Women who smoke during pregnancy put their babies at risk for a host of physical and developmental problems. But could they also tip the scales in favor of criminal activity and drug abuse by their children down the road?

Patricia Brennan, Ph.D., an assistant professor of psychology at Emory University in Georgia, found that daughters of women who smoked more than 10 cigarettes a day were almost three times as likely to be hospitalized for substance abuse and one and a half times as likely to be arrested than were women whose mothers did not smoke during pregnancy.

The sons of women who smoked this amount were also more likely to be arrested than were the sons of nonsmokers. Brennan examined maternal smoking and subsequent arrest and hospitalization records for 8,000 Danes born between 1959 and 1961. She could not ascertain maternal alcohol or drug use because this behavior was considered rare in Denmark at the time.

Brennan notes that the daughters’ substance abuse could have contributed to their higher arrest rate. “It is likely a combination of genetic factors, parenting and smoking on the part of the mother during pregnancy,” says Brennan, who published the results in The American Journal of Psychiatry.

Unfortunately, about eight of every 10 women who quit during pregnancy light up again by their baby’s first birthday. An M. D. Anderson research study called Project MOM is looking at ways to help women remain smoke-free after delivering their babies.

“You have all these women who have quit and are abstinent for eight months, so they’re through withdrawal, but then they go back to smoking,” says David Wetter, Ph.D., chair of M. D. Anderson’s Department of Health Disparities Research and Project MOM principal investigator.

“The goal of this study is to capitalize on this tremendous public health opportunity by developing an intervention to help them avoid relapse.”

Social stigma drives abstinence during pregnancy

The key is motivation. Pregnant women tend to be motivated to quit smoking by the desire to safeguard the health of their unborn baby and because the social pressures to quit are considerable. But following delivery that motivation may wane, and relapse often is the result.

“A lot of pregnant women quit because there are few behaviors as socially stigmatized as a pregnant woman sucking on a cigarette. So they quit, which is fantastic, but those reasons for quitting may not seem as important once their baby is born,” Wetter explains.

Any life stress can lead to relapse

Project MOM is different from other programs because it assumes individuals are not consistently motivated to remain smoke-free.

A woman may be highly motivated to quit smoking and remain abstinent following her baby’s birth, but a fight with her spouse or other stressful event may trigger a desire to smoke as a way of coping. “In a matter of 20 seconds, her motivation can just go through the floor,” Wetter says.

So there is a need to maintain and strengthen new mothers’ motivation despite potentially trying moments, as well as to educate them about the health risks smoking poses for their children.

Information combined with counseling

About 270 women, many representing minority and low socioeconomic groups, have taken part in Project MOM. They are randomly divided into three groups:

Usual Care- Participants receive brief advice to remain smoke-free, as well as self-help materials.

Motivational Relapse Prevention (MRP)- Participants receive therapy via six phone-based counseling calls.

MRP Plus- Participants receive telephone counseling and take part in two face-to-face visits with M. D. Anderson counselors.

The telephone counseling sessions, which last about 15 minutes, follow a detailed treatment manual but are highly individualized to focus on a woman’s specific situation and the issues likely to affect her ability to remain abstinent. Factors such as stress, depression and proximity to smokers can play major roles.

Participants receive help with topics, including:

• Stress
• Depression
• Parenting
• Relationships
• Support systems

“We know all these things are issues for them – and also are causes of relapse,” Wetter says. “So we may be able to help these women by addressing the general issues affecting their lives without an exclusive focus on smoking.”

Patient says so far, so good

Not all mothers in the program will stay abstinent, but Meagan Chase of Houston hasn’t smoked since she learned she was pregnant last year. She enrolled in Project MOM in December, when she was five months pregnant, and was placed in the MRP Plus group.

“I ended up being one of the people in the group with a counselor, and that has been a truly big help,” Chase says. “While I thought I was strong enough, it’s really good just to have someone you know you can talk to about the difficulty of quitting and staying smoke-free.”

Like many other moms who quit during pregnancy, Chase has thought of smoking since her son, Phoenix, was born in May.

“There was a time after delivery when I wanted to reach for a cigarette, but I remember reading one of the handouts they had given me about nicotine and breast milk. Also, I knew I was going to have to talk to [the counselor] in another week, and I didn’t want to have to tell her I smoked.’”

Women are eligible to take part in Project MOM if they:

• Are less than 34 weeks pregnant
• Are age 18 years or older
• Are able to speak, read and write in English

Participants also must have quit smoking no earlier than the second month of pregnancy.

