1.1 Introduction ……………………………….…………………………………5


2.1 Literaturereview……………………………………………………….………6

2.2 Objectives………………………………………………………………………10


3.3 Methodology ……………………….…………………………………………11


4.1 Results………………………………………………………………………….12


5.1 Discussion……………………….……………………………….………………15


6.1 Conclusionand Recommendation………………………………………………16

6.2 Bibliography…………………………………………………………………….18

Appendice1:Copy of Questionnaire

Appendices2: Risk assessment sheet

ABSTRACTTheobjective of this research is to establish the level of harm thatsmoking causes to a fetus at childbirth. It uses rich qualitativedata collected from mothers who have given birth in the UnitedKingdom since 1990s. The evaluation follows a fixed strategy so thatit can identify the relationships between child weight at birth andsmoking during the gestation period. According to the outcome of thestudy, a third of the adverse effects that result from smokingresults from undefined physical features of the mother. Many studiesindicate that smoking reduces the birth weight of children by atleast 1.7%. Nevertheless, smoking before the gestation period has noeffect on the birth weight of the infants. On the contrary, womenwho smoke throughout the pregnancy period face the highest riskassociated with the smoking habit.

Researchershave also found that mothers suffer from minimal harm when they stopsmoking by the fifth month from conception. Additional proof confirmsthat low income mother have higher vulnerability to become smokerscompared to parents from the wealthy homes.

Theresearch claims that cigarette smoking causes higher side effects onthe less educated compared to the more learned parents. Thedifference occurs in that the earned mothers use strategies that helpthem to minimize the number of cigarettes they consume during thegestation period, as well as use appropriate diets that helps toenhance the health of the developing fetuses. In summary, theresearch proposes that the UK healthcare stakeholders should mainlyfocus on creation of policies that target low educated mothers if thecountry is to achieve improved childcare health. Besides, they shouldtarget to offer the mothers a holistic health approach.


Smokingduring pregnancy, maternal health, child birth weight, gestationperiod


Thisstudy received immense financial support from Cancer Research UK andNuffield Foundation.

Chapter1 IntroductionCasesof women smoking during expectancy period are high in differentnations in spite of comprehensive studies that prove the habit isextremely risky. The realization of the detrimental effects thatsmoking has on expectant mother has motivated the United Kingdome tolaunch campaigns that educate potential mothers concerning thesignificance of refraining from smoking both before and afterpregnancy. In fact, healthcare stakeholders had intentions to developpolicies that would specifically target pregnant mothers.Nevertheless, the ambition is yet to be achieved because 20% ofpregnant women in the UK still smoke during expectancy period(Breslau, 2007 P.58).

Apartfrom understanding the after effects of smoking during pregnancy onthe health condition of the fetus at birth, the research will explorepotential policies that can restrict women from smoking when they areexpectant. Furthermore, it approximates the level of harm differentpeople suffer through estimating the variations and differences thatoccur during the gestation period (Savage, P.35).

Similarly,the research focuses on identifying the harm that smoking might causeon the expectant mothers using the delivery outcomes of four mothers. The study will determine if the delivery was preterm, theprobability of delivering underweight baby and other risks that facemothers who smoke during the expectancy period (Brennan, P. 45). Furthermore, the study will also use previous qualitative studies toenhance the findings of the study, as well as compare and contrastthe findings with past studies.

Chapter2LiteratureReviewSincethere are many cases of children suffering from serious side effectsassociated with smoking during pregnancy, many researchers havestudied the topic at different times. The purpose of this chapterwill be evaluation of the studies conducted in the past, as well asestablish their discoveries and recommended solutions to address theissues.

Oneof the sources of data concerning the topic is Centers for DiseaseControl and Prevention. The resource reports that many mothers whosmoke tobacco as well as marijuana are susceptible to deliver fetusprior to maturity. The research argues that expectant mothers arevulnerable to bear premature fetus, suffer certain birth defects,infant deaths and birth defects. The extra pregnancy complicationsmay accompany other conditions associated with the regular issuessuch as cardiac complications and cancer among other health defects(Shiono, P. 60). The researchers associate smoking with numerousdrawbacks such as difficulty to get pregnant, placenta problems,miscarriages, Sudden Infant Death Syndrome (SIDS) and susceptibilityto birth defects such as cleft palate or cleft lip Centers forDisease Control and Prevention (n.d).

