The issue of the impact of prenatal tobacco exposure, which refers to maternal smoking during pregnancy, on child health and development is still highly urgent and requires an appropriate governmental response. Researchers note that among “women who gave birth in Australia in 2012, 12% reported smoking during the first 20 weeks of pregnancy and this reduced to 9% after 20 weeks of pregnancy” (Burns et al., 2016, p. 57). Selya et al. (2018) provide the data that maternal smoking is one of the most influential factors of the possible risk of children’s smoking and that prenatal exposure to tobacco causes direct harm to fetal development. Thus, approximately one-tenth of children born in Australia may be affected by this negative impact. This policy brief describes the scientific evidence on prenatal tobacco exposure, the corresponding key issues and potential risks and gives concrete policy recommendations for addressing this situation.
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It should be noted that the scientific community has actively researched the problem of prenatal tobacco exposure during the last decade. This section discusses the evidence that maternal tobacco smoking during pregnancy causes individual deviations in child’s physiological and psychological development. Furthermore, it has been demonstrated that women that belong to certain social groups, and therefore their children, fall into the high-risk category. The results of relevant studies should provide the basis for effective and appropriate policy measures.
The primary focus of the research for the time being is related to the effect of prenatal tobacco exposure on the physiological characteristics of the fetus. Ip et al. (2016) state that tobacco is a systemic mutagen for the human body and leads to genotoxicity and alteration in the prenatal programming of fetal development. The authors report that smoking during pregnancy leads to a shortening of telomeres in children (Ip et al., 2016). Talati, Wickramaratne, Wesselhoeft, and Weissman (2017) state that children exposed to tobacco during their intrauterine development has lower birthweight. It should be concluded that smoking during pregnancy leads to deviations in the physical characteristics of the baby’s body compared to the statistical norm.
In addition to that, prenatal tobacco exposure also causes significant changes in brain anatomy and physiology. When the mother smokes chronically and regularly, the overstimulation of certain receptors embedded in serotonergic and dopaminergic neurons during pregnancy leads to their sensitivity transformation and disturbance of further development of the neural system (Talati et al., 2017). Moreover, researchers note that children exposed to tobacco during the intrauterine development were observed smaller global volumes of the brain, as well as thinner cortices throughout it (El Marroun et al., 2016). Thus, tobacco used during pregnancy has a significant impact on the subsequent functioning of the central nervous system that influences the emotional and cognitive qualities of children.
The researchers have highly focused on the relationship between maternal smoking during pregnancy and cognitive and behavioural development in children. According to Shisler et al. (2016), tobacco-exposed “infants exhibited lower levels of focused attention than non-exposed infants” (p. 1). In addition, researchers note that such children are “vulnerable to deficits in executive control and increased disruptive behaviour” (Clark, Massey, Wiebe, Espy, & Wakschlag, 2019, p. 1292). These data indicate that children affected by tobacco during the period of intrauterine development have problems with cognitive control and concentration. This may be due to previous nicotine influences on serotonergic and dopaminergic neural systems. The psychological impairments mentioned above obviously lead to particular behavioural outcomes. Talati et al. (2017) state that children exposed to tobacco in the prenatal period have higher levels of externalising psychopathology, including disruptive behaviour disorders. Therefore, cognitive deficits lead to specific impairments that follow a child both during and after maturation and affect his or her social interactions.
It should be pointed out that special social groups of mothers belong to the category of high risk. Researchers note that “smoking during pregnancy is more common among younger women, single women, women who are socioeconomically disadvantaged, women with lower rates of education, Indigenous women, and women in rural areas” (Burns et al., 2016, p. 57). It seems that these social groups are composed of mothers who are more socially vulnerable or have no information about prenatal tobacco exposure on their offspring’s health. Consequently, the children of these women are at high risk of exposure to tobacco during prenatal development. Moreover, researchers point out that parental smoking is a prominent risk factor for smoking among offspring (De Genna, Goldschmidt, Day, & Cornelius, 2017). This creates a particular risk of transmitting prenatal tobacco exposure “as an inheritance” to future generations. Thus, it should be emphasised that smoking in the family is the most common risk factor for tobacco impact on the child’s intrauterine development. More specific factors are the social vulnerability of mothers and their unawareness of the negative impact of tobacco on the developing fetus.
