Smoking, Alcohol, And Pregnancy

How Do Smoking And Drinking Affect Pregnancy?

Cigarette smoke and alcohol can damage the health of unborn babies.

Smoking by pregnant women is associated with low birthweight and premature birth, as well as higher rates of illness (colds, bronchitis, ear infections, etc.), breathing problems, and sudden infant death syndrome (SIDS) in their babies. Birth defects of the heart, brain, and face are also more common among babies born to smokers. Children whose mothers smoked during pregnancy tend to be physically smaller than children of non-smokers, and may continue to have higher rates of respiratory illness, such as asthma, for many years.

The effects of drinking alcohol during pregnancy are also alarming. In fact, the consumption of alcohol during pregnancy is the leading cause of birth defects. Fetal Alcohol Syndrome (FAS) is a collection of defects that may include any combination of reduced growth (before or after birth), facial deformities, a small head (likely related to reduction of brain size), and abnormal behavioral development.

FAS is by far the most common non-hereditary cause of mental retardation. In addition, pregnant women who drink are more likely to miscarry. Children of mothers who drank during pregnancy are more likely to have severe behavioral problems and attention deficit disorders, even if they have no obvious physical defects.

The dangers of smoking and drinking excessive amounts of alcohol are well known; both are major causes of preventable and premature death. Pregnancy offers a unique opportunity for women to think about their smoking and drinking habits; it is a time when women may feel particularly motivated to change their behavior.

Smoking and drinking, however, can be very difficult behaviors to change. Many people need help-support from friends and family, medical assistance, counseling, etc-to get through the process. Most importantly, the person must want to change her behavior-it cannot be forced.

Facts About Smoking And Drinking

  • One in five adult women smokes regularly.
  • Smoking is the single largest preventable cause of death today, claiming more than 400,000 lives every year in the U.S.
  • 90% of adults who smoke started by age 21 and half of them had become regular smokers by their eighteenth birthday.
  • From 1990-2000, the number of women reported to have smoked during pregnancy fell more than 30%, from 18.4% to 12.2% of mothers.
  • In 2000, more than 60% of women age 18-54 were identified as “current drinkers” (regular or infrequent) in a study conducted by the Centers for Disease Control. 82% of these women reported consuming 3 or fewer drinks per week.
  • Long-term, heavy alcohol use is the leading cause of illness and death from liver disease in the U.S., as well as a leading cause of cardiovascular illness (such as coronary artery disease, high blood pressure, and stroke).
  • Research indicates that women may be more vulnerable to alcohol-related liver disease, cardiovascular disease, and brain damage than men.
  • Regular, heavy consumption of alcohol (3 or more drinks per day) may contribute to the development of osteoporosis and breast cancer.

Smoking During Pregnancy

In 2000, 12.2% of mothers reported having smoked during pregnancy. This means that smoking is the most common addiction among pregnant women in the U.S. In fact, only 20% of women who smoke quit during a pregnancy.

It is not uncommon for smokers to reduce their use of cigarettes during pregnancy, but reducing the number of cigarettes smoked in a day does not necessarily reduce the amount of nicotine, tar, and other poisons consumed. For many people, reducing the number of cigarettes simply leads to an increase in the number of puffs or the depth of inhalation, so that the same amount of nicotine (the addictive substance in tobacco) is delivered.

When you inhale a puff of cigarette smoke, you inhale tar (which contains cancer-causing substances), nicotine, and carbon monoxide (a clear, poisonous gas).

  • Tar stains your teeth, clothing, and fingernails, and coats your lungs.
  • Nicotine causes changes in your brain and can damage nerve cells.
  • Carbon monoxide competes with oxygen for a place on the transport molecule hemoglobin (a protein that typically binds with oxygen, and gives your blood its red color), reducing the oxygen-carrying capacity of the blood. This actually reduces the amount of oxygen that can be carried to organs and tissues in the body and makes your heart work harder.

