PREGNANCY

“My mother smoked through both her pregnancies and while she was breastfeeding us and didn’t think a thing about it,” says Monique McCardle. But McCardle, a smoker herself, certainly didn’t feel that relaxed about the habit when she was expecting her own children. Women today know that the research on the risks of smoking during pregnancy is now substantial, and it’s scary.

Dr. Elliot Halparin, President of the Ontario Medical Association, lists just some of the potential problems. Women who smoke during pregnancy are more likely to miscarry and have higher rates of preterm birth; smoking also increases the risk of low birth weight and stillbirth. Even if born full-term and healthy, babies of mothers who smoke run a higher risk of developing asthma or dying of SIDS. A 2002 study in the British Medical Association Journal found that maternal smoking during pregnancy increased the risk of the child later developing diabetes by 500 percent and also increased the risk of obesity. Another study done at the University of Montreal found that children born to mothers who smoked were more likely to be aggressive as preschoolers.

And if you continue to smoke after the baby’s born, he will have an increased risk of SIDS, a higher risk of asthma, and increased respiratory infections and ear infections. Your child’s growth and intelligence may also be impaired.

Aside from all that, as Halparin points out, smoking isn’t good for you either. About half of all smokers will eventually die from smoking-related illness.

But knowing all those good reasons to quit doesn’t make it easy. McCardle, the mother of two daughters, started smoking at age 13 and it’s part of her life. “My entire family smokes, my husband smokes, it’s just so hard,” she says.

Despite that, she did manage to quit — temporarily at least — during both her pregnancies.

What helped? “Well, during the first trimester I get really, really sick,” McCardle explained. “I can hardly stand the smell of smoke. So it’s like my body pushes me to quit.” She smoked for about the first two months of each pregnancy and then stopped, cold turkey.

Another helpful factor, she believes, is the pressure she feels from others. “If people see you looking obviously pregnant and you’re smoking, it’s really frowned on. They’re horrified. So that helped motivate me to quit before anyone could tell that I was pregnant.”

Knowing the risk to the baby helps too, McCardle adds. “I always crave cigarettes when I’m pregnant, but I do have more motivation.”

Halparin comments that pregnancy is often an “opportune moment” for women to stop smoking, and that between 30 and 50 percent of smokers will successfully quit during pregnancy. (Unfortunately, more than half will start smoking again before the baby is six months old.)

Those who don’t quit are often able to cut back. Becky Kaye was smoking over a pack a day when she learned she was pregnant with her first baby. “I was also drinking about seven cups of coffee a day, and I often smoked while I drank my coffee,” she recalls. So her first step was to cut back on the java — down to two cups a day. That automatically helped her eliminate five or six cigarettes.

She also decided to limit the places where she smoked — no smoking in the car, no smoking at work, until she was down to fewer than 10 cigarettes a day.

Halparin says it can be very helpful to analyze when and why you smoke, and develop a strategy to take these factors into account. “You can do it one step at a time,” he says. “Decide not to smoke in the car, and when you’ve adjusted to that, pick another time when you promise yourself not to smoke.”

Finding a support group can also be very helpful, and you may be able to connect with one specifically for pregnant women, such as “Start Quit, Stay Quit,” “Born Free” or “Kick Butt for Two” (see Who Can Help? for more information about programs).

Sharon Yanicki, program director of Wellness Services in the Chinook Health Region, says she finds the “Kick Butt for Two” program a helpful way to address the special concerns of pregnant smokers. The program includes a series of six sessions with follow-up sessions at one month, two months, three months and one year.

“The main reasons women smoke are for weight control, for stress management, and for self-esteem and social reasons,” says Yanicki. In the sessions, women learn specific strategies that address these issues. “We teach about nutrition and healthy weight gain patterns in pregnancy, stress reduction techniques, and developing support systems. The group support is an important part of the program.”

Their results over the first year have been good, with about 80 percent of the women who complete the program either quitting or significantly cutting back. Those who do not attend all the sessions, however, are much more likely to continue smoking.

