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Are there socioeconomic differentials in under-reporting of smoking in pregnancy?

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SMOKING IN PREGNANCY: A BIGGER PROBLEM THAN YOU THINK: SELF-UNDERREPORTING & LOW LEVEL OF SUSPICION
Krzysztof M. Kuczkowski
Published on: 23 December 2003

Published on: 23 December 2003
SMOKING IN PREGNANCY: A BIGGER PROBLEM THAN YOU THINK: SELF-UNDERREPORTING & LOW LEVEL OF SUSPICION
- Krzysztof M. Kuczkowski, Director of obstetric anesthesia
I read with interest the recent article by Graham and Owen (1), which explores the socioeconomic differentials in underreporting of smoking during pregnancy. The authors are to be congratulated for preparing such an interesting, thought-provoking, and timely study on this subject. However, it seems important to emphasize that in addition to self- underreporting (or denial) of smoking status in pregnancy the problem also li...
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I read with interest the recent article by Graham and Owen (1), which explores the socioeconomic differentials in underreporting of smoking during pregnancy. The authors are to be congratulated for preparing such an interesting, thought-provoking, and timely study on this subject. However, it seems important to emphasize that in addition to self- underreporting (or denial) of smoking status in pregnancy the problem also lies in low level of suspicion on the part of health care providers for addiction to tobacco in pregnant women. While the illicit drug use in pregnancy has received significant attention over the past two decades far too little attention has been given to the consequences of the use of “social drugs” such as tobacco, ethanol and caffeine, which are by far the most commonly used substances in pregnancy. While the deleterious effects of cocaine, amphetamines, and opioids on the mother and the fetus are more pronounced and easier to detect, the addiction to tobacco, ethanol and caffeine is usually subtle and more difficult to diagnose (2). As a result recreational use of tobacco in pregnancy may continue undetected, significantly effecting pregnancy outcome and obstetric and anesthetic (labor analgesia) management of these patients. Approximately 80% of women who smoke before pregnancy continue to smoke when pregnant (2). Low cigarette consumption prior to pregnancy is the best predictor for smoking cessation in pregnancy. The majority of patients with a history of drug use in pregnancy (including tobacco) deny it when interviewed by primary care physicians, obstetricians and/or obstetric anesthesiologists (3). Risk factors suggesting tobacco use in pregnancy include lack of prenatal care, respiratory complications and history of premature labor. A high index of suspicion for tobacco (as well as other social and illicit drug) use in pregnancy, combined with non- judgmental questioning of every parturient is therefore necessary. REFERENCE: 1. Graham H, Owen L. Are there socioeconomic differentials in under- reporting of smoking in pregnancy? Tob Control 2003: 12: 434. 2. Kuczkowski KM. Tobacco and ethanol use in pregnancy: implications for obstetric and anesthetic management. The Female Patient 2003; 28: 16-22. 3. Kuczkowski KM. Labor analgesia for the drug abusing parturient: is there cause for concern? Obstet Gynecol Surv 2003; 58: 599-608.
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Conflict of Interest:
None declared.
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