This article discusses the topic of tobacco use during pregnancy. While the issue of cannabis use during pregnancy has been previously covered, it is equally important to address the need to stop smoking cigarettes. Quebec’s Institut National de Santé Publique (INSPQ has recently updated its health files on tobacco and pregnancy, and this updated information is worth sharing.

The following information aims to provide accurate details, raise awareness, and possibly support efforts to change smoking habits for the benefit of mothers, future babies, and other family members. With an educational purpose, the goal is to share helpful practices to maximise health for both the mother and the baby. It is acknowledged that these efforts address deeply ingrained habits that are difficult to change, yet taking steps toward change is always worthwhile.

Why is it suggested to never smoke? Why is avoiding smoking during pregnancy strongly recommended? Why is it important to steer clear of exposure to second-hand smoke as well? And what are the implications of tobacco use during breastfeeding? These topics will be explored here, along with available resources to support efforts in overcoming nicotine addiction.

The Use of Tobacco During Pregnancy in Numbers

Did you know that one in ten women has stated that she smoked during her last trimester of pregnancy? Of course, this number is likely much higher in reality given that many future mothers prefer hiding their habit due to social standards. It’s not cool to say that you smoke when your tummy is filled with a developing baby. Mothers don’t like the image that projects to those around them.

We know that tobacco and the chemicals found in tobacco aren’t good for anyone’s health at any age. In addition, smoking while pregnant will get you disapproving looks from people around you, similarly to drinking alcohol while pregnant. They fear being judged, and often pregnant women will hide their smoking habit, as it’s difficult to stop, especially if she smoked a lot before pregnancy. You should know that there is no safe level of cigarette use during pregnancy. The more a pregnant woman smokes, the larger the number of risks for her and her baby. 

Additionally, don’t forget that many pregnant women live with a partner that smokes in the house. The different components found in tobacco are present in the air, dust and on surfaces in their living environment. A pregnant woman can regularly inhale or be in contact with chemical products found in cigarettes, even if she doesn’t smoke herself.

Inhaling second-hand smoke from tobacco can also have impacts on health. This is why future fathers and visitors are also responsible for their actions. You need to make them aware of the health impacts to try to, at best, get them to stop, or at least get them to smoke outside far from openings to avoid second-hand smoke

The couple has to work as a team to support each other to reach their common goal of quitting smoking for good. They need to promote the best possible environment for them and their developing baby.

The Impacts of Cigarette Use

For anyone at any time in their life, there are always impacts on cigarette use. It can be a huge risk factor and cause many health problems, including different types of cancer or respiratory and heart diseases.

For pregnant women, the difference is in the fact that the impacts can also harm the baby she’s carrying in her uterus. The placenta is penetrable. Unfortunately, the harmful components in a cigarette can penetrate the placenta and harm the baby via the mother’s blood. It can directly expose the fetus to these factors and significantly hurt their growth and development.

The contents of a cigarette can include up to 7,000 different chemical substances, and these can have three types of impacts—on the pregnant woman’s health, the pregnancy outcome and the health of the baby.

The Impacts of Cigarettes for the Pregnant Woman 

As you know, pregnancy impacts women’s metabolism. It accelerates significantly to meet the growing needs of babies. Mothers provide their babies with essential nutrients and oxygenation required for their development. This begins very quickly after conception.

One of the nicotine effects is to reduce the size, diameter of blood vessels. In medical terms, this is called vasoconstriction. Blood vessels with a smaller diameter than expected don’t have the same ability to transport the quantity of blood required for oxygenating and feeding different organs and issues. This includes supplying the baby’s.

A pregnant woman who smokes will see and lower her capacity to absorb different vitamins, such as folates or vitamin C and B6. This will make her more vulnerable to infections, as her immune system is weakened.

She will likely have symptoms associated with increased respiratory problems. The contraction of the blood vessels will impact her respiratory capacity. Cardiorespiratory exchanges will be more difficult; on the one hand, eliminating carbonic gas, which is waste, and on the other, resupplying oxygen needs.

We also note, as a consequence, higher heart rates in pregnant women who smoke. Once again, the contraction of the blood vessels under the effect of nicotine is part of this phenomenon. The heart compensates by increasing its rate to meet the blood flow necessary for the organism to function. In the end, the cardiac load is higher, meaning that the cardiac muscle has to work much harder than it should to do its job.

Cigarette use for a pregnant woman increases her risks for gestational or pregnancy hypertension. This corresponds to an increase in blood pressure higher than desired during pregnancy. This complication can have an unwanted negative impact on the baby’s weight gain (low-weight baby) and the pregnancy outcome.

The Impacts of Cigarette Use on the Pregnancy Outcome

In a pregnant woman that smokes, we note that they will experience more pregnancy complications. The most common problems include spontaneous abortions (miscarriages), ectopic pregnancies (in the fallopian tube) (in french), praevia placentas (placenta lying in the opening of the cervix), premature breaking of water, premature deliveries and growth delays in the newborn.

In the worst case, there’s an increased danger for the baby’s life before birth or in the hours and days following its arrival due to newborn sudden death syndrome.

