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Smoking and Pregnancy

By Dr Dalila Znimi, Specialist Obstetrics and Gynecology at Al-Ahli Hospital / Qatar

Smoking and Chicha became social habits in the Middle East and especially in women. During pregnancy, some of them will continue smoking and to have a healthy newborn, it is very important to encourage decreasing tobacco consumption.

The prevalence of smoking during pregnancy in the world is estimated around 1, 7% (up to 20% in some western countries). The need of smoking is higher during pregnancy as the metabolic and renal clearance of the nicotine is increasing due to the changes in the physiology of the body. Therefore, the failure of weaning is predictable if no counselling and no supervision were done. Some risk factors are recognized such confinement at home, environment of smokers, depression… Antenatal visits and preconception visit are considered as the best time to stop smoking. As health professionals, we have to identify the smoker pregnant women as soon as possible. 

The Carbon Monoxide (CO) concentration measure in the expired air is an non-invasive and simple test used to identify smokers during pregnancy and post-partum. Some question tests as FTCD (Fagerstrom Test for Cigarette Dependence) and HSI (Heaviness of Smoking Index) are the most used for evaluation to nicotine exposure. The addiction to tobacco is evaluated by diagnostic criteria of DSM-V (Diagnostic and Statistical Manual of mental disorders version)

The active smoking during pregnancy especially if heavy will increase risks of miscarriage, ectopic pregnancy, congenital abnormalities, placenta abruption, placenta praevia, intrauterine growth restriction and intrauterine fetal death. An increased number of cesarean and deep venous thrombosis during post-partum are even noticed.

The passive smoking is responsible for increasing risk of preterm labor and there is an effect on the dose- dependency. 

There has been a decreased rate of preterm births since the restriction of smoking in public spaces. It is also associated with a high risk of stillbirth and intrauterine growth restriction < 2, 5 kg at birth.

The consequences of smoking on the newborn and childhood life are multiple like infant sudden death, lower respiratory tract infection, asthma especially if combined with the environmental pollution, cognitive deficiency, hyperactivity & attention deficit and decreased school performance.

A recent Irish study published that babies of mothers vaping (using E cigarettes exclusively) have the same birth weight compared to those not smoking. Vaping could be an alternative solution to those not able to stop smoking during pregnancy.

Other products of vaping ( like Chicha or warm tobacco ) are not advisable as there is no clear data about their effects in pregnancy. However, the use of nicotine substitutive therapy (pastilles, gums or patches) during pregnancy and breastfeeding are allowed as long as it is under control of a health professional. It is reducing smoke exposure and no bad effects on the baby have been reported yet. Bupropion ( ZYBAN ) and other non nicotine substitutive therapy are definitely not recommended.

In conclusion, the safest way is to not smoke or vape. If smoking cessation is impossible, vaping without nicotine would be the best option. However, vaping with nicotine could be if the withdrawal is still too difficult. The worst is to continue smoking even a few cigarettes.

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