Threat to motherhood

Tobacco use among women, especially pregnant women, has not been much discussed by public health experts.

Data from the fourth National Family Health Survey (2015-16) suggested that nearly 4.6 per cent of pregnant women consume tobacco; mostly smokeless.

The highest such usage is in the North East, Odisha and Chhattisgarh, the Global Adult Tobacco Survey 2016-17 suggested.

In India — where tobacco-control programmes focus mostly on men — about 17 per cent women started using tobacco before turning 15, surveys suggested. For men, the rate was 11 per cent.

Some women consume tobacco from an early age and continue during pregnancy. But there are several who form new habits due to sudden urges during this period. Some start eating mud, chalk, etc due to mineral deficiencies in their bodies; others start consuming more dangerous substances like tobacco and betel nut.

Some commonly consumed smokeless forms are gutkha, khaini, snuff, gul, zarda, pan masala, etc while smoking ones include cigarette, beedi, hookah, etc.

Such habits often go unnoticed by family members as they are easy to hide. They are also at times socio-culturally acceptable and are perceived to be low-risk. Older women in the family who consume tobacco also introduce it to younger members who later become addicted.

Other reasons associated with tobacco use are stress, suppression of hunger (when dietary needs are unmet), peer pressure and to relieve toothache (application of gul on the gums).

Generally, it has been found that pregnant women are not asked about their tobacco addiction during their routine antenatal check-ups; consequently, missing the well-established intervention opportunity to quit tobacco.

Studies from all over the world have linked exposure to nicotine in tobacco with various harmful effects on the mother, foetus and the newborn. Pregnant women who consume tobacco during pregnancy can suffer from:

• Hair loss

• Weight loss or no weight gain

• High blood pressure

• Low haemoglobin levels

• Placenta previa

• Abruptio placenta

• Vision defects

• Decreased amniotic fluid

• Ectopic pregnancy

• Miscarriages

• Different types of cancers.

Harmful effects on the foetus linked to maternal tobacco use are:

• Developmental defects

• Intrauterine growth retardation

• Premature delivery

• Permanent damage to lungs and brain

• Higher risk of stillbirth.

Various side effects have also been noted among newborns, like:

• Defects of mouth and lips

• Obesity

• Asthma

• Heart diseases

• Growth retardation

• Sudden infant death syndrome

• Behavioural abnormalities

In countries like India, antenatal care check-ups could be used as an opportunity to ask, assess and assist women to quit tobacco during pregnancy. However, no attempts have been made to understand the feasibility of offering tobacco cessation counselling during antenatal care.

The Indian Council of Medical Research (ICMR)-National Institute of Cancer Prevention and Research, Noida is conducting a study to narrow this knowledge gap and help such women. Pregnant women consuming tobacco are screened and behavioural intervention is provided to quit tobacco during their ante-natal check-ups.

Those enrolled are followed up through their pregnancy and delivery process to record quit rates and pregnancy outcomes. We also look at the feasibility of integrating cessation services within the existing health system by taking inputs from healthcare professionals including doctors, community health workers and pregnant women.

As this is an ongoing study and recruitment is under process, it is too early to comment on the data collected so far to establish a significant effect of tobacco on the pregnancy outcomes.

So far, 75 pregnant tobacco users have been enrolled in the study and will be followed-up throughout their pregnancy until they deliver. The enrolled pregnant tobacco users are being regularly counselled to quit use, during their antenatal check-ups and telephonically by using a comprehensive behavioural intervention module. Self-reported quitters have shown significant improvement vis-a-vis staining of teeth and overall oral hygiene.

Some tobacco users have developed complications such as intrauterine growth restriction, which resulted in medical termination of pregnancy, placental abnormalities leading to bleeding, high blood pressure, low or no weight gain.

One woman delivered a baby with severe respiratory distress requiring neonatal ICU admission. During their interviews with these women, it was revealed that most of these women were never asked about their tobacco habits or any other form of addiction by any health worker or doctor during their check-ups.

Knowledge about harmful effects of tobacco on their pregnancy outcomes has been found to be negligible among these women so far. Most of these women were introduced to tobacco use by their female family members, friends or neighbours. A detailed study report with findings will be submitted only after complete data collection and analysis.

Quitting tobacco comes with rewards by providing a safe and healthy pregnancy and baby, better quality of life, improves self-confidence, monetary benefits and saves both mother and the baby from chronic diseases such as cancers and heart diseases. DTE

The article has been jointly written by Jigisha Chaudhary, Shalini Singh, Ekta Gupta & Prashant K Singh. Views expressed are personal