The Biggest Gift: How to Quit Smoking in Pregnancy

How to quit smoking in pregnancy:  it’s a tough subject, isn’t it?  Most of the time, people want to close the page, forward to the next article. We all have our vices, nobody is perfect, it’s true… and these topics tend to elicit groans and a change of topic.  We all live busy, stressed-out lives. But let’s turn this around the other direction for a second.

What if there was something out there, a new wonder-drug, that would improve the health of at least 20% of all babies in Canada, across their entire lifespan… and you might be able to gain access to it?  What if this magic pill would reduce preterm birth, placenta previa, low birth weights, heart defects and the baby’s risk of developing cancer, diabetes, hypertension and a whole host of other diseases?  What if it improved the mother’s health, increased her (and her family’s) lifespan by as much as 10 years or more?  What’s more, what if the company PAID YOU to take it, resulting in as much as $1 000 – $12 000 extra money per family, per year?  It would be hailed as a wonder-drug. It would hit all the headlines. Somebody would win a Nobel prize for a health impact like that.

This magic pill exists, but it’s not actually a pill.   It’s quitting smoking, or cutting back.

Taking a pill is easy, but quitting smoking is hard. It’s really hard.  75% of smokers want to quit. Most first attempts aren’t successful. But today is International Smoking Cessation day, and this is really important!  How can we help you make the next attempt? Each attempt increases the chances that one will stick, which makes a huge health difference for your family!

So what’s so awful about smoking?  What does the research say?

Well, there’s lots of new research in smoking and pregnancy:  fore-warned is fore-armed, as they say.  We’re going to talk about shiny new research into the effects of smoking, and also the resources to help those who wish it, to quit, and give their families that Biggest Gift.  

How many babies are we talking about?

In Canada, the prevalence of people who smoked during their pregnancy was estimated to be 17% in 2000-2001.  The Canadian Community Health Survey in 2010 estimated rates to be 23% overall, and 18% in Ontario.  Those exposed to second-hand smoke in pregnancy is estimated to be about 37%.

That means that 1 in 5 Canadian women smoke during pregnancy.  Canada has a birth rate of approximately 384,000, so approximately 76,800 women smoke in their pregnancies in Canada, or approximately 30,000 women.  

So what does that mean for babies?

You likely have already heard these well-known risks:

• Risk of preterm labour
• Risk of low birth weight.

Actually… that sounds okay. A little too early, a little too small… that’s not so bad, right?  It’s easier to deliver a smaller baby!  What’s the big deal?  I’ve heard that said a lot.  Delivering a smaller baby can sound appealing.

Well, it is commonly said that babies are smaller because they are getting less oxygen and nutrients than other babies would, because the carbon monoxide in cigarettes is using the space on your red blood cells that oxygen would normally take… which is only part of the story.  Nicotine actually constricts blood vessels… so it’s almost like baby is breathing through a straw. Then add carbon monoxide instead of oxygen and the baby gets still less.  Even that doesn’t tell us enough, though.  Nicotine in cigarettes affects the DNA methylation in the placenta. That’s the process that allows genes to switch on and off.  It changes how it functions, how well it is able to protect babies from toxins, how well it works overall. The placenta, in a pregnancy, is everything, the baby’s protection, its food supply. Nicotine hits you right in the… er… placenta.  Here is how the risks of smoking play out:

Increased risks:

• SIDS (about two-fold for passive ‘environmental’ smoking and three-fold when smoking happened during pregnancy and afterward)
• Miscarriage (11% increase when exposed to second-hand smoke, plus 1% increase per cigarette smoked per day)
• Placenta previa (when the placenta covers the cervix and blocks the ‘exit door’)
• Placental abruption (when the placenta comes away from the uterine wall)
• Cleft palate
• Congenital heart disease
• Limb deformities
• Gastrointestinal disorders
• Still birth

And later in life,

• Immune system disorders such as asthma and allergies
• Cancer 
• Obesity
• Hypertension
• Type 2 diabetes
• Delayed psychomotor and mental development scores
• Delayed auditory processing which then impacts speech and language development
• Dose-response relationships for general cognitive ability, arithmetic, spelling

Yikes!  That’s bigger than any other pregnancy-related complication. Maybe bigger than them all… combined.

… but why?  Why so many poor outcomes?

