Interview of Pr. Michel Delcroix, President of APPRI and President of the Organising Committee on the 1st Consensus Conference on “ Tobacco and Pregnancy”, in Lille on October 7 and 8, 2004. [back to contents]
How is it that we have had to wait until 2004 for the 1st consensus conference on “tobacco and pregnancy” to take place given the risks of smoking run by mothers and their foetus ?
Pr Michel Delcroix : We have been confronted with considerable inertia from the medical world, either because smoking during pregnancy was considered banal, or because the problems were underestimated. I would add that as long as doctors and medical staff keep smoking, it will be difficult to set up a global policy against smoking.
What important message do you wish to bring home?
Pr M.D.: Doctors, midwives, gynaecologists, anaesthetists, nurses should set a good example ! Stop smoking and improve your practice when treating pregnant women who smoke!
Surveys have proved it: The rate of people who stop smoking is twice as high when the medical staff does not smoke and implement validated methods for giving up smoking. Furthermore, whatever the motive of the visit or the contact with the patient, the medical staff must take the opportunity of this meeting to bring home this minimum message: assess tobacco consumption, and, if there is any, motivate them to stop. The measurement of carbon monoxide is a tool easy to use in day- to-day practice making it possible to quickly assess the degree of intoxication as well as making it visually obvious to the patient - mother or father - who will then immediately feel more convinced of the necessity to stop smoking.
What are the consequences of smoking during pregnancy?
Pr M.D: Until a while ago, people tended to underestimate the effects of tobacco on the mother, and the risks to the foetus. Yet, they are important and serious risks for both mother and child, impairing their health on a short and long term basis. Smoking when pregnant should be considered high risk as tobacco increases extra-uterine pregnancies, spontaneous abortions, premature child births, retro-placental haematomas, slowing of foetal growth, intrauterine deaths … After birth, the babies of smoking mothers suffer more frequently from otitis, bronchitis, bronchiolitis; equally there are greater risks of sudden death; later they are more likely to have concentration difficulties and a tendency to hyperactivity.
Consequently, as far as stopping tobacco is concerned, there must be no half-measures: the objective is zero cigarette during pregnancy and afterwards too, of course … Women tend to resume smoking after their pregnancy, all the more so as they don’t breastfeed their baby, as if there were no risks of poisoning anymore. Yet, passive smoking is nocuous because of the presence of carbon monoxide in the surrounding air.
During this consensus conference, only nicotine substitutes were proposed as weaning means... what about other methods?
Pr M.D.: It is a pity indeed that the Consensus Organising Committee only referred to the pharmaceutical solution… A decision that experts justified because it has been proved clinically. Studies should be carried out to validate the efficacy of other methods for those methods to be taken into account. Acupuncture is worth thinking about; the latest meta-analysis by Dr. Castera does show interesting results for giving up smoking. Furthermore, the acupuncture approach is worth favouring. In fact, the very principles of that therapy are based on the understanding of one’s own personality, a key element during tobacco weaning, which questions behaviour, gesturing habits and even, on a larger scope, one’s way of life. Also of interest is the positive effect on stress, making relaxation easier. By strengthening the immune system, it can prevent, for example, bacteria-induced vaginoses, more frequent with smokers than with non-smokers and which make premature childbirth more likely.
By acting on the respiratory function, it quickly brings comfort to the smoking woman, encouraging her to hold on to her decision to stop smoking. Finally, with acupuncture the centres of pleasure are awakened; it is a more subtle effect but which leads the ex-smoker to change her way of life, from then on caring for taste, scents or else being able to treat oneself well, which implies better eating, practising sports, relaxing… all sensations and activities incompatible with smoking. For all these reasons, acupuncture should be the subject of studies for it to be mentioned as an efficient method.