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7 Ways Smoking Harms Babies in the Womb
4 Ways Smoking Increases the Risk of SIDS
Exposure to Kids
How Smoking Hampers Mothering
Health Warnings on Cigarette Packs
Resources to Help Stop Smoking

Consider the physiological effects of smoking on yourself and your baby, especially the increased risk of SIDS.

1. It retards growth. Smoking stunts the growth of the developing fetus. Nicotine narrows the uterine blood vessels, thus reducing blood flow to the baby. Also, smoking puts the oxygen blocker carbon monoxide into the blood that nourishes baby. Carbon monoxide robs oxygen from the baby. Levels of carbon monoxide have been measured at six to seven times higher in the blood of pregnant mothers who smoke. Carbon monoxide levels in cigarette smoke resembles that of automobile exhaust. Smoking thus reduces the oxygen supply to the infant in the womb, in effect slightly smothering the defenseless baby.

2. It retards brain development. Nicotine has been shown experimentally to retard fetal brain growth in animals. The developing brain is particularly vulnerable to low levels of oxygen, and immaturity of the brain center that regulates breathing could contribute to SIDS. Recent studies of smoking mothers' infants who died in the womb provide insight into how exposure to smoking may injure developing brains. Besides causing neurological damage by lessening oxygen supply to the developing brain, nicotine may be poisonous to area of the brain directly involved with heart and breathing functions and arousal from sleep. Also, infants whose mothers smoked during pregnancy are more likely to have diminished arousal from sleep in response to a low-oxygen challenge.

3. It impairs breathing after birth. Mothers who smoked at least half a pack of cigarettes a day during pregnancy are nearly three times more likely to have babies with mucus-blocked airways or episodes of apnea.

4. It increases the likelihood of prematurity. The risk of SIDS goes up as baby's birthweight and gestational age go down. Babies of smoking mothers end up being smaller (due to intrauterine growth retardation), and smoking increases the risk of complications of pregnancy that lead to prematurity: premature rupture of fetal membranes, placenta previa, and premature detachment of the placenta.

5. Passive smoking also harms the baby. When expectant mothers are exposed to smoke from other people's cigarettes, their babies are also exposed. One study showed that a pregnant woman's exposure to smoke for at least two hours a day doubled her risk of delivering a low birthweight baby. While older studies claimed no increased SIDS risk if the father smoked, a newer study reports a higher risk of SIDS if the father smokes. Demand that your husband and co-workers respect the life inside your womb. If your job requires working in a smoke-contaminated environment while pregnant, know that this is a proven health hazard to your baby and is grounds for reassignment to a baby-healthy environment. As a testimony to the wisdom of the body, many mothers find they have an aversion to being around cigarette and cigar smoke (and to drinking alcohol) while pregnant. Listen to the warnings of your body and hundreds of medical studies: Don't expose yourself and your baby to smoke while pregnant. Legally, you have the right to work in a smoke-free environment.

6. Smoking harms mothers and babies.

• Increases infertility (smoking could account for ten percent of infertility problems in mothers)
• Increases risk of ectopic pregnancy
• Increases risk of placenta previa
• Increases risk of premature separation of the placenta
• Increases risk of placental abnormalities (known as "smoker's placenta")
• Increases risk of problem pregnancies, e.g., pre-eclampsia
• Increases risk of prematurity under intrauterine growth retardation
• Increases risk of the newborn dying at birth by twenty percent; thirty-five percent if mother smokes more than thirty-five cigarettes a day
• Increases risk of respiratory infections in infant
• Increases risk of SIDS by two to five times

Studies have shown the following correlations between mothers who smoke during pregnancy, especially heavy smoking (greater than one pack a day) and the development of their children. Children of mothers who smoked during pregnancy are more likely to show:

• Decreased newborn Apgar scores (if smoking more than one pack a day)
• Decreased mental performance scoring at age one year
• Decreased academic performance scores in the school-age child
• Reduced I.Q.
• Shorter stature (by one to two centimeters)
• Smaller head circumference as infants
• Increased learning difficulties (children were 25 percent more likely to have learning disabilities if their mother smoked greater than 20 cigarettes a day)
• Increased hyperactivity
• Increased behavioral problems

Studies on the long-term effects of smoking during pregnancy on children's mental and physical development did not all agree. Some showed slight or no adverse effects. The above conclusions represent the general consensus of outcome studies.

