Women who smoke tobacco are at enhanced risk for a broad range of cancers (pancreatic, lung, cervical, bladder, kidney), pulmonary disease and cardiovascular disease. Cigarette smoke comprises numerous ingredients and toxins that negatively affect all stages of a healthy reproductive function, including endometrial receptivity, folliculogenesis, embryo transport, endometrial angiogenesis, uterine blood flow, steroidogenesis and uterine myometrium.

Long-term smokers face adverse health outcome as the effects of cigarette smoke are dose-dependent. It also affects fertility based on each person’s sensitivity, type of exposure, dose and time. A recent study has revealed that there is a higher risk of infertility in women smokers as compared with non-smokers. It is critical to quit the habit several months prior to pregnancy to avail maximum time and treatment options to attempt quitting.

Across the globe, more than 1/3 of women are exposed to second-hand smoke. Second-hand smoke exposure during pregnancy leads to intrauterine growth retardation and low birth weight and parental smoking around infants causes respiratory illnesses such as asthma, bronchitis, ear infections and sudden infant death syndrome.

Smoking in the preconception period can lead to infertility and delays in conception. During pregnancy, it increases the chances of spontaneous abortion, ectopic pregnancy, placenta previa, placental abruption, premature rupture of membranes and preterm birth, low birth weight, birth defects. Smokeless tobacco has also proven to be harmful to both the mother and the fetus.

Women need to be screened for both tobacco use and exposure to second-hand smoke during both the preconception period and pregnancy. It is important to understand the adverse effect of smoke during pregnancy to the mother and the unborn child. Behavioural counselling is recommended to assist with the cessation of smoking.

Eliminating smoking during pregnancy could reduce very preterm, moderately preterm and late preterm births and also remove the risk of preterm-related deaths and sudden infant death syndrome.

Health problems	Issues to maternal health	Issues to infant health
Smoking in the preconception period	Infertility, conception delay.	–
Smoking in the preconception period and pregnancy	Spontaneous abortion, ectopic pregnancy, placenta previa, placental abruption, premature rupture of membranes.	Preterm birth, low birth weight, birth defects (including oral cleft, limb-reduction defects, clubfoot, defects of eyes and gastrointestinal system, especially gastroschisis and abdominal hernias), sudden infant death syndrome.
Use of smokeless tobacco in the preconception period and pregnancy	–	Stillbirth, preterm birth, low birth weight.
Exposure to second-hand smoke during the preconception period and pregnancy	–	Lower birth weight, birth defects.

Smoking during pregnancy can be harmful to the growing baby. The first trimester of pregnancy is when the fetus is most vulnerable to the adverse effects of smoking. It is best that women quit the habit of smoking much before pregnancy as it can reduce and even eliminate the risks of birth defects that may occur in the early months of your pregnancy.

Smoking can result in low infant weight and preterm babies. It can lead to birth defects and even stillborn babies. Quitting the habit of smoking can be tough but it is one of the best ways you can protect yourself and your still-to-be-born baby.

Women who smoke during pregnancy have an increased risk to have a baby with an orofacial cleft, a birth defect of the mouth and the lip. Even being around tobacco smoke can be a risk factor for a pregnant woman and the developing fetus. If your partner won’t stop smoking, ask that he not smoke when you are around to avoid the risks that come with passive smoking.

Quitting the habit can be a hard battle but the benefits are worth it. You should talk to your healthcare provider to help you with strategies and support you in the journey to rid yourself of the habit of smoking. It is never too late to quit smoking.

https://www.aafp.org/about/policies/all/preconception-care.html