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Cigarette smoking: Impact on pregnancy and the neonate

Diana Rodriguez-Thompson, MD, MPH
Section Editors
Charles J Lockwood, MD, MHCM
James K Stoller, MD, MS
Deputy Editor
Kristen Eckler, MD, FACOG


Cigarette smoking during pregnancy is the most important modifiable risk factor associated with adverse pregnancy outcomes [1]. In 2002 in the United States, 5 to 8 percent of preterm deliveries, 13 to 19 percent of term infants with growth restriction, 5 to 7 percent of preterm-related deaths, and 23 to 34 percent of sudden infant death syndrome (SIDS) deaths were attributable to prenatal smoking [2].

In addition, smoking and secondhand smoke exposure increase the risk of infertility, placental abruption, preterm premature rupture of membranes (PPROM), and placenta previa. (See "Optimizing natural fertility in couples planning pregnancy".)

The scope of this problem, the pathophysiology and clinical effects of cigarette smoking on fetal outcome, and current recommendations for smoking cessation during pregnancy will be reviewed here. General issues of substance abuse during pregnancy and smoking cessation in a nonpregnant population are discussed separately. (See "Alcohol intake and pregnancy" and "Substance misuse in pregnant women" and "Overview of smoking cessation management in adults".)  


Screening methods — All pregnant women should be asked regularly about tobacco use [3]. In clinical practice, screening for tobacco use is done by asking the patient if she has ever smoked cigarettes, if she smoked when she found out that she was pregnant, and whether she smokes now. Women who smoke should be asked the number of cigarettes smoked per day.

The strong social norms discouraging smoking among pregnant women lead some women to fail to disclose their true smoking status, as detected by measurement of urine cotinine, a nicotine metabolite [4,5]. As an example, a retrospective cohort study comparing maternal urinary cotinine levels with self-reported cigarette use noted 16.5 percent of women tested positive for high-level nicotine exposure and an additional 7.5 percent tested positive for low-level exposure despite a self-reported cigarette use rate of 8.6 percent [6]. Urinary cotinine screening of pregnant women is feasible in practice and could increase detection of tobacco smoke exposure among pregnant women. Cotinine is found in urine, blood, and saliva for approximately five days after exposure to tobacco smoke.

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Literature review current through: Nov 2017. | This topic last updated: Sep 26, 2017.
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