One in Four Women Are Exposed to Nicotine While Pregnant

More women are smoking during pregnancy than scientists previously thought, according to a recent study in the Journal of Perinatology.

Researchers at the Perinatal Institute at Cincinnati Children's Hospital reviewed the birth records of 700 women who gave birth at Cincinnati Children's Hospital in 2014 and 2015. The women in question self-reported whether or how often they smoked during their pregnancy. Those answers were compared with the results of urine tests that measure nicotine exposure. 

While 9% of the women surveyed reported smoking while pregnant, the urine tests revealed 16.5% had high levels of nicotine exposure, and an additional 7.5% had low-level nicotine exposure, porbably from second hand smoke.  "We have long suspected that smoking status during pregnancy is under-reported," Dr. Jim Greenberg, director of the Perinatal Institute at Cincinnati Children's Hospital and the senior study author, said in a press release about the study. "Now we know just how many women struggle to quit smoking when they are pregnant."

The deleterious effects of smoking on newborns are well documented. Prenatal nicotine exposure is associated with a 25% increase in premature births, and is linked to Sudden Infant Death Syndrome and birth defects, according to the researchers. It's also associated with the most common causes of infant death.

The study also revealsed the importance of public health efforts to decrease tobacco and e-cigarette use among pregnant minority women. African American women reported tobacco use rates of 7.9 percent, but that number rose to 21.1 percent using specific measurement of nicotine. 

Some have pointed out that given the pressure that pregnant women are under—and the addictiveness of tobacco—it's no wonder some women have trouble quitting and may be reaching for a source of stress relief. As Emily Oster, an economist and the author of Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong--and What You Really Need to Know, wrote in The Atlantic "Pregnancy seemed to be a world of arbitrary rules." Plus, even trusted books and experts were frequently inconsistent: "They didn't always say the same thing, or agree with my doctor, but they tended to provide vague reassurances ("prenatal testing is very safe") or blanket bans ('no amount of alcohol has been proven safe')." 

Even random strangers are compelled to offer their opinions to pregnant women. Comedian and Inside Amy Schumer Head Writer Jessi Klein describes in a recent New York Times Op-Ed how a woman in a grocery store asked if she was having a natural birth, and when Klein replied no, "She turns and scurries away, like a missionary who’s just been told by a particularly stubborn native that she’s very excited to go directly to pagan hell."

In other words, just shaming pregnant women who smoke is not going to do a lot of good. 

Smoking while pregnant is one of the few things both random strangers and experts agree is not good for women or their babies, but this new information about its prevalence is a sign that we need to focus more on public health campaigns and prevention (for women of all backgrounds), rather than a series of confusing and arbitrary rules. 


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