Suppose you were about to take your baby into a room when you noticed a sign that read: Warning, this room contains poisonous gases of around 4,000 chemicals, some of which have been linked to cancer and lung damage, and are especially harmful to the breathing passages of young infants. "I certainly wouldn't take my baby into there," you conclude. Yet, that's exactly what happens when you take your baby into a room frequented by smokers. "But we always sit in a non-smoking area of public places," you add. This is helpful, but not enough. Having a "Non-smoking area" is like trying to chlorinate half a swimming pool. Pollutants travel through the air. "But I only smoke outside," you rationalize. Also helpful, but not enough. Smoke sticks to clothing and hair. When your baby nestles on your shoulder with his nose on your smoke-contaminated clothing and near your hair your baby's inhales pollutants.

Parents have a right to fume over the poisonous gases that come from a cigarette or cigar burning in their baby's presence. Among the many toxic ingredients in cigarette smoke are the oxygen blocker carbon monoxide; benzene, a potential carcinogen; ammonia; hydrogen cyanide, which is used in making rat poison; formaldehyde; and of course, nicotine. Here are some of the effects.

1. Bothers little breathers. Any poison that deprives the infant of oxygen increases the risk of SIDS. Cigarette and cigar smoke deprive the infant of oxygen, which could interfere with development of the brain center that controls breathing. When the body is chronically deprived of oxygen, it tries to compensate by increasing the production of a chemical that facilitates oxygen transport, called 2,3 DPG. Levels of this substance have been found to be higher in children exposed to smoke, indicating they are trying to compensate for chronic oxygen deprivation. Cotinine, the main chemical produced when the body breaks down nicotine, has been found in the blood of babies exposed to passive smoke, proof that harmful chemicals enter babies' bodies from cigarette or cigar smoke in the environment. Nicotine, cotinine, thiocyanate, and another nicotine byproduct, have also been found in the blood of breastfeeding infants whose mothers smoke. (Whether these poisons enter the baby via mothers' milk or secondhand smoke is uncertain.) The blood levels of the nicotine byproducts were proportional to the number of cigarettes smoked by the mother.

2. Hurts little hearts. Besides being harmful to growing lungs, smoking may harm growing hearts. Levels of HDL, best known as the "good cholesterol" that may protect from heart disease, was lower in children of smoking parents. In addition, researchers have found high levels of cotinine in the fluid around the hearts of some infants who died of SIDS. Smoke toxins have also been implicated in depressing the automatic regulation of heart rates.

3. Injures little brains. Previously, I mentioned how smoking prenatally may retard the growth of baby's brain. It appears that the brain of a baby of a smoker doesn't fare much better outside the womb. In experiments, nicotine acts as a breathing stimulant to animals that are breathing normally. But as soon as their breathing is compromised, nicotine seems to depress the compensatory breathing control mechanisms in the brain that should return the animal's breathing to normal. It is possible that a smoking mother's infant, whose breathing is already compromised, say, from a cold, could fail to restart breathing because of the effects of nicotine.

4. Blocks little noses. The nasal passages of babies are particularly sensitive to smoke and other irritants and allergens. Also, some babies are obligate nose breathers; meaning they insist on breathing through their nose and, unlike adults, do not switch to mouth breathing if their noses are blocked. Nasal passages that are stuffy and blocked because of smoke could compromise baby's breathing.

The lower respiratory tract is lined with tiny filaments, called "cilia," which wave back and forth to clear mucous from the airway passages and help keep them open. Smoke paralyzes these cilia, leaving the increased mucous that is secreted during colds and allergies to clog the air passages. Children of smoking parents have two to three times more doctor visits because of respiratory infections. Respiratory viruses are frequently found at postmortem examination of SIDS infants. Respiratory infections within two weeks of death have been implicated in setting up a baby for SIDS.

