1. SMOKING IN PREGNANCY Dr Catherine Angell

2. Write 3 words to describe how this image makes you feel......keep hold of this for later

3. Physiology of smoking Why do people enjoy smoking? Dopamine feelings of pleasure and satisfaction Adrenaline increased heart rate, blood pressure, respiration release of glucose from the liver raised blood sugar and appetite suppression Norepinephrine increased concentration, sharpness and arousal Seratonin calming, pain-killing, sedative effect Nicotine is unique in the change in effect achieved by different doses

4. Physiology of smoking Smoking has particular health implications for women Infertility/delayed conception Earlier menopause Osteoporosis Cervical cancer Breast cancer (Odiase, 2009) Heart attack/stroke if using oral contraceptives PUBLIC HEALTH ISSUE

5. Smoking during pregnancy Researching risk of pregnancy smoking is problematic because Smoking habits related to social group Poverty Less educated General health Delay in seeking health care Other risk factors ; diet, alcohol, medication, drugs Less likely to breastfeed Women may be reluctant to disclose level of smoking Exposure to passive smoking (Jarvis and Wardle, 1999) ???

6. Risks to the woman of smoking during pregnancy Ectopic pregnancy Miscarriage Placenta praevia Urinary tract infections Placental abruption Pre-term labour Premature rupture of membranes Haemorrhage Inadequate breast milk production (Castles et al, 1999) But not for:  Pre-eclampsia (Engel et al., 2008)  PIH (Yang et al., 2006)  Gestational diabetes (Wendland et al., 2008)

7. Risks to the infant Nicotine transfer to the infant Nicotine and carbon monoxide move easily across the placenta Nicotine and carboxyhemoglobin concentration is 10-15% higher in the fetus than in the mother Nicotine is also carried in breast milk (Briggs and Freeman, 2005)

8. Smoking during pregnancy Note down as many physical effects of smoking for the FETUS as you can

9. Risks to the infant IUGR Low birth weight Premature birth Poorer outcomes for pre-eclampsia Neonatal mortality Congenital malformations Cardiovascular Cleft lip and palate Genitourinary Talipes Sudden infant death syndrome (SIDS) Respiratory problems, eg. pneumonia Asthma Ear nose throat problems, eg. glue ear Undecended testes (Edwards and King, 2007; Graham and Smith, 2007; Malik et al., 2008; Pipkin, 2008))

10. Risks to the child Obesity Asthma Respiratory disease Meningitis Childhood cancers (linked to paternal smoking at conception) Diabetes Earlier menarche (start of periods) and menopause Fertility difficulties Delayed development Emotional problems Behavioural problems More likely to be a smoker (Gilman et al., 2008) (Sterjfelt et al., 1986; Hofhuis et al, 2003)

11. Smoking in pregnancy

12. Smoking rates amongst pregnant women in the UK: 23% in 1995 19% in 2000 17% in 2005 (Baxter et al., 2009) But RCM has noted concern about rises in pregnancy smoking rates since 2005

13. Why women smoke in pregnancy Stress Experience of smoking appears to offer relief from stress Pregnancy anxiety, unplanned pregnancy Money, work, housing Partner, children, family Guilt because of smoking Women may believe smoking is better than stress for themselves, their baby and family BUT smoking does not actually reduce stress...smoking increases stress hormones and having a cigarette generates dopamine which masks these (Ebert and Fahy, 2007)

14. Why women smoke in pregnancy Coping with depression and anxiety Social reasons Habit and lifestyle Fitting in with partner/social group (Wakefield et al 1998) Lack of understanding of risks Risks of smoking distant and abstract (Graham, 1993) Weight issues Weight gain Small baby=easier birth (Stillman et al., 1998) Support from health professionals does not meet needs