Long-term smoking causes death from one or more of a number of diseases:

  • Lung cancer is the leading cause of cancer death in women. More women die every year from lung cancer than from breast cancer.
  • Cancers of the voice box (larynx), oral cavity, windpipe (trachea), pancreas, bladder, kidney and cervix have all been associated with smoking.
  • Bronchitis is a lung disease defined by inflammation of the air passages, a build-up of mucus or phlegm, and a chesty cough. In 1999, 6.2 million women were diagnosed with chronic (long-term) bronchitis.
  • Emphysema is a lung disease in which the damaged lung tissue acts like a soggy sponge so that the lungs cannot inflate properly. In 1999, 1.2 million women were known to have been diagnosed with emphysema during their lifetimes.
  • Heart disease and diseases of the blood vessels (cardiovascular disease) are more common in women who smoke than in those who don’t. Research indicates that women who smoke and also use hormonal contraceptives have a particularly high risk of developing heart disease or blood clots that can lead to stroke.

Smoking is also associated with illnesses and conditions which are not necessarily life threatening. To name just a few examples, can aggravate the condition of those suffering from asthma, irritate the eyes, and has been associated with loss of skin tone and the development of wrinkles!

Need To Know:

So-called “second-hand” smoke also poses health risks to a pregnant woman and her unborn baby. Regular exposure to second-hand smoke poses all of the same health risks (to a woman and her unborn child) as active smoking, but to a lesser degree

How Does A Mother’s Smoking Affect Her Unborn Baby?

A general rule of pregnancy is this: if you eat it, drink it, or breathe it, so does your unborn child. All nutrients, drugs, and chemicals in a pregnant woman’s bloodstream are transferred to the baby through the placenta and umbilical cord. These structures do not filter out harmful substances, like the carbon monoxide and nicotine inhaled as you smoke. If you smoke while pregnant, the toxins you inhale will be passed directly into the bloodstream of your unborn baby. Together, nicotine and carbon monoxide significantly reduce the amount of oxygen the baby’s blood.

The health consequences for the growing baby are serious. The major effect is reduction or retardation of normal growth; babies born to smoking mothers usually have a lower birthweight than those born to non-smoking mothers.

Low birthweight babies have a higher mortality-death-rate at birth and in the first 6 months after birth. Low birthweight babies are also at higher risk for serious complications and illness, including breathing disorders, as newborns. They may require specialized medical care in a newborn intensive care unit (NICU).

Sudden infant death syndrome (SIDS, also known as crib death) is more common in babies whose mothers smoked during pregnancy. Growth retardation may also continue, so that children of smokers may be physically smaller than children of non-smokers. Intellectual and behavioral development may also be affected as the child grows.

Smoking mothers have a higher rate of miscarriage than non-smokers and are also more likely to deliver their babies prematurely. Premature babies are typically quite small with low birthweight, and may also have underdeveloped lungs and brains. These babies have an even poorer chance of survival in the early months after birth. Other pregnancy complications that have been linked to smoking include placental complications, infections of the uterus, and premature rupture of the membranes.

Need To Know:

The affects of smoking on the child do not end with the pregnancy. Smoking in the home (by parents or other caregivers) has been found to be associated with increased respiratory (breathing) illnesses in babies in their first year of life.

Can Women Give Up Smoking?

The number of women who smoke has been falling steadily in recent years. No one can deny that quitting smoking it is a difficult process. Even so, many women give up smoking for good during pregnancy. Women who give up smoking early in pregnancy and who receive encouragement from their partners and from midwives are most likely to be successful in becoming permanent non-smokers.

For more detailed information about how to quit smoking, go to Smoking: How To Stop.

Drinking Alcohol During Pregnancy

People drink alcohol for a variety of reasons-social pressure, as a means of reducing stress and emotional upset, addiction-and these reasons don’t go away when a woman becomes pregnant. So even though the knowledge about the dangers of drinking during pregnancy has increased in recent years, the use of alcohol among pregnant women is still high.

From 1991-1995, the rate of pregnant women who reported any drinking during the previous month increased from 12.4% to 16.3%; four times more pregnant women reported frequent drinking in 1995 (3.5%) than in 1991 (0.8%). In this study, “frequent drinking” was defined as having 7 or more drinks per week or 5 or more drinks on a single occasion (also known as “binge drinking“) during the month prior to the interview.