For more information, please contact the M. D. Anderson Information Line at 1-800-392-1611, option 3.

In March 2001, the Office of the US Surgeon General released a long-awaited, detailed report entitled “Women and Smoking,” along with the following statement:

“When calling attention to public health problems, we must not misuse the word ‘epidemic.’ But there is no better word to describe the 600-percent increase since 1950 in women’s death rates for lung cancer, a disease primarily caused by cigarette smoking. Clearly, smoking-related disease among women is a full-blown epidemic.” – David Satcher, MD, PhD

Smoking is the most preventable cause of early death in this country. According to the Centers for Disease Control and Prevention (CDC), smoking-related diseases caused the deaths of about 178,000 women in each year from 1995-1999. On average, these women died 14.5 years earlier because they smoked.

The most recent CDC survey (from 2006) showed that about 1 in 5 American women aged 18 years or older (18%) smoked cigarettes. The highest rates were seen among American-Indian and Alaska-Native women (29%), followed by white (20%), African-American (19%), Hispanic (10%), and Asian women (5%). The less education a woman has, the more likely she will smoke. For instance, women with less than a high school education are twice as likely to smoke as college graduates.

Overall, women are less likely to smoke than men, but it is a disturbing trend that smoking is more popular among younger than older women. About 21% of women ages 25 to 44 smoke, but only about 8% of women 65 and over do. As these younger women age and continue to smoke, they will have more smoking-related illness and disability. Smoking rates are somewhat lower among women aged 18-24, a little more than 19%.

Overall, women are less likely to smoke than men, but it is a disturbing trend that smoking is more popular among younger than older women. About 21% of women ages 18 to 44 smoke, but only about 9% of women 65 and over do. As these younger women age and continue to smoke, they will have more smoking-related illness and disability.

Women who smoke typically begin as teenagers — usually before high school graduation. And the younger a girl is when she starts, the more heavily she is likely to use tobacco as an adult. Teenage girls are just as likely to smoke as are boys. The most recent CDC surveys showed that 23% of female high school students and 9% of girls in middle school had smoked at least one cigarette in the past 30 days.

How Can Smoking Affect Your Health?

Cancers

Tobacco use accounts for nearly one third of all cancer deaths. Tens of thousands of women will die this year from lung cancer, which has greatly surpassed breast cancer as the leading cause of cancer death among women. Almost 90% of these deaths will be due to smoking.

Not only does smoking increase the risk for lung cancer, it’s also a risk factor for cancers of the:

• cervix
• mouth
• larynx (voice box)
• pharynx (throat)
• esophagus
• kidney
• bladder
• pancreas
• stomach

Smoking is also linked to some forms of leukemia.

Environmental tobacco smoke (ETS), also known as secondhand smoke, has also been shown to increase the risk of lung cancer. The 2006 Surgeon General’s report on secondhand smoke concluded the following:

• Secondhand smoke causes premature death and disease in children and adults who do not smoke.
• Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome (SIDS), respiratory infections, ear problems, and more severe asthma.
• Exposure of adults to secondhand smoke has immediate negative effects on the cardiovascular system and causes coronary heart disease and lung cancer.
• The scientific evidence shows there is no risk-free level of exposure to secondhand smoke.
• Many millions of Americans, both children and adults, are still exposed to secondhand smoke in their home and workplaces even though there has been a great deal of progress in tobacco control.
• Getting rid of smoking in indoor spaces fully protects non-smokers from exposure to secondhand smoke. Separating smokers from non-smokers, cleaning the air, and ventilating a building cannot eliminate exposures of non-smokers to secondhand smoke.

Heart Disease and Stroke

Women who smoke greatly increase their risk of heart disease (the leading killer among women) and stroke. Risk increases with the number of cigarettes smoked and the length of time smoked. Even though most of the women who die of heart disease are past menopause, smoking increases the risk more in younger women than in older women. Some studies suggest that smoking cigarettes increases the risk of heart disease even more among younger women who are also taking birth control pills.

Lung Function

Smoking damages the airways and small air sacs in the lungs, and is related to chronic coughing and wheezing. About 90% of deaths due to chronic bronchitis and emphysema — together these are also known as chronic obstructive pulmonary disease (COPD) — are caused by smoking. The risk increases both with the number of cigarettes smoked each day and with the length of time a woman has been smoking. Female smokers aged 35 or older are almost 13 times more likely to die from emphysema or bronchitis than those who don’t smoke. Smoking “low tar” or “light” cigarettes does not seem to reduce these risks, or any of the other health risks of tobacco.

