Changes in Smoking and Drinking During Pregnancy

EDITORIAL COMMENT: If maternal nicotine and alcohol usage really do cause more harm than the combination of diabetes, preeclampsia and all other conditions screened for routinely during pregnancy, then we must pay even more attention to these evils. To properly advise our patients we urgently require information regarding the degree of risk of mild to moderate indulgence, since about I in 3 women smoke and at least as many consume alcohol during pregnancy, often in the early weeks before the pregnancy has been suspected, and when the risk of teratogenesis would be expected to be greatest. Moreover, we must avoid needless panic of the patient who has now stopped drinking but had not done so in the few weeks before her symptoms of pregnancy began. Obviously prepregnancy counselling or general public education are necessary, but so too is data concerning the patient's chance of kicking the habit if this is her wish. This exploration of the problem in 40 patients indicates that it is easier to abstain from alcohol than nicotine, and some of the implications of this finding are discussed. A recent visit to the United States of America indicated that Australia certainly does not lead the world in legislative insistance that vendors of alcoholic beverages post warnings of the possibility of harmful effects on the fetus. Summary: Changes in alcohol and nicotine usage during pregnancy are reported from a sample of 40 pregnant women, 28 of whom smoked prior to pregnancy and 32 of whom drank alcohol. Although most women wanted to reduce or stop their intake during pregnancy, the drinkers were far more successful in their attempt than the smokers. Thus, 85% of drinkers achieved or bettered their target behaviour (in terms of consumption), while 53% of smokers ‘failed’ in their attempt. Women can identify reasons which influence their smoking and drinking behaviour during pregnancy and, in particular, the amount of emotional attachment to the unborn child appears to be important. However, endorsement of a particular reason docs not appear to relate in any simple way to actual consumption, and a major disparity between health beliefs and actual behaviour was apparent. Implications for primary prevention programmes and future research are discussed.