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Jornal de Pediatria

Print version ISSN 0021-7557On-line version ISSN 1678-4782

J. Pediatr. (Rio J.) vol.80 no.1 Porto Alegre Jan./Feb. 2004 



Smoking in pregnancy: a bigger problem than you think



Krzysztof M. Kuczkowski

M.D., Professor of Anesthesiology and Reproductive Medicine. Director of Obstetric Anesthesia, Departments of Anesthesiology and Reproductive Medicine, University of California San Diego, San Diego, California, USA



Smoking compromises female pre-conception reproductive function, pregnancy outcome and lactation.1 Since pregnant women usually are in close contact with health professionals (prenatal care), antismoking campaigns are frequently successful in this period. However, for these efforts to succeed the following considerations should be emphasized.

First, while the illicit drug use in pregnancy has received significant attention over the past two decades far too little attention has been given to the consequences of the use of "social drugs" such as tobacco, ethanol and caffeine, which are by far the most commonly used substances in pregnancy.

Second, while the deleterious effects of cocaine, amphetamines, and opioids on the mother and the fetus are more pronounced and easier to detect, the addiction to tobacco, ethanol and caffeine is usually subtle and more difficult to diagnose.2 As a result recreational use of tobacco in pregnancy may continue undetected, significantly effecting pregnancy outcome and lactation.

Third, approximately 80% of women who smoke before pregnancy continue to smoke when pregnant.2 Low cigarette consumption prior to pregnancy is the best predictor for smoking cessation in pregnancy.

Fourth, the majority of patients with a history of drug use in pregnancy (including tobacco) deny it when interviewed by primary care physicians, obstetricians and/or neonatologists.3

Fifth, risk factors suggesting tobacco use in pregnancy include lack of prenatal care, respiratory complications and history of premature labor.

A high index of suspicion for tobacco (as well as other social and illicit drug) use in pregnancy, combined with non-judgmental questioning of every parturient is therefore necessary.



1. Mello PR, Pinto GR, Botelho C. The influence of smoking on fertility, pregnancy and lactation. J Pediatr (Rio J). 2001;77:257-64.

2. Kuczkowski KM. Tobacco and ethanol use in pregnancy: implications for obstetric and anesthetic management. The Female Patient. 2003;28:16-22.

3. Kuczkowski KM. Labor analgesia for the drug abusing parturient: is there cause for concern? Obstet Gynecol Surv. 2003;58:599-608.

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