Teenage girls who smoke have reduced rates of lung growth. Adult women who smoke start losing lung function in early adulthood.

Other Health Problems

Smoking is linked to peripheral vascular disease (PVD), a narrowing and hardening of major blood vessels in the body. This can limit everyday activities such as walking. Stopping smoking lowers the risk of PVD. In people who already have PVD, quitting smoking improves the odds that treatment will work.

Women who smoke, especially after going through menopause, have lower bone density and a higher risk for fracture, including hip fracture, than women who do not smoke. They may also be at higher risk for developing rheumatoid arthritis and cataracts (clouding of the lenses of the eyes), as well as age-related macular degeneration, which can cause blindness.

Your Reproductive Health

Tobacco use can damage a woman’s reproductive health. Women who smoke are more likely to have trouble getting pregnant. Smokers are younger at menopause than non-smokers and may have more unpleasant symptoms while going through menopause.

Smoking can also cause complications during pregnancy that can hurt both mother and baby. Smokers have a higher risk of the placenta (the organ that protects and nourishes the growing fetus) growing too close to the opening of the uterus. Smokers are also more likely to have premature membrane ruptures and placentas that separate from the uterus too early. Bleeding, premature delivery, and emergency Caesarean section (C-section) may result from these problems. Smokers are more likely to have miscarriages and stillbirths, too.

Smoking Can Affect Your Baby’s Health

More than 10% of women smoke throughout their pregnancies, and some studies put the number at 16% or higher.. Smoking is linked to an increased risk of preterm delivery and infant death. Research also suggests that infants of mothers who smoke during and after pregnancy are 2 to 3 times more likely to die from sudden infant death syndrome (SIDS) than babies born to non-smoking mothers. Of the women who are able to stop smoking during pregnancy, only 1 out of 3 remain quit one year after the delivery. The risk of SIDS is somewhat less for infants whose mothers stop smoking during pregnancy and resume smoking after delivery. But infants of non-smoking mothers have the lowest risk of SIDS. As many as 10% of all infant deaths could be prevented if pregnant women did not smoke.

Smoking during pregnancy is responsible for 20% or more cases of low birth weight infants. Smoking during pregnancy slows fetal growth. This often causes babies to have health problems that are a result of being born underweight. Quitting smoking during pregnancy reduces this risk.

Many women are able to quit smoking during early pregnancy. But women who have a mood disorder, such as depression, often find it much harder to quit. Researchers have learned that between a third and a half of women who smoke during pregnancy have a mood disorder. It can be difficult for pregnant women to be treated for depression, anxiety, or nicotine withdrawal with drug therapy because of concerns about the drugs hurting the fetus. Counseling or mental health therapy may be helpful to some of these women. If the woman is unable to quit with therapy, she may want to talk with her doctor about medicines that she can take during pregnancy.

Some harmful chemicals in tobacco smoke can also be passed on to a baby through breast milk.

Smoking Can Affect Your Children’s Health

Almost 3 million children in the United States under the age of 6 breathe secondhand smoke at home at least 4 days per week. Studies show that older children whose parents smoke get sick more often. Their lungs grow less then children who do not live around smokers. They have bronchitis and pneumonia more often. They cough and wheeze more. Smoking can also trigger a child’s asthma attack. More than 40% of children who go to emergency room for their asthma live with smokers. A severe asthma attack can be life-threatening.

Children who live with parents who smoke also get more ear infections. They have fluid in their ears as a result and may need surgery to have ear tubes placed for drainage.

Many women who manage to quit smoking during pregnancy pick up the habit again after the baby is born. If you find yourself tempted to start back, get help right away (see the section, “Kicking the Habit”). Parents who smoke are also more likely to have children who smoke.

Kicking the Habit

More than 75% of women say they want to quit smoking, and almost half report having tried to quit in the past year. The chance for quitting and staying quit is about the same for both men and women.

Quitting can help reduce the risk of many of the health effects listed above. The risk of heart disease is greatly reduced just 1 to 2 years after quitting. The risk of stroke returns to normal 10 to 15 years after quitting.

Many women are afraid to quit for fear of gaining weight. Some women who quit smoking do add a few pounds, mostly in the first year. Although figures vary, women gain an average of around 5 to 10 pounds after quitting. This amount of weight gain can usually be controlled through diet and exercise. And the health benefits of quitting are much greater than any problems posed by a small weight gain.