In 1999 and 2000, the numbers were slightly lower. In the 18-25 age group, 10.1% of pregnant women reported past-moth use of alcohol (4.8% of which reported binge drinking). In the 26-44 age group, 14.0% reported drinking (3.1% reported binge drinking).

How Does Drinking Alcohol Affect A Woman’s Health?

When we take an alcoholic drink, most of the alcohol is absorbed quickly into the bloodstream through the walls of the stomach and intestine. Because it is absorbed directly, the effects of alcohol can be felt very quickly. Alcohol is a depressant, meaning that it slows the activity of the nervous system. In addition to impairing the thought process, this means that the use of alcohol may contribute to a “depressed” emotional state.

Heavy, regular drinking has also been associated with many diseases and conditions that can lead to death:

  • Cirrhosis of the liver (a disease in which the cells of the organ are irreversibly damaged)
  • Kidney failure
  • Brain damage (alcohol kills brain cells)
  • Cancers of the mouth, esophagus, and stomach

Regular moderate to heavy drinking can also cause stomach ulcers and inflammation of the pancreas, and is associated with pneumonia. Regular heavy drinking is associated with a range of social problems such as violence in marriage, child neglect, debts, separation and divorce, and problems at work. Alcohol is also a major contributor to fatal traffic accidents.

Need To Know:

The US Departments of Agriculture and Health and Human Services have published guidelines that recommend drinking in moderation, for those who choose to drink at all. Moderate drinking is defined as one drink per day for women (two drinks per day for men).

One drink equals:

  • 12 ounces of beer
  • 5 ounces of wine
  • 1.5 ounces of 80-proof (40%) distilled spirits (whisky, vodka, gin, etc)

How Quickly Does The Body Get Rid Of Alcohol?

It can take over an hour for the body to rid itself of the alcohol contained in one drink. The elimination process of alcohol is therefore quite slow, but eventually most of the alcohol is removed from the liver. Some finally passes out through the urine. If drinking is heavy and habitual, this process can damage the liver. Once excessive drinking has damaged the liver, this process slows down even further; alcohol stays in the bloodstream even longer.

Nice To Know:

The popular belief that dinking coffee will help a person “sober up” is a myth-only time and a properly functioning liver can get rid of the alcohol in a person’s bloodstream.

What Causes Hangovers?

Dehydration is one of the factors that cause hangovers. Alcohol tends to make water move out of body cells and accumulate in the blood. This means the alcohol has what is called a “diuretic effect”; that is, it causes increased urination and an overall loss of water from the body. The most common symptoms of dehydration are headache and dryness in the skin. Impurities in drinks and colorants may also contribute to the “hangover” and “headache” effects of too much alcohol.

How Does A Mother’s Drinking Affect Her Unborn Baby?

Every time a pregnant woman has a drink her unborn child has one, too. Alcohol, like carbon monoxide from cigarettes, passes easily through the placenta from the mother’s bloodstream into her baby’s blood. The best known effect of heavy drinking during pregnancy is Fetal Alcohol Syndrome (FAS).

FAS is characterized by particular physical and mental/neurological defects-abnormal facial features, reduced or slowed physical growth, a small head, and slowed intellectual/behavioral development. The latter defects are thought to be related to reduced or slowed development of the brain itself. Damage to the nervous system-the brain, spinal cord, etc.-can occur in the first few weeks of pregnancy, before a woman even knows she is pregnant.

Not all babies exposed to alcohol before birth are born with FAS. FAS is typically diagnosed only when the facial abnormalities and reduced growth are present-the intellectual and behavioral defects may not be immediately apparent.

The term “Alcohol-Related Neurodevelopmental Disorder” (ARND) is used to describe impairments of the nervous system-brain, spinal cord, or other nerves-that can be linked to alcohol consumption during pregnancy. These impairments may include mental retardation, poor motor skills or hand-eye coordination, severe behavioral problems, learning disabilities, and attention deficit, among others. The term “Alcohol-Related Birth Defects” (ARBD) describes physical or functional defects of the skeleton and other major organ systems.