The above data suggest that the primary concern with prenatal tobacco exposure is the harm to the proper development of the younger generation. It bears mentioning that approximately 10% of children are subject to prenatal tobacco exposure, and this could have a significant impact on population health statistics in the future (Burns et al., 2016, p. 57). Given the broad range of developmental disorders and health complications, this problem takes on a national priority. Moreover, due to the possibility of the development of physiological and psychological impairments, the intervention of various professionals may be necessary and should be paid for. Tobacco exposure in prenatal development often affects children of mothers from socially vulnerable groups. Hence, it might be concluded that they are not always able to afford particular health care services, which raises the issue of the lack of social welfare in this regard.
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A particular danger of this phenomenon is that it reproduces itself. Maternal smoking is a predictor of both certain physiological and psychological deviations of the offspring and the occurrence of the same habit in children. There is a severe risk of reproduction of all health problems related to children exposed to tobacco in the intrauterine development in the following generations. Thereby, unless there is some government intervention, the problem cannot be solved by itself, but can only worsen subsequently.
Possible policies to address this problem are divided into two groups: corrective and preventive. It bears mentioning that recovery measures for child health require greater resources than certain preventive measures, the implementation of which could fully or partially eliminate these effects. To this purpose, a national campaign to inform young families about the harmful effects of smoking during pregnancy on the health of future children is to be implemented. In addition, a public program on smoking cessation for families preparing to have a child or expectant mothers should be established. They are to be accessible, including to pregnant smoking women who have decided to take care of the problem at a certain stage of pregnancy. According to Shisler et al. (2016), “smoking interventions, even in the third trimester, may have a positive impact on attentional outcomes for infants” (p. 1). Such intervention will prevent the self-renewal of prenatal tobacco exposure and reduce the number of children affected.
The assistance is also to be provided to those socially vulnerable families or mothers whose children have already been adversely affected. A public fund should be established to specifically pay for health services for children who have been exposed to the relevant adverse effects or have started smoking themselves. The primary purpose of these funds would be to support low-income families in restoring the health of their and to help mothers and their children quit smoking. This will prevent or correct the negative consequences for those children who have already been affected if their parents are not able to pay for such treatment. A part of the fund should also be used for research on the possible effective health care measures.
Burns, L., Coleman-Cowger, V. H., & Breen, C. (2016). Managing maternal substance use in the perinatal period: current concerns and treatment approaches in the United States and Australia. Substance Abuse: Research and Treatment, 10, 55-61.
Clark, C. A., Massey, S. H., Wiebe, S. A., Espy, K. A., & Wakschlag, L. S. (2019). Does early maternal responsiveness buffer prenatal tobacco exposure effects on young children’s behavioral disinhibition? Development and Psychopathology, 31(4), 1285-1298.
De Genna, N. M., Goldschmidt, L., Day, N. L., & Cornelius, M. D. (2017). Prenatal tobacco exposure, maternal postnatal nicotine dependence and adolescent risk for nicotine dependence: birth cohort study. Neurotoxicology and Teratology, 61, 128-132.
El Marroun, H., Tiemeier, H., Franken, I. H., Jaddoe, V. W., van der Lugt, A., Verhulst, F. C.,… White, T. (2016). Prenatal cannabis and tobacco exposure in relation to brain morphology: a prospective neuroimaging study in young children. Biological Psychiatry, 79(12), 971-979.
Ip, P., Chung, B. H. Y., Ho, F. K. W., Chan, G. C. F., Deng, W., Wong, W. H. S.,… Tung, K. T. S. (2016). Prenatal tobacco exposure shortens telomere length in children. Nicotine & Tobacco Research, 19(1), 111-118.
Talati, A., Wickramaratne, P. J., Wesselhoeft, R., & Weissman, M. M. (2017). Prenatal tobacco exposure, birthweight, and offspring psychopathology. Psychiatry Research, 252, 346-352.
Selya, A. S., Cannon, D. S., Weiss, R. B., Wakschlag, L. S., Rose, J. S., Dierker, L.,… Mermelstein, R. J. (2018). The role of nicotinic receptor genes (CHRN) in the pathways of prenatal tobacco exposure on smoking behavior among young adult light smokers. Addictive Behaviors, 84, 231-237.
Shisler, S., Eiden, R. D., Molnar, D. S., Schuetze, P., Coles, C. D., Huestis, M., & Colder, C. R. (2016). Effects of fetal tobacco exposure on focused attention in infancy. Infant Behavior and Development, 45, 1-10.