Pregnant and puffing on a smoke
Norwegian research shows that one out of four female smokers in Europe continue to smoke cigarettes during their pregnancies. Vivid differences are seen among the European countries in this regard.
It is fully clear that maternal smoking poses a significant threat to the unborn child.
Many of the thousands of compounds in tobacco smoke can impact the foetus. Carbon monoxide also bonds with red blood cells and the foetus gets insufficient oxygen. A whole array of scientifically proven results can follow, all undermining the health and development of the unborn child and the infant. The World Health Organization says there is no safe lower limit of tobacco smoke during pregnancy – one smoke a day is one too many.
Research has shown cigarettes increase the risks of spontaneous pregnancy loss (unintentional abortions), birth defects, low birth weights, lung and breathing problems and preterm deliveries ― to mention a few of the risks.
Despite such knowledge, a Norwegian study indicates that 26 percent of European who were smokers when they got pregnant, continued to smoke during their pregnancies.
Survey of 8,000 women
The study is based on the information provided by over 8,000 pregnant women who responded to a questionnaire on the web. The women were from 15 European countries.
The disparities were sizeable both with regard to the percentages of the populations that smoke on a regular basis and in terms of how many continue to smoke, despite being with child.
According to the study, over half the women in Croatia smoke daily, or now and then, and nearly 20 percent continue to do so during pregnancy. A high share of women in Iceland smoke prior to pregnancy – 41 percent – but when they have a baby onboard all but four percent give up the habit.
In Norway nearly 34 percent of women smoke daily or occasionally, while seven percent continued after getting pregnant.
Far too many
The results were not completely unexpected and in several countries the share of pregnant smokes was fairly low. But the combined number of European women who smoke during pregnancy is still disturbingly high, assert the researchers.
“This is a wake-up call. It’s an important reminder that thousands upon thousands of children are being exposed to the effects of their mothers’ tobacco smoking in the womb. This is still a major problem in Europe,” says Janne Smedberg of the University of Oslo, who was responsible for the analyses in the study.
As the survey was conducted among women in 15 countries, Smedberg and her colleagues could make geographical comparisons within Europe.
The results among the pregnant women reflect two general smoking patterns. The number of smokers has dropped in many Northern European countries and the relatively few women continue to smoke during pregnancy. Smoking is more common in Eastern Europe, where it is also fairly prevalent among pregnant women.
Smedberg says several common denominators are found among pregnant smokers all across Europe as well.
“They usually have little education. Many live alone but we also see a relatively large share of homemakers, women without jobs outside the home, who smoke while pregnant. They often already have children,” she says.
“Many of these women have problems comprehending health information. Their pregnancies are often un-planned and fewer of them take folic acid tablets, which are known to help prevent serious birth defects.”
More acceptable some places
Smedberg and her colleagues have not studied why expectant mothers choose not to quit smoking or don’t manage to break the habit.
“I some countries there might not be so much focus on the dangers of smoking during pregnancy as in Norway,” says Professor Hedvig Nordeng of the University of Oslo, who led the study.
In Norway the health authorities put heavy emphasis on anti-smoking campaigns, particularly targeted toward pregnant women. The general population considers smoking during pregnancy unacceptable.
There can also be cultural differences between Northern Europe and Eastern Europe with regard to seeing a woman with a swollen abdomen puffing on a cig.
“If the mother says that she smoked when you were in the womb and everything turned out okay, that the warnings are exaggerated ― that can influence your attitudes. You listen to those who are close to you, people you trust,” says Nordeng.
Another factor is that information from health authorities can be complicated. Smedberg thinks the conditions of living and the situations many of these women are in need to be considered too.
“Maybe they are in such a vulnerable situation because smoking doesn’t seem to be all that important. If they experience high levels of stress, it can be much harder to quit habits such as smoking,” says the researcher, who adds that health personnel need to be cautious about moralizing.
“When a woman goes to the midwife during pregnancy the focus is on the health of the child. If the woman admits to smoking, she’s a bad mum, even though she wants to quit.”
“Some think that it’s better to focus on the mother and what’s positive. We can say ‘I understand that it is difficult, but what can we do to help you quit and to continue as a non-smoker after the birth? We can do it!’”
Joint European effort
It’s important to confront the problems both on an individual and a general level, according to the researchers.
“The European health authorities should have a joint focus on quitting smoking during pregnancy. They should look at the experiences of what works and what doesn’t, then arrive at a mutual plan for all of Europe. Special emphasis should be given to the countries where smoking during pregnancy is common,” says Nordeng.
Translated by: Glenn Ostling
- Characteristics of women who continue smoking during pregnancy: a cross-sectional study of pregnant women and new mothers in 15 European countries, BMC Pregnancy and Childbirth 2014, 14:213.