NationalHealth Services (n.d) contends that it is essential for expectantmothers to avoid exposing their young ones to tobacco smoke. Thisincludes pregnant mothers who are still smoking during pregnancy.Scientists claim that one cigarette contains more than 4,000chemicals that are extremely dangerous to the fetus. The smokerestricts oxygen intake into the body therefore, the mothers andbabies’ hearts are compelled to beta harder so that they can ensureuniform distribution of oxygen throughout a patient’s body. Commoncomplications associated with miscarriages such as untimelyseparation of the placenta from the mother that leads to pregnancybleeding can be avoided if a mother quits smoking early enough.Furthermore, the study argues that children to mothers who aresmokers are likely to be underweight (Banks 2006, P. 66). Parallelstudies have also claimed that the offspring of mothers who smoketend to bear children who portray less intelligence compared to theinfants from mothers who does not smoke.

Curie(2007, p.44) notesthat smoking defects are not passed through genetic inheritance.Instead, they are deformities that results from introduction of toxicsubstances in the body of a woman that is supporting development of afetus. The poisons in turn interrupt correct development of thefetus. Bankset al. (2006)asserts that the good health varies substantially across people fromdifferent socioeconomic backgrounds. In particular, he identifiessocioeconomic status as one of the major factors that define thewealth difference. The significance of this study is definingexploring the detrimental effects of smoking on the unborn infants. Tourmaa(1955, p.99) discussesin detail the differences between fetuses that are born by motherswho smoke as compared to the kids on mothers who are not smokers. Henotes that smokers consume a lot of carbon monoxide that later turnsmerges with hemoglobin to form carboxyhaemoglobin.The compound restricts adequate intake of oxygen for the fetus, whichin turn leads to diseases associated with limited oxygen generationor fetushypoxia.Floydet al (1993, P.100) argues that all pregnant mothers who smoke suffers from reducedintrauterine development.The condition can occur at any human development phase. Growthretardation of fetus development results into substantial reductionof the fetus. Harris(2014,p.244)notes that the hormone variation during pregnancy may sometimes makesome mothers are attracted to smoking. The research argues thatresearch findings that are influenced on invisible factors such ashormones are often biased because they vary from one person to theother. LienandEvans (2005)asserts that fetus that are born of mothers who smoke are often 0.888weeks earlier than non-smoking mothers. Besides, the infants tend tobe 506% lighter than healthy children from non-smokers are. Theresource further claims that the weight can even be less when theunobservable factors such as the original health of the mother anddieting are accounted for in the analysis.

Jarvis(2001, P. 18) claims that healthcare professionals should emphasiseon assisting expectant mothers to quit the habit. Nevertheless,subsequent health care programs should complement the step to quitbecause the effects of smoking can remain in the body of a mother formany years. As such, proper follow up is important to ensure thefetus develops well.

Addaand Cornaglia (2006, P. 56) concludes that the harm on fetuses isnegligible when expectant mothers quit during the initial stages ofpregnancy. However, the risk can be decreased even further if womenplanning to conceive can quit the habit in advance.

