Can smoking during pregnancy cause mental health issues in children?

Smoking while pregnant isn’t only harmful to the mother, but it can also be detrimental to the fetus. In fact, smoking during pregnancy is associated with an array of medical problems for children and a higher incidence of substance use disorders, autism, ADHD, and many other conditions in children whose mothers smoked.

How does smoking during pregnancy affect the baby?

Mothers that smoke during pregnancy pose health risks to themselves and their babies. On the one hand, women who use tobacco are more likely to have a miscarriage. They are also less likely to become pregnant in the first place and more likely to deliver their babies early.^[1]

On the other hand, smoking while pregnant can damage fetal tissue in the brain and lungs, leading to possible health issues after birth. Some studies also show a link between smoking while pregnant and children having a cleft lip, a cleft palate, or both.^[2]

Additionally, studies show that about one in five babies whose mothers smoke are born with below-normal birth weight. Even mothers who don’t smoke yet are exposed to secondhand smoke are likelier to give birth to babies with lower-than-average birth weight.^[2]

These are not the only risks of smoking while pregnant. Alarmingly, infants whose mothers smoke are roughly three times as likely to die from sudden infant death syndrome (SIDS) than babies with no exposure to tobacco smoke.^[1]

Which mental health disorders are linked to prenatal smoking?

Aside from the physiological damage smoking during pregnancy can cause to an unborn baby, it can also increase the risk of the child developing a mental health disorders as they grows up.

For instance, a longitudinal study of a birth cohort found a correlation between maternal cigarette smoking and the development of Axis 1 psychiatric disorders in children. Axis 1 disorders included mood disorders, psychotic disorders, and anxiety disorders. Moreover, the same study found that personality disorders were more prevalent among children whose mothers smoked during pregnancy.^[3]

As another example, a longitudinal study of nearly 1,300 children found a higher risk of psychiatric symptoms among adolescents whose mothers smoked. These psychiatric conditions included conduct disorder, depression, alcohol use, and substance abuse.^[4]

The rates of psychiatric symptoms were two times higher in children of maternal smokers than in children whose mothers did not smoke. What’s more, many other psychosocial conditions were more likely in children of smokers, ranging from an increased likelihood of living in poverty to a greater incidence of family problems to impaired parenting practices.^[4]

This same birth cohort study revealed interesting associations between the number of cigarettes smoked and the potential for children to have mental health disorders.

For example, smoking while pregnant resulted in a 45 percent higher chance of children developing Generalized Anxiety Disorder (GAD) and a 75 percent higher chance of developing depression. Children whose mothers smoked daily cigarettes were at an even higher risk for developing these disorders.^[5,6]

However, it should be noted that there are limitations to this research. Some of the associations between smoking while pregnant and childhood mental health disorders are accounted for by the mother’s mental health.^[5]

Additionally, much of the associated research relied on self-report measures, which, though common in psychological research, poses some concerns regarding the validity of the findings. That is, there is concern that pregnant women underreported how much and how often they smoked to minimize the severity of their behaviors.^[7]

Further concerns about the validity of some research in this area include small study sample sizes, variable measures of reporting smoking and related behaviors, and limited control of confounding variables.^[6] In other words, though it’s clear that smoking is dangerous, the precise connection between smoking during pregnancy and developing mental health issues in children is more difficult to pin down.

Other medical conditions linked to prenatal smoking

As explained earlier, an array of medical conditions are linked to smoking during pregnancy, including low birth weight, cleft palates, and an increased likelihood of SIDS. While in the womb, babies whose mothers smoke might experience the following:^[8]

• Slowed growth and development
• Reduced oxygen supply and nutrients because of nicotine and carbon monoxide
• Weaker movements in the womb, especially in the hour after the mother smokes

Additionally, the following conditions are possible once the child is born:^[9]

• Increased likelihood of stillbirth
• Increased incidence of asthma and wheezing
• Altered cardiorespiratory responses

Furthermore, babies whose mothers smoke are at a greater risk of colic and sleep disturbances. There may also be a link between maternal smoking and childhood obesity.^[8]

So, why should pregnant women refrain from smoking? Aside from the psychological and physiological effects smoking has on mothers, it can also cause serious harm to the fetus and presents potential health risks to children as they age, too. There is nothing good that can come from smoking while pregnant.

When to quit smoking

If you’re a smoker considering having children, quitting before you’re pregnant is best.

Quitting smoking is easier said than done, though. Thankfully, there are many resources you can utilize to help you quit for good:^[10]

• Tell your loved ones you’re trying to quit so they can support you.
• Support groups are helpful for feeling like you aren’t alone in your journey to quit smoking.
• Identify your triggers for smoking. For example, if you smoke when stressed out, you can try replacing smoking with a healthier alternative for dealing with stress, like mindfulness exercises. Keep a craving journal and write down your feelings, urges, and details about the situation to help you identify your triggers.
• Telephone hotlines, such as 1-800-QUIT-NOW, connect you with resources for quitting, including counselors who will provide ongoing support. Other technologies, like text messaging, websites, and apps, are also available.
• Minimize contact with other smokers. Doing so will help minimize your urge to smoke as well.

Above all, try not to get discouraged. Research suggests that quitting smoking as late as the fourth month of pregnancy can significantly reduce some adverse effects on babies, especially the risk of premature birth and low birth weight.^[8] 

If the self-help tips for quitting smoking listed above don’t seem to work, it’s time to visit a professional. Mental health professionals have many tools, including cognitive-behavioral therapy, motivational interviewing, and various medications (e.g., anti-anxiety medications like bupropion and smoking cessation medications like varenicline) that can get you on the path to quitting.^[10]