In other communities, pregnant women may need to attend groups offered to the general public. Rose Atkins, health promotions officer in Point Edward, Ontario says: “Pregnant women are encouraged to participate in our eight-session Stop Smoking program. We also address stop smoking strategies for pregnant women in prenatal classes and preconception and early pregnancy workshops.”

Like “Kick Butt for Two,” the Stop Smoking sessions are free. Atkins says the program covers goal setting, stress management and relaxation, self-esteem, healthy weight maintenance, increasing physical activity, and handling roadblocks (including withdrawal symptoms, relapses, and high-risk situations).

What about the popular patches and gum to reduce nicotine cravings? Myla Moretti, assistant director of the Motherisk Program at Toronto’s Hospital for Sick Children, says that “there is no reason to suggest that nicotine patches or gum are more harmful than smoking. The few studies that have looked at fetal effects from the patch did not show a risk to the baby. Also, with nicotine replacement therapies, women are exposed to only nicotine and not the more than one thousand other chemicals that are in cigarettes.”

Moretti adds that buproprion (sold as Zyban and often used by smokers trying to quit) is still being studied. “In fact,” she explains, “the Motherisk program is currently following pregnant women using this drug.” While the results of this study are not yet available, the data so far (as well as data from previous studies done by the manufacturer) do not suggest a risk for birth defects. But more research needs to be done.

Do these quitting aids help? Moretti says that’s not clear. “Right now a couple of studies which looked at the effectiveness of the patch found that women not exposed to the patch quit smoking just as often as women who used the patch. We don’t know why that is. It could be that pregnant women have different metabolism of nicotine than non-pregnant women and we just haven’t figured out the right dosage yet.”

If a support group is not available to you, or simply not your thing, Rose Atkins offers the following tips to help you kick the habit:

1. Make a list of all the reasons you want to quit. Quitting for yourself is important for long-term success.
2. Keep a daily smoking journal and record the time and number of cigarettes you smoke to identify when and why you smoke.
3. Talk to your doctor about smoking cessation aids such as the nicotine patch.
4. Set a quit date.
5. Find a support person or buddy. Another mother who successfully quit smoking during pregnancy might be a good choice. Look for someone who will be non-judgmental and able to empathize with you during the tough times.
6. Start to reduce the number of cigarettes by using the four “D” techniques: delay, drink water, do something different and deep breaths.
7. Create and maintain a smoke-free environment at home.
8. Choose healthy foods and increase physical activity.
9. Plan a reward system, and give yourself rewards for each accomplishment! This is a hard thing to do and you need all the encouragement you can get!

Atkins also has some important advice for the partners of pregnant women who are stopping smoking. “Couples tend to have a greater chance for success if they quit at the same time,” she notes. She urges partners to remove all reminders from the environment — ashtrays, lighters, etc. “If you continue to smoke, take it outside. Support her decision to quit, and be understanding of her moods. Changing behaviour is always stressful,” Atkins adds.

Halparin reminds women: “Cigarettes are not your friend, they’re your enemy. They are like the friend who is nice to your face but says terrible things about you behind your back. There has been an actual decline in the life expectancy of women in the past few years, and that is entirely due to smoking.” He urges pregnant women to ask their physicians about the help available to them in their community, saying: “Quitting smoking, and staying smoke-free, will be one of the most important things you can do not only for your baby’s health, but for your own.”

Who Can Help?

Your physician or midwife will know of resources in your local community and whether there are groups specifically for pregnant women. You can also contact your local Public Health or Community Health Services for information about local programs.

Health Canada’s Web site includes, among other helpful resources, a list of self-help groups and stop smoking programs across Canada, including contact information. You can also sign up to receive a daily email to help you quit smoking one step at a time: www.hc-sc.gc.ca/hecs-sesc/tobacco/prof/cessation.html.

The Canadian Lung Association offers Stop Smoking programs across Canada, and has programs specifically for pregnant women in some communities: www.lung.ca.

The Canadian Cancer Society may also offer programs: www.cancer.ca.

Originally published in Today's Parent Pregnancy & Birth, Winter 2002/03