SAY IT ISN'T SO

Smoking and Infant Development

Infants born to women who smoke cigarettes during pregnancy have difficulties with feeding, due primarily to sucking difficulties and irregular sleeping habits. Also, delays in achieving developmental milestones such as rolling over, crawling, walking during infancy stage and behavior and learning disorders, particularly during preschool and early school years, are more common to infants of mothers who smoke during pregnancy. During middle and high school years these behavioral and learning difficulties become more apparent, as well as memory problems and poor judgement.

Smoking and Pregnancy Intervention

In 2000, a panel of health professionals reviewed over 6,000 tobacco articles to determine what an effective smoking strategy for women look like. While the panel recommended a model known as the 5-A Method, the model was originally developed for men. Because the 2001 Surgeon General's report on women and smoking revealed that there were no established and gender specific differences in effective smoking cessation, this model is considered the most effective to date. The 5-A Method is a five step program adapted from the National Institute on Alcohol Abuse 4 step model. The five As stand for ask, advise, assess, assist and arrang-followup.

Ask, is to ask the client if she smoke or have been a former smoker; Advise, is to advise the client to quit smoking because of the health threat to the infant as well as the mother; Assess, is to assess the client willingness to quit smoking within 30 days; Assist, is to assist client with ways to stop smoking by identifying smoking triggers and healthier alternatives, and lastly, arrange followup, which is to monitor progress, give support and observe the mother's smoking status.

Social and Behavioral Risk Factors Among Pregnant Smokers

While programs to help pregnant women stop smoking do exist, research has shown that we cannot assume they are effective. Although 50% of infant mortality in the Unites States are attributable to maternal behavior factors, only 5% of health care resources are directed at improving the manner in which social and behavioral risk factor are addressed with pregnant women. The inequities of this must be addressed. It is important that healthcare professionals find ways to allocate more resources toward programs that effectively help reduce social and behavioral risk factors among pregnant smokers. It is also important that those who will be the recipient of these resources play a role in determining how to allocate best these resources.

Clinical Results for Pregnant Mothers

Successful treatment for women who smoke have significant effect on pregnancy outcomes. A review of clinical results for pregnant mothers who quit smoking indicated a 20% reduction in the number babies born low birth weight, a 17% reduction in preterm births and an average increase in infant weight of 28 grams.

Further research suggests that even when a pregnant mother stops smoking well into the pregnancy the results have proven beneficial to the fetus and the birth outcomes. Mothers who quit smoking as late as the 30th week were found to still experience positive outcomes related to the effect on infant birth weight.

The Impact of Smoking and Substance Abuse on Maternal Health

The death rate that is associated with smoking is enormous. In the United States, between 1998 and 2000, public health officials estimated that 170,000 women died each year from causes related to smoking. Tobacco use has contributed to cardiovascular, neoplastic, and cerebrovascular diseases which have considered leading causes of death among women since the 1930s until the present. The American Cancer Society estimated that, in 1991, approximately 67,000 women died of lung and bronchical cancer compared to 40,200 who died of breast cancer. Death risks from cardiovascular, neoplastic, and cerebrovascular diseases among women 35 to 84 are approximately 90% higher for women who smoke as opposed to non-smoking women.

Substance Abuse

Drinking alcohol during pregnancy has been related to a series of congenital malformations that are described as fetal alcohol sydrome. Fetal alcohol syndrome is characterized by a pattern of serious birth defeats that are associated with use during pregnancy. The birth defects include prenatal and postnatal growth retardation, central nervous system disorders as well as the distinct abnormal craniofacial features. Heavy alcohol drinking has been cited as the leading preventable cause of mental retardation in the world (Abel & Sokol, 1987).

The literature reveals that children who are born to a mother who continues to drink during their pregnancy are significantly smaller in birth weight, shorter in height and have a smaller head circumference than children born to mother who stop drinking. A study of French mothers revealed that those who consumed 35 or more drinks a week delivered infants that weighted 202 grams which is about seven ounces less than infants who were born to mothers who consumed six or less drinks a week (Larroque, Kaminski & Lelong, 1993).

The other illicit drug use that has been under investigation is the use of cocaine, also known as crack, during pregnancy. Prenatal cocaine use, as well as heroine abuse, during pregnancy is clearly associated with negative birth outcomes. The use of cocaine and heroine has been associated with low birth weight, premature labor, and fetal distress (Zuckerman, Frank, & Hingson, 1989).