The increasing numbers of female adult smoker is worrying. This group of people, sooner or later will plan to have babies and this further poses future public health risk. A survey in 2011 by the Global Adult Tobacco Survey (GATS) found that almost 1percent of the female adult population in Malaysia are actually regular smokers. This number is rising despite smoking being seen as a lifestyle with some social stigma. Numbers of secondary smokers are also high. With almost 43.9% of adult males are smokers (shocking!) , women are at risk of being indirectly affected from its side effects. It was found that there is an increased risk of perinatal problems in baby of which father smokes more than 10 cigarettes per day. This signifies that paternal smoking habits are also affecting the pregnancy outcome.
For many who thought, that smoking before pregnancy is safe as it will not affects the overall pregnancy aspects should think twice about it. There’s an increase risk of miscarriages and ectopic pregnancy (pregnancy outside the womb) in those who were smoking prior to conception. During pregnancy if the smoking continues fetus is exposed the dose dependant nicotine level that crosses the placenta freely resulting in placental insufficiency (reduced placental function). Placenta insufficiency is detrimental with high risk of preterm birth and abruption (premature separation of placenta). Risk of premature rupture of membrane is also increased almost 2 fold in smokers. This further exposes the fetus to problems of prematurity and infection. Prematurity demands special care with unavoidable problems related to digestion , eye or respiratory. Purposely imposing these risk to the unborn child is selfish.
Evidence shows risk of fetal anomalies are increased with smoking, such as Gastrochisis (where the content of abdomen would be outside the abdomen), hernia and craniosynostosis are significantly increased. Other abnormalities such as heart defect, musculoskeletal problems and undescended testes has also been reported. Smoking significantly increases the chance of having abnormal babies.
If the smoking mother is lucky enough not to have all this side effects, most babies are born in the lower birth weights or even has double the risk of intrauterine growth restriction .This may effect the overall health of the child during neonatal period or even afterwards. However this effects may be halted if the mother decided to stop smoking in the early part of their pregnancy. So early decision may effects the overall pregnancy and the outcome.
There are recents reports associating parental smoking antenatally with significant effects in later life of the children affected. Lower academic achievement and even ADHD (Attention Deficit Hyperactive Disorder) have been noted to be high in those mother who smokes during pregnancy. Risk of wheeze and asthma are more prominent in children whose mothers smokes than those who don’t.
Regardless of the postulation that smoking efficiently reduce risk of getting pre-eclampsia (high blood pressure with protein in urine) other risk should outweighs it minuscule benefit. Being a parent is more than having cute baby to play with or to be proud of. You are responsible in providing a safer environment for them free from danger including health risk. Be wise in choosing cause it may just be another puff for you but your baby may be heavily affected by it.
Major (Dr) Che Hasnura is an Obstetric & Gynaecology specialist who has also served in overseas missions. Find out more about her at The Team page.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]
References
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- 4. Hackshaw et. al Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls Human Reproduction Update 2011 ;Vol.17, No.5 pp. 589–604