The effects of alcohol do not end in infancy. The physical and mental defects described above are typically lifelong impairments. By drinking during pregnancy, a woman risks sentencing her child to a lifetime of difficulty.

Drinking during pregnancy is also associated with higher rates of miscarriage, premature birth, complications during birth, and low birthweight. Low birthweight babies have a higher risk of death at birth and in the weeks soon after. They are also at higher risk for serious complications and illness, including breathing disorders, as newborns. They may require specialized medical care in a newborn intensive care unit (NICU).

FAS, ARND and ARBD affect more newborns every year than Down’s syndrome, cystic fibrosis, spina bifida and Sudden Infant Death Syndrome combined. But they are 100% preventable. If she does not drink any alcohol during pregnancy, a woman can be certain that her baby will not have fetal alcohol syndrome or other alcohol-related health problems.

How Much Is It Safe To Drink During Pregnancy?

Because so many factors contribute to the development of the unborn baby, it is impossible to determine a “safe” level of alcohol consumption during pregnancy. Therefore, most health care professionals recommend that women stop drinking alcohol during pregnancy. In fact, since much of the damage associated with alcohol can occur very early in pregnancy-before a woman may know she is pregnant-a woman who is trying to conceive should not drink, either.

Need To Know:

Alcohol can also be passed to an infant in breast milk. If you choose drink while you are breastfeeding, the following guidelines may reduce the risk of passing alcohol to the baby.

  • Drink no more than one serving (12 oz. of beer, 5 oz. of wine, 1.5 oz. of distilled liquor) per day
  • Wait 2 hours to resume nursing
  • If you intend to have more than one drink, you should pump and store milk ahead of time. Although it is likely that alcohol will no longer be expressed in milk if you no longer feel “tipsy”, you should wait about 2 hours per drink before nursing again. The stored milk will allow you to bottle feed the baby while your body gets rid of the alcohol in your bloodstream. If your breasts feel uncomfortably full during this time, you should pump and dispose of the milk.

Smoking, Alcohol, And Pregnancy: Frequently Asked Questions

Here are some frequently asked questions related to smoking, alcohol, and pregnancy:

Q: Are smoking and drinking really dangerous to the unborn baby?

A: Yes. Smoking and drinking alcohol are both associated with serious complications during pregnancy and birth, as well as potentially severe birth defects. In order to protect the health of her baby, a pregnant woman should not smoke or drink during pregnancy. In fact, since damage can occur very early in pregnancy (before a woman even knows she is pregnant), quitting both smoking and drinking before trying to become pregnant is recommended.

Q: Is it okay to reduce, rather than stop, smoking or drinking during pregnancy?

A: No. Although smoking fewer cigarettes or drinking less alcohol could reduce the effects on the baby, that is not a certainty. It is impossible to determine a “safe” level of exposure-even a little bit could harm the baby. Carbon monoxide and alcohol are both poisons, and the unborn baby should not be exposed to them.

Q: I just found out I’m pregnant. Is it too late to stop dinking and/or smoking? Is the damage already done?

A: Although it’s true that some damage can be done in early pregnancy, you can still protect your baby’s health by not drinking and/smoking from now on. Because smoking and alcohol affect the baby differently at different stages of development, you can still prevent a wide range of effects. In addition, research shows that some of the potential effects of drinking in early pregnancy may be reversed if you quit during the first trimester.

Q: Doesn’t fetal alcohol syndrome only occur when the mother drinks heavily during pregnancy?

A: Not necessarily. Many factors can affect the developing baby, and it is unknown just how much alcohol is needed to cause fetal alcohol syndrome. There may not even be a specific amount-each case, each woman, each pregnancy is unique. The only certain way to prevent fetal alcohol syndrome is to avoid drinking during pregnancy.

Q: What are the risks associated with low birthweight?

A: Low birthweight is associated with higher infant mortality-death-than normal birthweight. Low birthweight babies are also at higher risk for serious complications and illness, including breathing disorders, as newborns. They may require specialized medical care in a newborn intensive care unit (NICU).