Objectives Theprimary purpose of the study is to analyze the harm caused by smokingupon childbirth and gestation. Thesecond objective is evaluating the existences of other unobservabletraits in the mother and their effects on childbirth to assist policymakers in designing more effective policies on maternal health.Specifically, the study aims to test the following hypotheses:1.Establishthe probabilitylow childbirth weightdue to smoking.2.Determinewhether there areinvisibletraitsduring pregnancy that increasesthe probabilityofa woman delivering an underweight infant.3.The effect of smoking on pregnant women increases with the socialstatus such as the level of education among womenChapter3 Methodology Thestudy usedquestionnaires and existinginformation records from the UnitedKingdomNational Child Development Study(Young1987, P. 213).A sample of 30female groups of mothers and children was applied. Sixgroups of mothers were black people while another twelve groups werecomposed of white women. The study deliberately allowed higheropportunities for interviewing white women because they are themajority. The findings would have been biased if we could have usedequal number of the majority whites with the minority races such asthe blacks. However, other minority groups such as Hispanics, Arabsand Asians smoking trends in the United Kingdom determined. Each ofthese minority immigrant croups’ were represented by five groupseach. Besides, the study also determined the socioeconomic status ofeach of the respondents because we intended to determine whether thewealth influence does either encourage smoking during pregnancy.Evaluation of women from diversified background was critical toacquire non-biased findings. Thestudy aimed at estimating the harm caused by maternal smoking byconsidering the mothers endogenous decision to smoke during thepregnancy period.&nbspIn order to identify a wealth of informationspanning the lifetime of the mother, the study used the NationalChild development study to capture the unobserved healthy attitudesof the mother. It included the weather, the status of exercises,drinking behavior as well as whether her parents smoked when she wasage 16(Banks et al. 2006, p. 84).The eligible parents included mothers who ranged between sixteen andthirty five years. The study preferred the age gap because many womenin the United Kingdom have high production rate during this age gap. Ethicalissuesand how they are handled in the research Thestudy observed the capacity of the respondents to provide therequired information. The capacity issue was dealt with in thequestionnaire by use of filter questions whenever the respondentconfirmed that they do not smoke, the interview was cancelled. Thisensured the acquiring of appropriate targets with necessaryinformation (Curie 2007, p.44).Thestudy also enhanced the confidentiality of the information collectedby ensuring the anonymity of the respondents. TheConsent of the respondents was ensured by making the respondentsunderstand the purpose and the method to be used in the study beforeengaging them in the interview. Further, the participants wereallowed to withdraw from the interview at any time.Riskin a health setting and relationship to this research Cigarettescontain harmful compounds such as sulphides, nicotine, cadmium,cyanide and carcinogenic hydrocarbons. They are harmful to fetaldevelopment. Smoking of pregnant mothers is a common cause of lowbirth weight especially in the UK. Further, smoking has beenassociated with the long-term neurobehavioral and physical growth. Several behavioral disorders such as attention deficit, poorself-conduct and hyperactivity have also been linked to smoking.Nicotine has been linked to tremors, startles and irritability amonginfants. The infants who have been exposed to nicotine are recordedto exhibit behavioral problems that lead to social disadvantage ofdeprivation later in their childhood. The behavioral problemsdiminish educational developments which further compromise the lifetime opportunities that open up to the affected children. Smoking hashence been linked to social inequalities in health and mortality. Thestudy identifies the relationship between smoking amongst pregnantwomen and the chances of a low weight birth. Further, the study aimsat establishing the relationship between other unobserved mothercharacteristics during pregnancy that may contribute to compromisingthe health of an unborn baby.Importantvariables in the research and how they have been handled Theimportant variable in the research include the required informationfor the purpose of enhancing a fixed approach to ensure consistencyof results. In addition to direct smoking, the study aimed toestablish chances of exposure to passive smoking. Hence, it aimed atestablishing a comprehensive source of endogenic reason to smokeduring pregnancy. Thequestionnaire further enquired about the paternal smoking status.Further information was obtained about the siblings to the mother inorder to establish a systematic relationship for the fulfillment ofthe requirements of the fixed model and provide information about themother’s endogenic decision to smoke(Adda &amp Cornaglia 2006, P. 56).Torecognizeifa anexpectant woman can lower the vulnerability of hazards associatedwith smoking, they are dividedinto groupscontaining the women who are smokers and the ones that quit duringthe secondtrimesteras well as the ones who maintain the habit throughout thewholepregnancyperiod (Almond, Chay &amp Lee 2005, p. 34).Thedistinction is determined by the fact thatthe fetus develops the skeletons duringthe first few months and a few organs,hence,is the most crucialtimeconcerningthematernal characteristics.The observance of birth weights may provide different results sincethe baby gains most of its weight during the final 20 weeks. Thismay make the study to consider the last months as the most important.It is also an important factor to consider in maternal smoking due tothe time lag between conception and realization of the pregnancy (Behrman, 2004, p.55).



Compositionof the descriptive statistics

Theprobability of having a low birth child weight.

Theresults are indicated in the graph below:

Therisk of delivering underweight infant is 60% for smokers and 40 % fornon-smokers

Likelihoodof having a premature birth

Smokershave an increased likely hood of having a premature birth by 2.3%compared to nonsmokers.

Smokermothers are at a higher risk of suffering the adverse effectsassociated the drug. In addition, the study found that most motherswho were smokers before they conceived often continue with the habituntil they deliver.

Comparisonof harm caused during pregnancy

One-thirdof the damage was from unobserved characteristics.

Whenthe harm was evaluated in a fixed model, it was observed thatone-third of the damage was from unobserved characteristics.

Uponelimination of fixed effects

50%of the damage during pregnancy is due to unobservable factors.

Further,when the mother fixed effects are eliminated for a continuous smoker,it reduces the harm by half indicating that50% of the damage duringpregnancy is due to unobservable factors.

