sudden infant death related to in utero smoke

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My office is on the 13th floor of Roanoke Memorial Hospital.  I take the elevator that stops directly in front of the Labor and Delivery unit. Usually a happy place, this is where babies are born. It is also where mothers are admitted if they are in premature labor, placed on drugs to stop the contractions, and gain some time for the infant to mature before birth.

I often see mothers with their medication bottles hooked up via intravenous lines, sitting in wheelchairs being accompanied by a friend or relative bringing them to the lobby, on route to the small clearing across the street from the hospital where smoking is allowed. It has always bothered me to witness this picture, as cigarette smoke is harmful in many ways to the fetus and the newborn. Smoking can actually LEAD TO premature delivery, so it blows my mind to think that these women can be in the hospital to stop their labor, while continuing to smoke, and thus working against the point of the medication infusion.  Smoking can cause babies to be born with low birth weight, and may lead to other problems as well.

In_utero_smoke_exposure has been shown to increase the risk of sudden infant death syndrom (SIDS--also known as crib death).

It likely does this by causing problems with the baby's respiratory pattern, arousal responses and breathing response to stimuli.  According to the article that you can access by clicking the link above, infants born to mothers who smoked during pregnancy have a two to five times higher chance of SIDS than other babies. 

Of all the nasty things that enter your body from smoking, nicotine is most likely (based on some animal studies) the chemical that causes the most harm to the baby's control-of-breathing center in the brain stem.

This makes it harder for the nicotine-exposed fetus to arouse himself when his breathing slows or stops, or to "auto resuscitate" when breathing has stopped, leading to severe slowing or stopping of the heart.

It is inconceivable to me that a parent could continue to smoke, knowing that the risks of having a baby die suddenly in their sleep is going to be so much higher than that of a baby born to a non-smoking mother.

If I ruled the world, I would probably want to make smoking during pregnancy illegal, but I know that is unlikely to happen.

Nonetheless, I will feel even more compelled, armed with this additional knowledge, to encourage every pregnant woman I see to stop smoking for the sake of the baby, if not for her own sake. Please join me in getting the word out that smoking during pregnancy is REALLY BAD for the baby, and encourage every woman you know or you see for the first time who is pregnant and who smokes, TO STOP.

Recent Comments

Alice I couldn't agree with you more. I'll go even one step further in teaching mothers to avoid smokey or smoke filled areas as well. Second hand,unfiltered smoke is just as if not more dangerous to the mother and fetus.Perhaps you should get this to the syndicated newspapers as well.

Janet,
The newspapers already have this information. Its just not sexy anymore to rant about cigarette smoke, cancer, chronic lung disease or any of the rest of the problems related to cigarettes. Each of us can continue our battle to work on this one person at a time.

I totally agree. I am currently in administration and am working on my nursing degree. My goal is to work with L&D patients. Just from some job observations I have done, it is very evident that this is a huge issue among
pregnant population. And its sad. As a nurse, are you able to "professionaly" explain what smoking is doing to her baby? I don't know how understanding or compassionate I could be to a smoking mother. It would never interfear with the quality of care but I think this needs to be communicated more. Its kind of like its been kept in the closet. And just as Janet has said, 2nd hand smoke is worse! My husband and I will not allow our 2 and 4 year old to visit Grandma's house because she smokes inside. Of course we are not the most favorite parents in Grandma's eyes, however we are doing what we feel is in the best interest of our children.

Indeed, second-hand smoke is increasingly being found to be more than just distasteful and disgusting. Recently, studies have documented carcinogens in the urine of children exposed to secondhand smoke. My mother smoked her entire life, and I hated it. I threw away her cigarettes regularly. I made her smoke outside when she came to visit me and my children. I even made her go outside to smoke after she broke her hip and was recuperating in my home in Baltimore, before my family moved to Roanoke. My brother has also smoked all his life and recently died of a very aggressive lung cancer. You wonder how anyone can continue to expose their bodies to the horrors of nicotine and tobacco.

There's no doubt about the many harmful effects of cigarette smoking, but remember that it's always easier to judge the bad habits (or addictions) of others while ignoring those bad practices we ourselves choose. I know no one who follows every piece of health-promoting advice, particularly as it evolves. Time was when pregnant women were urged to restrict their weight gain, take their DES... the list goes on. I don't put smoking in the same category---no reasonable person thinks the health hazards of smoking aren't real--but we have to realize that changing almost any habit is VERY hard, especially those with a physiologic payoff like a hit of nicotine. Expecting your health care professional to condemn your behavior is almost a guarantee that you won't be honest in reporting what's going on, which can itself lead to poor care. How many nurses or physicians are overweight? Don't sleep or exercise enough? Forget to take all of their prescribed medications as "ordered"? A big dose of humility may lead to more honest, and even more effective, interventions to help patients change bad habits, because health care professionals will be seen as allies in the battle, not adversaries.

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About Dr. Ackerman

Alice Ackerman, MD, MBA, FAAP, FCCM is the Chair of the Department of Pediatrics at Carilion Clinic and Professor and Founding Chair of Pediatrics at the Virginia Tech Carilion School of Medicine. Dr. Ackerman is recognized nationally as an expert in pediatric critical care.

She has been at Carilion Clinic since June of 2007. Her primary goals are to enhance the health care of children in the Roanoke Valley and Southwest Virginia, and is actively working to do this both as physician in chief of the children's hospital, as well as through involvement with many state-wide initiatives.

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