• Chemicals
  There are more than 4,000 chemicals in cigarette smoke including benzo(a)pyrene, nicotine, and carbon monoxide, and more than 40 of these chemicals are known carcinogens.
• Baby gets more than mum
  Nicotine crosses the placenta, and fetal concentrations of nicotine can be 15% higher than maternal concentrations.  
• Epigenetics
  One of the forefathers of the theory of fetal programming is David Barker who, in the 1980’s, proposed that poor nutrition (say, during a famine) would alter how babies develop. I wrote a post on this.  That theory is now extending past nutrition to, well, everything else. Scientists are now calling this, ‘developmental origins of health and disease’.  In short, what we consume and are exposed to acts as postcards from the outside, and baby develops accordingly.

 Epigenetics?  Whut?

Let’s take an example.  In a study done at McMaster in 2008, rats were given nicotine while pregnant. 

Not quite like in this picture, no.  They were given doses appropriate, per weight, to what a woman would ingest as an average smoker. What they found was that the mitochondria and the pancreatic islet cells in the babies were affected.  The mitochondria became abnormal and the pancreatic islet cells died off at a far greater rate than the control group.   This became greater with age as those babies grew to adults. Now, islet cells are responsible for insulin – that substance that helps us maintain our blood sugar levels.  Predictably, those offspring rats developed signs and symptoms of diabetes. Mom ‘smoked’, and babies developed obesity, diabetes, etc.

Now here’s the kicker:

They bred that second group of rats (the now grown-up babies), and didn’t expose those to nicotine at all.

Their offspring, the grandbabies of the smoker-rats, showed the exact same effect, and also developed a higher risk for diabetes, despite the fact their parents were not exposed to nicotine themselves.

We know that epigenetics has big implications even generations down the line… but this is huge.  This means that by quitting smoking, you may not be helping only yourself and your baby, but also your grandbabies.

Quitting is hard, in part because it is one of the most addictive substances we know of.  But it’s worthwhile.  Not only for your own health and that of your children and perhaps even grandchildren, but for the extra cash in your wallet, the taste of your food and the smell of your home and clothes. The payback for your effort is simply massive.

But there’s quitting, and then there’s staying quitting.  According to the CDC, of women who smoked 3 months before pregnancy, 55% quit during pregnancy. Among women who quit smoking during pregnancy, 40% started smoking again within 6 months after delivery.  Which means the likelihood that the kids in that household will smoke also goes up. The cycle continues.

Be aware… this is a family project, and a family commitment.  I have seen countless women reduce their smoking or quit altogether… but sometimes their partner says, ‘Why do I have to quit? I’m not carrying the baby!’   Nope, nada, zilch, that won’t fly!   Family support makes a huge difference.  Dads, loved ones, grandparents, partners… what are the chances that a pregnant person will quit, when the people around them are smoking?

Exactly.

If you are a dad, loved one, grandparent or partner of someone who is pregnant and smokes and you also smoke, you can make a huge difference. In most cases, you are the difference. Even if you can’t quit yourself, be enthusiastic, encouraging and supportive about other people’s interest in quitting. Try not to be defensive even if you feel like you are being criticized.  Smoke outside. Change your shirt and wash your hands after you smoke. Even if you and the person that you know who is pregnant and smokes are not ready to quit, check out the resources below for ideas for how you can cut back. Every little effort makes a difference and increases health. You, as a support person, are key.

Ready to start?

Here are the resources to help. These resources are Ontario-based. 

• Smokers Help Line – Offers contests and challenges (for cash!), an online quitting program, free help by phone or text, and online forums
• Pregnets  – The Pregnets website hosts the most up-to-date information on smoking cessation practices for pregnant and postpartum women, an anonymous Online Discussion Board and a personalized plan for quitting or reducing smoking.  You can also get your questions answered by a health care professional.
• Break It Off – A free app to help you quit
• STOP with Family Health Teams or Community Health Centres – If you are a member of a Family Health Team or Community Health Centre, your Nurse Practitioner or Family Physician may be able to help you quit with nicotine replacement therapy, counselling, and more, all free of charge.
• Run To Quit – There is good evidence that in pregnancy, exercise is one of the most effective methods to quit smoking.  Quit smoking and get fit doing it, running or walking! This program also offers contests (for $1000 or a car!).
• MyQuit –  Register here.  A whole host of help focused in the Champlain region (City of Ottawa, City of Cornwall, Renfrew County, Lanark County, Leeds & Grenville, Prescott-Russell and Stormont, Dundas & Glengarry). This includes:
  • Individual one-on-one coaching
  • Four-week group coaching
  • Weekly drop-in support groups
  • STOP on the Road workshops
  • Telephone coaching
  • Online coaching

Parenthood is the toughest job there is.  This is tough too, really tough, but we know you can do it, and you are not alone. There is help available and you are in good company.  Ask your midwife or other health care provider for help.  

Heather Mason is a registered midwife with Generations Midwifery Care. Find out more about Heather here.