Smoking and Pregnancy

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Smoking is one of the modifiable factors that impacts fertility. Studies have demonstrated that women who smoke are 1.6 times are likely to be infertile than women who don’t. Additionally, women who smoke go through menopause 1-4 years earlier than non-smokers.

The increased risk of infertility and earlier menopause suggest that smoking likely impacts egg supply. Our current understanding is that women are born with all of the eggs they will have. At 20 weeks in-utero the ovaries have 6-7 million eggs. This drops to 1-2 million at birth and around 0.5 million by puberty. The egg supply continues to decline until menopause, average age of 51 years. Generally, only one egg is used, or ovulated, each month, but the ovary goes through hundreds to thousands of eggs to select and ovulate a single egg. The remaining unused eggs for that month die off. Smoking likely decreases the total number of eggs and, as a result of the decreased egg supply, menopause comes early.

Smoking is also associated with pregnancy and neonatal complications including increased risk of ectopic pregnancy (pregnancy outside of the uterus), miscarriage, intrauterine growth restriction (small babies), placenta previa (placenta placement over the cervix), abruption (tearing of the placenta away from the uterus), preterm premature rupture of membranes (breaking your water early), and low birth weight babies. According to the American College of Obstetricians and Gynecologists “An estimated 5-8% of preterm deliveries, 13-19% of term deliveries of infants with low birth weight, 23-34% of cases of sudden infant death syndrome (SIDS), and 5-7% of preterm-related infant deaths can be attributed to prenatal maternal smoking.” Even after pregnancy is achieved, children born to women who smoke are at in increased risk of health concerns including asthma, colic, and obesity.

Tobacco use among men does not impact fertility as significantly as it does in women. Some studies have demonstrated lower sperm parameters (concentration, movement, and shape) on semen analysis among men who smoke, but studies have not conclusively demonstrated reduced fertility. However, second hand smoke has been shown to increase the risk of low birth weight babies.

Men and women should stop smoking as soon as possible for overall health benefits. This is especially important for those trying to create a pregnancy due to the infertility, pregnancy, and neonatal risks.

 

 

 

References:

1.       Augood C, Duckitt K, Templeton AA. Smoking and female infertility: a systematic review and meta-analysis. Hum Reprod 1998;13:1532–9.

2.       Baron JA, La Vecchia C, Levi F. The antioestrogenic effect of cigarette smoking in women. Am J Obstet Gynecol 1990;162:502–14.

3.     Adena MA, Gallagher HG. Cigarette smoking and the age at menopause. Ann Hum Biol 1982;9:121–30

4.     Optimizing natural fertility: a committee opinion. Ferti Steril. 2017 Jan;107(1):52-58.

5.     Committee Opinion No. 721: Smoking Cessation During Pregnancy. Obstet Gynecol. 2017 Oct;130(4):e200-e204.

6.     Dietze et al. Infant morbidity and mortality attributable to prenatal smoking in the US. Am J Prev Med 2010; 35:45-52.