| Abstract: | It is likely that the most important example of passive smoking is that which is imposed on the fetus. An article in the April 18, 1988, issue of the "Medical Journal of Australia" makes it clear (Condon and Hilton) that great difficulties will be faced in dealing with the effects of smoking during pregnancy. Gritz (1980) examined the evidence for fetal toxicity from tobacco smoke and the risk ratios for the various hazards. The risk of spontaneous abortion is increased by a factor of 1.8, low birth weight by a factor of 2.0, and perinatal mortality by a factor of 1.35. These increases come as no surprise given what is known regarding the pathophysiology of tobacco's effect on the fetus and the placenta. Condon and Hilton report on the observation that pregnant women find it much easier to stop drinking alcohol than to quit smoking cigarettes. Women who reported positive feelings about their pregnancy also indicated that their concern about, and attachment to, their unborn child provided insufficient motivation to stop using nicotine. It is assumed that the women described in this article were aware of the risks to the fetus from smoking in that such information is available almost as a routine part of antenatal care, and all but 1 of the smokers did try to reduce or to stop their use of nicotine. Yet, 14 of the 35 smokers failed in their efforts to reduce their smoking; another 7 smokers could manage only a small reduction. The 23,000 tobacco-associated deaths/year support the importance of developing a strategy to deal with nicotine dependence, particularly in situations of high risk such as pregnancy. The most reasonable and potentially effective approach would be to expend energy on preventing or dissuading young women from smoking in the 1st place. Over the past decade there have been numerous efforts at mass-media and educational campaigns to dissuade women from smoking, but these efforts have been overwhelmed totally by the determined drive on the part of tobacco companies to recruit female smokers. |
