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Smoking while pregnant is dangerous because the poisons in tobacco can be passed on to the baby . Women who smoke when they are pregnant may have more problems than non-smokers during pregnancy and labour, and are at higher risk of:
Smoking in pregnancy also means the baby may:
Smoking is one of the most important preventable risk factors for these complications in pregnancy and poor health outcomes for babies . It is best if mothers can stop smoking before getting pregnant, but the earlier they stop during pregnancy the better. It is also important for pregnant women to try to avoid being around smokers altogether .
Second hand smoke (passive smoke) is associated with a range of harmful health effects both for pregnant women (and their unborn babies) and for infants and children who are exposed to second hand smoke in their environments . Emerging research is also pointing to the serious health risk of third hand smoke which includes pollutants from tobacco smoke that remain on surfaces and in dust, commonly in homes and cars, after active smoking has ceased . Infants and children may be particularly vulnerable to the harmful effects of third hand smoke given their early developmental stage .
Among women who do quit smoking during pregnancy, approximately 80% relapse within one year . One study exploring smoking knowledge and attitudes among Aboriginal and Torres Strait Islander women found they were unlikely to identify the health importance of a woman remaining a non-smoker after the birth of a child, and that cutting down only for the duration of a pregnancy was common . Given the identified health risks of second and third hand smoke, addressing relapse and promoting smoke-free environments for infants and children must be a key priority area in addition to targeting smoking during pregnancy [5, 6, 8].
When women are pregnant, it is a good time for intervention as they may be more likely to consider making changes such as quitting or reducing smoking, to ensure the healthy development of their baby . As well as having positive health outcomes for the child, this can have a longer-term preventative effect; children who live with non-smokers are less likely to commence smoking themselves .
Given that one of the most commonly identified factors contributing to smoking behaviours among pregnant Aboriginal and Torres Strait Islander women, new mothers, and the broader Aboriginal and Torres Strait Islander population, is stress [7, 11-13] addressing social factors that contribute to stress and high tobacco use among pregnant women and new mothers, and developing healthier strategies to deal with stress among women, their partners and family, may be effective targets for successful smoking prevention interventions within this population . Strategies that offer alternative stress reduction and coping methods, including activities to keep smokers mentally and physically occupied have been highlighted as particularly important among Aboriginal people who smoke .
Studies have highlighted the ‘normalisation’ of smoking in Aboriginal and Torres Strait Islander populations and the complex issues that influence the health and wellbeing of Aboriginal and Torres Strait Islander people, as significant contributing factors to high rates of smoking . Smoking among partners, family and friends, and the social obligations to exchange and share tobacco, pose significant barriers to cessation and prevention efforts, particularly when cessation may lead to isolation from social activities and exclusion from a group [7, 11, 14, 15].
Low levels of knowledge among Aboriginal and Torres Strait Islander women about the specific risks to the fetus as a result of smoking during pregnancy, and the high rates of relapse, may also contribute to persistent high rates of smoking among pregnant women [4, 7].
Therefore, tobacco prevention activities must include approaches that acknowledge and incorporate the socioeconomic determinants in people’s lives and the unique social and cultural contexts within which Aboriginal and Torres Strait Islander people live [15, 16].
Tobacco use among pregnant Aboriginal and Torres Strait Islander women in Australia is disproportionately high. Aboriginal and Torres Strait Islander women accounted for 17% of women who smoked at any time during their pregnancy in 2014, despite accounting for only around 4% of mothers. Almost one in two Aboriginal and Torres Strait Islander women reported smoking during pregnancy (45% compared to 13% of non-Indigenous women - age standardised). There has been a slight decrease in the amount of the proportion of Aboriginal and Torres Strait Islander women who smoked at any time during their pregnancy in the period 2009 (50%) to 2014 (45%). In 2014-15, 39% of pregnant Aboriginal and Torres Strait Islander women reported having smoked or chewed tobacco during pregnancy. In 2012, a higher proportion of Aboriginal and Torres Strait Islander women (40%) had one or more complications during pregnancy compared with non- Indigenous women .
The age-standardised rate of smoking cessation during pregnancy among Aboriginal and Torres Strait Islander women was 12%, which is less than half that of non-Indigenous mothers (24%) (based on mothers who reported smoking in the first 20 weeks of pregnancy and not smoking after 20 weeks of pregnancy).
For a comprehensive overview of tobacco use among Aboriginal and Torres Strait Islander people read Tobacco in Australia  (Chp 8).
For more information on tobacco and how it affects the body, access the tobacco chapter in the Handbook for Aboriginal alcohol and drug work .
Pregnancy is an effective and easy time to try and encourage women to quit or reduce their smoking, as it is a time women may be more likely to make changes to ensure the healthy development of their baby . In general, guidelines recommend assessment of smoking status, with advice and support for smoking cessation, as a routine and integral part of antenatal care .
However, there is little evidence for effective approaches to supporting pregnant Aboriginal women to quit smoking . The current antenatal smoking cessation guidelines are not specific to Aboriginal and Torres Strait Islander women and therefore do not incorporate the socioeconomic and cultural determinants of smoking, and barriers to quitting among this group .
Further key points on best practice strategies for smoking prevention and cessation interventions with pregnant Aboriginal and Torres Strait Islander women, new mothers and their families are outlined here:
This portal specifically focuses on tobacco smoking in pregnancy and does not included dedicated information on cannabis. Information on cannabis is available from the Australian Indigenous HealthInfoNet AOD Knowledge Centre.
Tobacco in Australia Chapter 3.7: Pregnancy and smoking  - includes information on spontaneous abortion, ectopic pregnancy, complications of pregnancy, and preterm delivery.
Tobacco in Australia Chapter 3.8: Child health and maternal smoking before and after birth  - includes information on birthweight, respiratory health, stillbirth, sudden infant death syndrome (SIDS), birth defects, health issues in infancy, long-term development, and breastfeeding and smoking.
Tobacco in Australia Chapter 4.11: Second hand smoke and pregnancy  - includes information on fertility, low birthweight and preterm delivery, lung development in the unborn child, spontaneous abortion (miscarriage) and stillbirth, birth defects, and cardiovascular effects.
Management of smoking in pregnant women in the Australian Family Physician - reviews the evidence for best practice intervention by general practitioners, includes information on guidelines for the use of Nicotine Replacement Therapy in pregnancy .
National Clinical Guidelines for the Management of Drug Use During Pregnancy, Birth and Early Development Years of the Newborn  - Chapter 3.2: Tobacco
A Pragmatic Guide for Smoking Cessation Counselling and the Initiation of Nicotine Replacement Therapy for Pregnant Aboriginal and Torres Strait Islander Smokers .
Handbook for Aboriginal Alcohol and Drug Work  - pages 113 - 117 - describes how to help a client tackle their smoking
Tobacco in Australia Chapter 4.9: Health effects of second hand smoke for infants and children  - for non-clinical health workers who may be exploring smoking prevention projects and strategies, there are also a range of general guides on best practice for health programs in Aboriginal communities which are available through the health promotion resources list for this topic.
Making two worlds work: using a health promotion framework with an ‘Aboriginal lens' .
Make Smoking History: for community services .
Appropriate health promotion for Australian Aboriginal and Torres Strait Islander communities: crucial for closing the gap .
Integrated health promotion: A better way to health .