Smoking, Alcohol, And Pregnancy: Putting It All Together

Here is a summary of the important facts and information related to smoking, alcohol, and pregnancy:

  • Smoking is a factor in several of the leading causes of death in the US, as well as a major contributor to lost work days and high healthcare costs.
  • Smoking during pregnancy is dangerous to the health of the unborn child. The effects include low birthweight, impaired respiratory function, and higher risk of sudden infant death syndrome.
  • Children whose mother smoked during pregnancy suffer more colds, inner ear infections, and bronchial infections, are sometimes physically smaller, and have a higher risk of developing asthma than children of non-smokers.
  • Alcohol is a factor in several debilitating (often fatal) diseases, including liver disease, heart disease, and cancer.
  • Drinking alcohol during pregnancy is associated with a wide range of mental and physical birth defects.
  • The effects of alcohol on the developing baby are often permanent, leading to lifelong mental retardation and learning disabilities.
  • Alcohol can also be passed to the baby through breast milk, so you should never breastfeed immediately after drinking.
  • Smoking and drinking are associated with higher rates of miscarriage, premature birth, and complications during delivery.
  • There is no “safe” level of drinking or smoking during pregnancy-sometimes, defects are seen in babies with very little exposure.
  • If you are trying to become pregnant, you should stop drinking and smoking now. If you become pregnant, you should stop right away to minimize any effects on the baby.
  • Although it is best to stop smoking and/drinking before becoming pregnant, stopping during the pregnancy can still help to protect the health of the baby.

Smoking, Alcohol, And Pregnancy: Glossary

Here are definitions of medical terms related to smoking, alcohol, and pregnancy:

Binge drinking: Typically defined as having 5 or more drinks within one day.

Carbon monoxide: Poisonous gas found in cigarette smoke; can displace oxygen from hemoglobin and thus reduce the bloods ability to carry oxygen to the cells.

Fetal alcohol syndrome (FAS): Collection of defects including specific facial abnormalities, reduced fetal growth, and mental retardation caused by consumption of alcohol during pregnancy; typically, though not exclusively, associated with frequent or heavy drinking during pregnancy.

Hemoglobin: Protein on the red blood cells that carries oxygen to the cells.

Low birthweight: Applies to babies weighing less than 5 pounds, 8 ounces at birth; associated with a higher rate of infant mortality and a higher rate of serious complications/illness during the newborn period.

Nicotine: Poisonous component of cigarette smoke; the substance in tobacco to which smokers become addicted.

Sudden infant death syndrome (SIDS): A sudden, fatal stoppage of breathing; thought to be caused by a defect in the central nervous system.

Tar: Solid components of cigarette smoke typically associated with lung disease and various cancers.

Smoking, Alcohol, And Pregnancy: Additional Sources Of Information

Here are some reliable sources that can provide more information on smoking, alcohol, and pregnancy:

American Lung Association 
Phone: 212-315-8700

The American Lung Association offers a variety of smoking control and prevention programs, along with information about the risks associated with cigarette smoking.

American Cancer Society 
Phone: 1-800-ACS-2345

The American Cancer Society offers information and support for cancer patients and their families, as well as educational materials on the cancer risk associated with smoking and drinking.

National Organization on Fetal Alcohol Syndrome 
Phone: 202-785-4585

The National Organization on Fetal Alcohol Syndrome provides information and support for families and children dealing with fetal alcohol syndrome, as well as general educational information about FAS.

National Institute on Alcohol Abuse and Alcoholism

The National Institute on Alcohol Abuse and Alcoholism, one of the National Institutes of Health, provides information for families and health care professionals, as well as supporting research and prevention and treatment initiatives.

Alcoholics Anonymous 
Phone: 212-870-3400

Alcoholics Anonymous is focused on helping alcoholics recover and maintain sobriety. In the U.S./Canada: Look for “Alcoholics Anonymous” in any telephone directory.

March of Dimes To find your local chapter. To contact March of Dimes directly.

March of Dimes provides information and supports research to help families and their babies beat the threats to their health: prematurity, birth defects, low birthweight.

Cord Blood Banking Information

Provides information on public and private umbilical cord blood collection and storage.


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