Smoking and pregnancy


Zsuzsanna Jakab, World Health Organization, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen, Denmark

This issue of the journal highlights an important problem for the health of women and children. In most of the WHO European Region, smoking in pregnancy is the leading cause of poor pregnancy outcome and prenatal death. It can cause serious health problems including ectopic pregnancy, increased risk of miscarriage, complications during labor, preterm birth, stillbirth, low birthweight and sudden unexpected death in infancy. Women smokers are also less likely to breastfeed, tend to wean their babies earlier and have lower milk production than non-smokers.

Even being exposed to other people's smoke is especially dangerous for pregnant women, who have a 20% greater chance of giving birth to a low birthweight baby than women who are not exposed to secondhand smoke (SHS) during pregnancy.

While smoking is declining among women in some high income countries it is increasing in low and middle income countries (LMIC). Europe contains some of the world's richest countries, but it also is home to many LMICs. Two decades ago, transnational tobacco companies seized the opportunity of the switch to a market economy to buy state-owned tobacco companies, locally produce and heavily promote ‘western’ brands of cigarettes in the countries of Central and Eastern Europe. Much effort was concentrated on creating a market for cigarettes among women. Currently about a quarter of women in LMICs in the European Region smoke and prevalence is still rising.

Even in wealthier countries, smoking is stubbornly concentrated among the most disadvantaged. In countries like the UK or Sweden, those who smoke through pregnancy are likely to be among the socially disadvantaged - young, single, of low income and educational attainment.

In both disadvantaged populations in richer countries and in LMIC, male smoking rates are high exposing women and children to SHS at home and in public places. Within the European Union, lung cancer deaths are nearly three times higher for female compared to male non-smokers.

A smoke free pregnancy is vital to both mother and child. Health professionals should offer advice and information to all pregnant smokers at the first prenatal visit and throughout the pregnancy. Help to quit should also be extended to the fathers or other family members living with the pregnant smoker. They should understand the consequences of their own smoking on the pregnant woman, the child and on themselves.

However advantageous a smokefree pregnancy is, health professionals and policy makers should not allow attention on the health of the baby to eclipse the health of the woman herself. Many women spontaneously stop smoking in pregnancy only to return to smoking after the birth of their child. The message to women needs to be clear: quitting smoking now is the best present you can give your baby; staying stopped for life is the best present you can give yourself.

Unless policy makers act decisively, smoking will rise among European women in the next decade. An increase in smoking prevalence has already been observed in some countries. The Global Youth Tobacco Survey shows an increase in smoking among 13–15 year old girls in between 2003 and 2008. Moreover, there are indications that the health message is not getting through to girls: a greater proportion of girls had favorable attitudes to smoking and more indicated that they were likely to start smoking in the next year compared to the previous survey.

The WHO Framework Convention on Tobacco Control (FCTC) is our key instrument for effective tobacco control nationally and internationally. The FCTC clearly points out the alarming increase in tobacco use among women and girls, the need for gender-specific tobacco control strategies and the necessity for women to participate at all levels of tobacco policy making. Parties to the Convention are obliged to implement a range of measures, and some of these will be especially important to helping women stay smokefree - tobacco price, smokefree places, pictorial health warnings and promotion and marketing of tobacco.

I would urge governments in the WHO European Region and around the world to be proactive in their implementation of the FCTC. They should see their responsibility as not just to satisfy the minimum requirement, but to try to attain the highest standards as part of their comprehensive approach to controlling tobacco use. The world's mothers and children deserve no less than a healthy, smoke free pregnancy and life.