Smoking in pregnancy-
Evidence based
More females become smokers
- CVS effect- mortality largely due to
- Lung CA
- Cervical CA
- Thromboembolism
- Menopause
- Miscarriage
- LBW, preterm delivery- smoking is the major preventable cause. And also for perinatal mortality.
Incidence: ¼
20-30% in developed countries
↑ among those in
- Low socio-economic state
- Without partners
- Already having children
Effects
- Prematurity
- IUGR
- ↓ IQ
- Infertility
- Ectopic
- Miscarriage
- ↓ Preeclampsia
1.Prematurity
- Spontaneous- PPROM
- Iatrogenic-Placenta previa, abruption
Early Preterm birth X2 risk- perinatal death
LBW- ↑SBP in children born to smokers. [in utero programming. ↓ fetal growth potential]
2.IUGR
~200g ↓
Dose effect relationship. Smoke >10/day→ LBW
More in male fetus
Passive smoke also risk
3.↓ IQ
Also long term respiratory illness
4.Infertility: ovarian function, implantation
5. ↑ Ectopic
6. ↑ Miscarriage
7.↓ Preeclampsia
Although it reduces, but other risks more than this benefit.
Smoker get PE→ More severe disease.
- IUGR
- Perinatal mortality
- Abruption
Management
- Specialist staff counselling. X2 cessation rate.
- Focused counselling. ~7% give up
- Programme- smoke cessation
- Self help material ~4% benefit
- Nicotine replacement
- Ban smoking. In Ireland. SGA ↓
Evidence: 6% quit →10-15% ↓ in LBW and Preterm birth
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