Educationof the mothers

Concerningthe education of the mothers, the less educated women are 2% higherthan the learned. Consequently, education discourages women fromsmoking during the gestation period.

Theresults are as indicated below:

Anotherpremise is that the weight of a child weight decreases as the mothercontinues smoking. In fact, the average weight of infants born tomothers who does not smoke is higher with 239 grams compared with thebabies of smoker mothers. Furthermore, passive smoking was alsodiscovered to have almost similar detrimental effects on the victimsas the passive smokers.



Thehypothesis of planned behavior, subjective norms and perceivedbehavioral controls says that they control personal behaviors andhabits. It implies that people learn to behave through mechanismsthat include conditioning, positive and negative reinforcement. It ishence possible to assist pregnant mothers to quit smoking due to theeffects on their health as well as the child.

Similarly,Lien &amp Evans (2005) analyze the effect of imposing highertaxation on tobacco. The authors conclude that increased taxation ontobacco motivates some people to quit smoking because it directlyincreases the cost of cigarettes. On the contrary, Almond, Chay andLee (2005, pp. 30-39) investigate the susceptibility of gettingunderweight children. Nonetheless, the resources are related becausethey focus on the adverse effects associated with the smoking habit.Both sources are advantageous because they use data from crediblesources such as government records and national statistics findingsin the United States. However, the conclusions are drawn fromanalyses restrained within a specific period. The results are oftenmore accurate when they are based on a wide scope such as a datadrawn from a decade evaluation.

Inaddition, according to Psychological theories, the smokers attributethe effect of smoking with other conditions such as mood swings thatenhance their personal characteristics. The ideology means that inorder to assist smokers to quit the behavior, there is needed toestablish the feelings that the smoker associate with the behaviorand develop appropriate interventions for specific populations ofsmokers. It further implies that there should hence be tailoredhealth messages in order to stimulate greater cognitive activity inhelping people to change behavior.

Thestudy identifies varying levels of smoking between educated anduneducated mothers. There is need to identify the resulting factorsthat promote smoking among the women in order to assist them to quitthe behavior and hence reduce the implications on their health aswell as that of the children. The inclination shows that learnedwomen have lower probability to become smokers during pregnancy whilemost of the uneducated women often use tobacco during the gestationperiod.

Agraph showing the level of education of pregnant women against theireducation level

Conclusion:the higher the women are educated, the less likely they are to beginsmoking.

Accordingto healthcare psychology, Smoking is considered as a behavioralfactor that has an effect on human health. Psychological practicescan use the results from the study to advance the quality of servicesthey provide for example assisting the smoking pregnant women to quitby making them understand the underlying dangers from the habit.Further, in the efforts to ensure child health, nurses can extend thequality of services beyond the smoking arena to other areas thataffect the health of the child and the mother- the unobserved factorssuch as exercise during pregnancy.

Graphicalrepresentation of smoking trends during and after pregnancy ofexpectant mothers.

However,the study concludes that giving up smoking is only half of thebattle, in order to raise child health, there has to be a moreholistic approach to understand other behaviors&nbspof the pregnantwoman which needs to be improved during her pregnancy.&nbsp

Thestudy further found out that quitting smoking during pregnancy bearsno harm to the child’s weight which is consistent with scientificfindings that in week 1-12, the baby develops facial features and in13-28th week the growth takes place hence the weight.

TheNational Health Services (n.d) is similar to Harris and Balsa (2014)in that the sources focus on adverse effects that expectant mothersface due to the smoking habit. Nonetheless, the National HealthServices (n.d) mainly elaborates about the adverse effects that apatient would suffer as a result of smoking during pregnancy. On theother the hand, the resource concentrates on the evaluation of thecritical factors that attract an individual into continued substanceabuse.

Agraph representation of the vulnerability of an infant to sufferingfrom adverse health effects associated with tobacco against smokingperiod:

Conclusion:the longer an expectnat mother smokes, the higher the probability ofthe child suffering from tobacco use associated complications

Asa result, health care professionals reduce harm to the child byassisting pregnant women to discontinue behavior in the first twotrimesters that include quitting smoking. Women who smoked for ninemonths gave births to children who were 7.2% lighter which reduced to5% upon the elimination of full-time smokers and considered thechangers only. According to the recent statistics in the UnitedKingdom, the number of expectant women decreases as they advance inage.