This is serious, so think about it!

Impacts on the Baby

Nicotine can have consequences on the in-utero development of the baby’s brain and blood vessels found in the umbilical cord. They may likely be forced to contract.

Add to that an accumulation of carbon monoxide in their blood. This reduces oxygen supply and exposes them to many other chemical products found in cigarettes. This can have a real and dangerous impact over the short, medium and long term. Unfortunately, when your child is born, we won’t be able to tell you how it will be affected.

There are many possible impacts, such as low birth weight or more difficult temperament. Longer term, learning disorders, speech disorders, increased diagnosis of hyperactivity and attention deficit disorder (ADD), behavioural disorders, more asthma and a predisposition to consuming tobacco products and other substances later in life may occur.

After childbirth, there may be questions about whether breastfeeding is appropriate for individuals who smoke. Detailed information on this topic will be provided in the next section.

Tobacco and Breastfeeding

Even if the pregnant woman uses tobacco products during pregnancy, breastfeeding remains the best choice to feed the baby after childbirth.

Although the new mother smokes, the benefits of breast milk are higher than the negative effects of nicotine on the baby. However, basic recommendations to reduce the transfer of nicotine to the baby during breastfeeding exist. What are they?

1. Try to smoke after breastfeeding.
2. If possible, wait 2-3 hours after smoking before breastfeeding again.
3. Never smoke during breastfeeding, exposing the baby to second-hand smoke.
4. Get help to quit smoking.

To learn about options to quit smoking, read the next part of this article.

How can I deal with my smoking addiction?

The pregnancy period for women is a time in life where they’re open to and made aware of the need to quit smoking. This is to ensure that the pregnancy goes fine, but it’s especially important for the health of their baby. In the best of worlds, you will be able to quit smoking.

If you can’t crush the habit for good during pregnancy, what treatment options are available?

Professionals can work with you to stop smoking. Since it’s nicotine that causes your tobacco addiction, health professionals can guide you while reducing the impact of cigarette use.

Nicotine replacement therapies (NRT)

Nicotine replacement therapies (NRT) are available, but these methods don’t fully eliminate nicotine as they contain calculated amounts lower than in cigarette smoke. If your doctor prescribes this, it’s because they have evaluated your situation and believed that there are more benefits than costs for you and your baby.

The different nicotine replacement therapies may use lozenges, patches, vaporisers or gum. With appropriate monitoring and guidance, the final goal is progressively reducing the concentration of nicotine, gradually weaning you off your cigarette and nicotine addiction.

Electronic cigarettes

Please note that electronic cigarettes (vaporizer) aren’t recommended for pregnant and breastfeeding women to stop smoking.

Health Canada points out that, even if vaping products contain fewer chemical substances than cigarettes, they nonetheless carry health risks for mothers and/or babies, just as nicotine can. In addition, we can also question the components of vapour emanations from the vaporizer (toxic product content), which we can’t describe in concrete terms at the moment in terms of our scientific knowledge (studies to be continued for a better understanding).

Having said that, paediatric research on the subject clearly shows that exposure to second-hand cigarette smoke and/or to aerosols in suspension from the vaporizer weakens young children due to their immaturity, making them more susceptible to developing major respiratory problems (asthma, bronchitis, etc.). Repeated and sustained exposure can also cause growth and developmental delays in some children (SOGC).

Addictions are never easy to deal with. You first have to be surrounded by people that want to help you and encourage your efforts, and celebrate your daily victories. Always avoid being in the presence of people happy to smoke around you.

If you need specialised help, Quit Smoking Centres (CAT—in Quebec) can be very helpful and can provide free services to guide you through your efforts to stop smoking. For 24/7 support, there are telephone numbers, online resources and text message services at smat.ca.

It is hoped that this article has provided helpful information about tobacco use during pregnancy and breastfeeding. With an emphasis on education, the aim is to lay a foundation that can support the process of becoming smoke-free.

Marie Fortier
The Baby Expert

Updated article : March, 2025.

References :

• https://www.canada.ca/fr/sante-canada/services/tabagisme-et-tabac/vapotage/risques.html#a
• Guide pratique sur le vapotage, 2021 https://cps.ca/uploads/clinical/VapingTool-FR.pdf 
• La protection des enfants et adolescents contre les risques du vapotage, 2021 https://cps.ca/fr/documents/position/la-protection-des-enfants-et-des-adolescents-contre-les-risques-du-vapotage
• INSPQ : Vivre dans un environnement sans fumée https://www.inspq.qc.ca/mieux-vivre/sante/bebe-en-securite/vivre-environnement-sans-fumee
• SOGC : Grossesse et Vapotage https://sogc.org/fr/fr/content/featured-news/declaration-de-la-sogc-le-vapotage-et-la-grossesse.aspx?
• Québec sans fumée: la fumée du tabac augmente les risques de problèmes de santé chez les jeunes enfants. https://www.quebecsanstabac.ca/je-minforme/dangers-sante/risques-accrus-pour-les-enfants