• If both parents smoke, baby's SIDS risk is 3½ times greater than if neither parent smokes.
• If mother smokes, but father doesn't, baby's risk is 2 times greater.
• If father smokes, but mother doesn't, baby's risk is 1½ times greater.

Smoking interferes with natural mothering. Lack of breastfeeding is a risk factor for SIDS. Mothers who smoke tend to either, not breastfeed or wean earlier and to have more breastfeeding problems. Perhaps smoking suppresses lactation by interfering with the milk-producing hormones. Also alarming is a finding that mothers who smoke have lower levels of prolactin , the hormone that regulates milk production and affects mothering behavior. Diminished maternal awareness of an infant's needs has been implicated as a risk factor of SIDS, and a mother with less prolactin going through her may have less awareness of her infant, an especially worrisome situation when one considers that these infants are already compromised due to their exposure to smoke and nicotine.

At this writing at least five reputable scientific studies conclude that smoking around babies increases the risk of SIDS, and the more cigarettes the parents smoke the higher the risk.

Normally, mothers would never do anything to deliberately harm their babies, except when smoking addiction overrules. Your infant needs healthy lungs and healthy parents. You owe it to yourself and to your baby to stop smoking. Smoking and parenting don't mix – without a risk.

Why isn't there such a warning on cigarette packages like there is against drinking alcohol while pregnant? Health authorities refuse to do this because, they claim, there is no proven cause and effect relationship between smoking and infant damage and death – only a statistical one. Sounds like the same feeble excuse that delayed the smoking-causes-cancer labeling.

I would like to see warnings such as: smoking kills babies or smoking retards infants on every cigarette pack. There are warnings on alcohol bottles that drinking during pregnancy could cause birth defects, yet the risk of SIDS is 3.4 times greater from smoking than from consuming alcohol while pregnant. I propose that enough evidence exists today to merit putting on each pack of cigarettes and on all tobacco ads a warning label such as: research has determined that smoking while pregnant or around infants may cause SIDS.

Despite the warning in the "Back to Sleep" campaign that smoking may increase the risk of SIDS, researchers in England found that the anti-smoking warning campaign had no impact on mothers who already smoked (though it did seem to deter some mothers from starting). Smokers followed the other SIDS risk reduction suggestions, such as switching their baby's sleeping position from front to back, but continued to smoke. I'm surprised at these results since, normally, mothers would never do anything to deliberately harm their infant. I conclude, therefore, that concerning smoking a mother's addiction can override her intuition. When it comes to smoking too many people still feel they'll beat the odds: "It just can't happen to me." "It just can't happen to my baby."

From this mind-set we can learn the following things: First, there must be laws to protect infants who can't help themselves and parents who can't, or won't. Also, there needs to be support resources to help parents, especially mothers, quit smoking. Finally, information on how smoking hurts babies needs to reach pre-smokers; namely teens (infants of teen mothers are at higher risk of SIDS). This tactic is being tried in New Zealand with the KIDS-AGAINST-SIDS campaign, in which teens are taught the hazards of smoking before they get pregnant or start smoking. The surgeon general's 1994 report "Preventing Tobacco Use Among Young People" concludes that if people don't start smoking as adolescents, most will never become smokers.

If SIDS parents, health-care professionals, and other concerned citizens start to scream louder than the tobacco executives, we may soon see effective warning labels, public health campaigns, and a decrease in parental smoking. Researchers estimate that if maternal smoking could be eliminated altogether, the overall infant death rate could be reduced by ten percent and the SIDS rate by twenty-seven percent.

Pamphlets and information on how to quit smoking can be obtained from these resources:

American Cancer Society
800-227-2345

American Lung Association
212-315-8700

A Pregnant Woman's Guide to Quit Smoking By Richard A. Windsor and Dianne Smith
Available through your library or from bookstores, this book contains a ten-day, twenty-step workbook on practical ways to quit smoking.