It is interesting to note that 48% of Americans say that a pregnant woman who smokes or drinks should be liable for harm to the fetus. Meanwhile, laws are not being instituted to protect fetuses. Rather, smoking continues to rise in most women of child rearing age, with some exceptions in the 20-24 year old age range. Most distressing is the trend toward cutting funding to assist with prevention and cessation programs.

Particularly alarming is the continual flow of research highlighting increased risk for both the mother and fetus.These include: reduced fertility; increased risk of tubal pregnancy, spontaneous abortion, perinatal mortality, stillbirth, pre-term delivery, low birth weight babies,intrauterine growth retardation, the sudden infant death syndrome, oral clefting, a depressed or low 1- and 5-min Apgar score, and lower respiratory tract illness during the first 5 yr of life for children born to mothers who smoked during pregnancy.

Nonetheless, almost 25% of US women smoke throughout pregnancy, with higher proportions in unmarried women and women with less education. A substantial proportion of women report having quit after becoming pregnant (16-41%),with estimates of those resuming smoking while still pregnant ranging from 20-35%. About 80% of women who quit during pregnancy relapse following delivery, although there is some evidence that women who quit early in pregnancy are more likely to stay quit.

Other health consequences include: women who smoke have 3.6 times the risk of having a heart attack when compared with women who have not smoked for at least three years. Women smokers have 10 times the risk of developing a stomach ulcer in the next ten years. Evidence also exists for an increased risk of stroke for women who use oral contraceptives; an increased risk of cervical neoplasia; higher rates of osteoporosis; earlier menopause increased risk of vertebral or hip fracture; increased central adiposity. Apparently, body fat distribution in women smokers tends to resemble the male pattern of body fat distribution, which in turn is associated with increased risk of diabetes, cardiovascular disease, hypertension, stroke, and ischemic heart disease.

Some of the increased risks are thought as being related to the masculinizing effect of smoking in women and nicotine's antiestrogenic effects. These effects are seen as compromising some of the protection that estrogen gives women during pre-menopausal years against cardiovascular disease, osteoporosis, and other conditions. Smoking may counteract the protective effect of oral estrogen replacement against osteoporotic hip and other fractures in women.

In countries where there is extensive use of smokeless tobacco (e.g.,India), oral cancer is the most common cancer. Smoking appears to be more detrimental in its effects on lung function in women than in men.

5/29/98

Marlene M. Maheu, Ph.D. is the founding Director of the Nicotine Recovery Institute. She is the designer of the Nicotine Freedom System, and specializes in the treatment of nicotine-related disorders. Such disorders include underlying depression and anxiety. She has worked extensively with smokers and tobacco chewers in hospital, industrial, and private settings, and is available for individualized consultation and program design. Her program and materials have been developed after completion of her doctoral dissertation in smoking cessation, and following a decade of work with thousands of smokers. Through colorations with SelfhelpMagazine, she offers telephone based services for individuals and groups seeking freedom from nicotine in any form. For more information on this convenient application of her program, email her directly.