Pregnant and still smoking, but trying to quit?

Q: I used to be a half-pack smoker. I just became pregnant and I’m trying to cut down. If I can’t stop cold turkey right away, will I harm my baby?

A: Unfortunately, any amount of smoking can decrease oxygen and blood flow to the uterus, placenta and fetus. At the time of conception it can increase your risk of ectopic or tubal pregnancy

And once the pregnancy “takes” it spreads nicotine and other chemical compounds straight through the placenta to the fetus and stunts fetal growth. It can cause the placenta to grow on the lower part of the uterus so that once the cervix begins to dilate hemorrhage may occur (placenta previa) and, if this is not scary enough, smoking is also associated with an increased risk of abruptio placenta (a separation of the placenta from the uterine wall causing bleeding and even fetal death)!

All the studies show that if you continue to smoke you increase the risk that your baby will die before or within the first 28 days after delivery (perinatal mortality).

Now for my generalized public health announcement: If the 11 percent of pregnant women who still smoke could all stop completely, it would cut fetal infant death rates by five percent, decrease low birth weights by 10.4 percent, and reduce the risk of sudden infant death syndrome (SIDS), as well as their children’s future risk of asthma, colic and childhood obesity.

The good news is it’s never too late in your pregnancy to stop smoking. We now know that if you can do this however, before the end of the first trimester, you eliminate the risk of growth retardation — the baby grows and “catches up” by the time it’s delivered.

Quitting smoking is one of the most important things you can do for your health and your baby’s health. I hope that once you are aware of all of its negative effects you can stop on your own.

Here are some tips that may help: Avoid the triggers that occur before you smoke, seek out a “quitting buddy” at work or among friends and family; create a smoke-free home; and make sure those around you understand that you may initially experience cravings or irritability.

Gum, toy cigarettes or sugar-free lollipops can ease a stubborn oral fixation. Try calling a smoking quit line. One national quit line established by The Legacy Foundation that focuses specifically on pregnant women is Great Start: 1-866-66-START. (I should note that I’m on their medical advisory board.)

As for products like the nicotine patch, I know there’s some concern about putting chemicals or medications in your body while pregnant. But don’t forget that cigarettes have nearly 3,000 chemicals in them, whereas nicotine replacement products have only one.

Unfortunately, replacement products have not been completely evaluated to determine their absolute safety during pregnancy, but my sense is if it’s a minimal dose — just enough to get through your initial nicotine withdrawal — it’s probably better in the long run than the cigarette itself.

Some tobacco control experts say that during pregnancy, you should stick to intermittent control doses of products like gum or inhalers, and if you use a patch you should remove it at night.

Approximately 60-80 percent of pregnant women, who quit smoking fall off the wagon within a year postpartum, so be forewarned that even if you’re able to quit now, that maternal urge may not be there to help you later. To maintain the proper health to raise a child — and to set a good example for that next generation — I hope you can battle that 60-80 percent.

Dr. Reichman’s Bottom Line: I congratulate you on starting to tackle this extremely harmful addiction. Now, keep going: If you can cut out those remaining cigarettes within the next few months, you can have an amazing impact on the health of your unborn baby and your own health as you embark on the care for this child for decades to come.