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J Psychoactive Drugs. 1984 Oct-Dec;16(4):327-38.

Smoking and pregnancy.


Smoking during pregnancy is associated with many adverse outcomes, including fetal and neonatal death. These consequences are tragic in many ways, but perhaps the greatest tragedy is that they are preventable if the smoker ceases to smoke during pregnancy. Although in some instances the so-called constitutional hypothesis is difficult to disprove, the available evidence seems more than convincing that it is smoking itself, and not the smoker's unique constitution, that is responsible. Cessation from smoking is clearly advisable at any time, but more so during pregnancy when every cigarette affects both the smoker and her unborn child.


This article reviews the literature on the proven and suggested effects of maternal smoking during pregnancy on pregnancy outcomes. Specific areas addressed in relation to smoking are infertility, spontaneous abortion, birthweight, perinatal mortality, malformation, and postnatal effects (sudden infant death syndrome, other respiratory disorders, susceptibility to cancer, growth, and behavior). Estimates of the incidence of smoking during pregnancy in the US have ranged from 35-48%, with an average daily consumption of 10 cigarettes. Study data consistently indicate that smoking during pregnancy is associated with infertility, spontaneous abortion, decreased birthweight, increased perinatal mortality and morbidity, and childhood behavioral problems. Although smoking has been linked with several different physiologic effects, each of which can independently affect development, hypoxia has emerged as a unifying factor. Specifically, decreased oxygenation of the maternal-fetal unit has been noted in complications of pregnancy such as fetal apnea, increased carboxyhemoglobin levels, increased placenta-to-birthweight ratios, placenta previa and abruptio placentae, and reduced uterine and placental blood flow. Another possible mechanism of the effects of smoking during pregnancy involves absorption of cyanide from cigarette smoke. It is stressed that the adverse outcomes associated with maternal smoking during pregnancy are preventable through cessation of the habit.

[Indexed for MEDLINE]

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