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Smoking, Alcohol and Pregnancy


Source: Health Canada website and Media Photo Gallery, Health Canada, Reproduced with the permission of the Minister of Public Works and Government Services Canada, 2006.

Alison is 19 years old and is currently three months pregnant. She works a minimum wage job as a cashier, and lives with her boyfriend in a one bedroom apartment. Both Alison and her boyfriend smoke about a half of a pack of cigarettes a day. Alison has been smoking since she was 12.

Recently, Alison visited her family physician for a routine prenatal check-up. When asked how she was doing, Alison explained that she and her boyfriend have been finding it difficult to make ends meet since her hours were recently cut back. The physician listened, and then suggested that if they quit smoking, they would have more money. He told her that she shouldn’t be smoking anyway, especially now that she is pregnant.

After leaving the office, Alison felt guilty, felt like a bad mother and a person who couldn’t do anything right. She did not quit smoking because she thought she would just fail anyway and was a ’loser’.


Why do you think Alison’s physician reacted the way he did?


Can you think of a better approach to try and help Alison become a non-smoker?

  • Keep in mind that smoking tobacco is an addiction, and is not comparable to other ’choices’ about how to spend money.

  • Women in the lowest income bracket smoke more than women in the highest income bracket (36% vs. 13%).[9]

  • During pregnancy, 35.9% of women with less than a high school education smoke, compared with 9% of women with a university or college degree.[10]

  • Smoking during pregnancy is associated with a higher risk of preterm birth and intrauterine growth restriction, in addition to perinatal complications such as placenta previa and premature rupture of membranes.[1][4]

  • Women of higher socioeconomic status are more likely to drink alcohol during pregnancy.[9]

Smoking Cessation

The following is a general guide for promoting smoking cessation.[1]

  • Ask women about their smoking status and document the answer so you’ll remember to ask again at the next visit

  • Encourage women who smoke to stop

  • Assess whether the patient is willing to quit within 30 days

  • Assist women who are willing to quit by providing pregnancy-specific self-help materials

  • Arrange follow-up to track progress

For more information about women, tobacco use, and smoking cessation programs, see the Gender and Lung Cancer module.



1. American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. Guidelines for perinatal care, 5th Edition. 2002

4. Kramer, MS, Seguin, L, Lydon, J, Goulet, L. Socioeconomic disparities in pregnancy outcome: Why do the poor fair so poorly? Paediatric and Perinatal Epidemiology 2000;14:194-210.

9. Federal, Provincial and Territorial Advisory Committee on Population Health. Toward a healthy future: Second report on the health of Canadians. 1999.

10. Health Canada. Canadian Perinatal Health Report, 2003. Ottawa: Minister of Public Works and Government Services Canada, 2003.

All references for this section