Smoking and Pregnancy: Risks and How to Quit Safely

In short: Smoking in pregnancy is linked to miscarriage, death of the baby, separation of the placenta, preterm birth, low birth weight and sudden infant death, because nicotine and carbon monoxide deprive the baby of oxygen and affect brain development. Pregnancy is one of the best opportunities to stop, with the help of psychological and behavioural support and nicotine replacement.

Smoking during pregnancy is considered a dangerous habit that can negatively affect the health of both the mother and the developing baby. The good news is that quitting — at any stage of pregnancy — brings real benefits, and there is support available to help you succeed.

Studies over many decades have shown that smoking during pregnancy is linked to a number of complications:

• Miscarriages
• Death of the fetus inside the womb or immediately after birth
• Placental abruption during pregnancy, leading to severe bleeding
• Premature birth
• Low birth weight
• In the long term, poor neurological development in the child, endocrine problems, and an increase in the percentage of tumors during childhood
• Sudden infant death syndrome
• Poor academic performance of the child

Second-hand smoke and argileh (shisha/waterpipe) carry the same risks: one argileh session can deliver more carbon monoxide and smoke than a pack of cigarettes, so it is not a safer alternative, and your home and car should be smoke-free.

What are the harmful substances in cigarette smoke?

• Nicotine
• Carbon Monoxide
• Many carcinogenic substances
• Heavy metals
• Tar

What is the effect of carbon monoxide on pregnancy?

Carbon monoxide binds to hemoglobin with greater affinity than oxygen…

• This prevents the binding of oxygen to hemoglobin
• Which prevents oxygen from reaching the placenta and fetus

This leads to poor fetal growth and increases the rate of premature birth.

What is the effect of tar on pregnancy?

• It accumulates inside the respiratory tract of a pregnant woman and builds up on the mucous membranes, leading to mechanical damage of the respiratory system.
• It has a toxic effect on the fetus, which can limit fetal growth (fetal growth restriction).

What is the effect of nicotine on pregnancy?

Nicotine is able to cross the placenta and reach the fetus directly.

• It binds to brain receptors in the fetus and directly affects the development of the fetal brain.
• When the child grows up, he or she is more likely to become a heavy smoker later in life, and the risk of addiction also increases.

Is it possible to stop smoking during pregnancy? Yes — in fact, the rate of successfully quitting smoking during pregnancy is one of the highest compared to other times in life, as motivation to protect the baby is strong.

What are the ways to help pregnant women quit smoking?

• Psychological and social support (encouragement and motivation, cognitive behavioral therapy, support groups, and similar approaches)
• Nicotine replacement therapy: where the nicotine from cigarettes, which contains many toxic substances, is replaced with pure nicotine products free of the harmful elements found in cigarettes

How is nicotine replacement therapy used to help stop smoking?

• Nicotine is broken down in the liver. Taking nicotine through the digestive system or mucous membranes (chewing gum, pills and tabs, oral sprays, nasal sprays) reduces how much of it becomes active in the body.
• It can also be introduced through the skin (nicotine patches), since nicotine enters the body through the skin at a very slow rate. During pregnancy, nicotine is broken down faster, so a patch alone may not control cravings well; your doctor may suggest combining a patch with a short-acting product such as gum or lozenges. Patches are usually removed at night.

It is generally preferable to use nicotine replacement therapy alongside psychological and social support, as combining both approaches can improve the chances of quitting successfully.

Are there side effects of nicotine replacement therapy during pregnancy?

Studies have shown that it does not affect fetal growth and does not increase the rate of premature birth.

There may be mild local side effects from nicotine patches, such as skin irritation.

What about electronic cigarettes and pregnancy?

An electronic cigarette is a battery-powered device that heats water, propylene glycol, nicotine, and a flavoring substance, turning the mixture into a spray that the user inhales.

With e-cigarettes, the amount of nicotine reaching the blood varies with the device and liquid; it is usually similar to or lower than with a regular cigarette and rises more slowly.

Electronic cigarettes do not contain carbon monoxide or tar, and some newer devices are designed to reduce many carcinogenic substances as well.

Electronic cigarettes are thought to be much less harmful than smoking tobacco, but they are not risk-free, and their long-term effects, especially in pregnancy, are not fully known.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist

The electronic cigarette is considered by some as one of the tools that may help with quitting smoking.

A large study in pregnant smokers (2022) found that e-cigarettes helped women quit at least as well as nicotine patches, with similar pregnancy outcomes. The best option is to stop all nicotine, but if you cannot, switching completely to an e-cigarette with support is safer than continuing to smoke. Talk to your doctor before using one.

If you are pregnant and would like personalized guidance on quitting smoking safely, our team at Dr. Najeeb Layyous clinic is here to support you with compassionate, evidence-based care throughout your pregnancy journey.