage Inadequate breast milk production (Castles et al, 1999)

But not for:Pre-eclampsia (Engel et al., 2008)

PIH (Yang et al., 2006)

Gestational diabetes (Wendland et al., 2008)

Risks to the infant

Nicotine transfer to the infant

Nicotine and carbon monoxide move easily across the placenta

Nicotine and carboxyhemoglobin concentration is 10-15% higher in the fetus than in the mother

Nicotine is also carried in breast milk (Briggs and Freeman,

2005)

Smoking during pregnancy

Note down as many physical effects of

smoking for the FETUS as you can

Risks to the infant IUGRLow birth weightPremature birthPoorer outcomes for

pre-eclampsiaNeonatal mortalityCongenital malformations• Cardiovascular • Cleft lip and palate• Genitourinary• Talipes

Sudden infant death syndrome (SIDS)Respiratory problems,

eg. pneumoniaAsthmaEar nose throat problems, eg. glue earUndecended testes

(Edwards and King, 2007; Graham and Smith, 2007; Malik et al., 2008; Pipkin, 2008))

Risks to the childObesityAsthmaRespiratory disease

MeningitisChildhood cancers (linked to paternal smoking at conception)

DiabetesEarlier menarche (start of periods) and menopauseFertility difficultiesDelayed developmentEmotional problemsBehavioural problemsMore likely to be a smoker

(Gilman et al., 2008)(Sterjfelt et al., 1986; Hofhuis et al, 2003)

Smoking in pregnancy

Smoking in pregnancySmoking rates amongst pregnant women in the UK:

23% in 199519% in 200017% in 2005

(Baxter et al., 2009)

But RCM has noted concern about rises in pregnancy smoking rates since 2005

Why women smoke in pregnancyStress

Experience of smoking appears to offer relief from stress• Pregnancy anxiety, unplanned pregnancy• Money, work, housing• Partner, children, family• Guilt because of smoking

Women may believe smoking is better than stress for themselves, their baby and familyBUT smoking does not actually reduce stress...smoking increases stress hormones and having a cigarette generates dopamine which masks these

(Ebert and Fahy, 2007)

Why women smoke in pregnancyCoping with depression and anxietySocial reasons• Habit and lifestyle• Fitting in with partner/social group (Wakefield et al 1998)

Lack of understanding of risks• Risks of smoking distant and abstract (Graham, 1993)

Weight issues• Weight gain• Small baby=easier birth (Stillman et al., 1998)

Support from health professionals does not meet needs