Theeffect of age on influencing smoking habits on expectant mothers

Conclusion:Smokingfrequency of women decreases as they advance in age

Further,upon the elimination of mother fixed effects for a continuous smoker,harm was reduced by 50% indicating that half of the damage duringpregnancy is due to unobservable factors. In conclusion, in additionto quitting smoking, pregnant mothers have to adapt to otherbehaviors like regular exercises to improve the child’s health.

Withregards to education, the studies indicated that the harm fromsmoking is relatively higher for uneducated mothers by 2% per eachcigarette compared to those who were educated. The significance ofthis result is relevant for policy targeting. The low educated womenare&nbspexpected to smoke&nbspmore compared to their educatedcounterparts.&nbspHence, the low educated parents should be thefocus of policies to change behavior during pregnancy.



Thestudy was conducted on pregnant mothers smoking during pregnancy andthe effect on children. It established that there was a conditionaleffect of 5.6% on the total sample and 3.3% of women who changedtheir smoking habits within the pregnancy period. The total fixedeffect was identified at 1.7%. The study concludes that smokingaffects children’s health, however there are other behaviors overand above smoking habits that contribute to the health of the child.The behavior of the mother has been identified to affect the childfurther and hence, policies on maternal health should aim ateducating parents on health behavior generally.

Consequently,the negligible effect of maternal smoking if the mother quits by thefifth month suggests that there is a cumulative effect caused bysmoking. Up to 13% of children classified as low birth weight andborn to smokers could have been classified as healthy if the mothersdid not smoke.

Theharm from smoking was found to be decreasing with the education ofthe women. This is as a result of the number of cigarettes smokedduring pregnancy. Uneducated women were related to smoking more thanthe educated women.

Theimplications for the study suggest that the policies towards thecessation of smoking are not adequate to solve the inequalities inchildren health. The potential solution must offer help to mothersespecially the uneducated ones.


Inthe future studies, I will use quantitative analysis approach hbecause it draws conclusion based on a wide population. The presentevaluation could be biased because a small number of pregnant mothersare used to represent the generalized smoking trend of women inLondon. A quantitative study will allow incorporation of limitlesscandidates, especially, pregnant mothers from various socio-economicbackgrounds.


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Appendix1: Copy of questionnaire



(Thequestionnaire was administered to women who had given birth in thepast two years before the study)

Nameof Investigator–

StartingTime —


Lead–in / Introduction

Hello,my name is —, I amcurrently conducting a research on the effects of smoking amongstpregnant mothers in the UK. Instructionto investigator: please use pencils and circle the code whereapplicable and write the answers in legible handwriting in the spacesprovided for responses.


  1. What is your name?

  2. What is your age ?–

  3. Location/address:—


  1. Do you smoke? [ ] Yes[ ] No

  2. Do you take Beer? [ ] Yes[ ] No

(ifyes continue to question 3, if no skip to question9)

  1. How many pieces of cigarettes do you smoke per day? (Tick appropriately.)

  1. [ ]Less than 5

  2. [ ]Between 5 and 10

  3. [ ] More than 10

  1. What amount of beer do you take (specify) per day?

  2. For how many months did you smoke while in you were in the pregnancy period? (tick appropriately )

[ ] Less than 2 months.

[ ] Between 2 and 5 months.

[ ] More than 5 months.

[ ] For the whole nine months.

  1. Are you married [ ] yes [ ] No( if yes continue to vi, if no skip to )

  2. Does the father to the child smoke [ ] yes [ ] No

  3. Did you live with anyone who smoked in the same environment during your pregnancy term? [ ] yes [ ] No


  1. Does anyone in your family background ( eg brother sister first cousins) smoke?

[ ] yes [ ] No

  1. Did your parents smoke when you were young [ ] yes [ ] No

  2. What was the gender of the child[] Male[] Female

  3. What was the weight of the child upon birth in grams?


  1. Kindly indicate your current level of education

[] Certificate [ ] Diploma [ ] Degree [ ] Masters [ ] PHD


  1. Are you employed? [ ] yes [ ] No

  2. If no what is your major source of income? –Unobserved effects

  3. Do you exercise [ ] yes [ ] No

  4. If yes, what kind of exercise do you engage in —

Appendix 2: Risk assessment sheet

Risk hazards

Potential victim of harm

Likely hood and extent of harm

Controls available to minimize harm

Further intervention to reduce harm

Illnesses that develop over time e.g. lung cancer, heart disease, stroke

The direct smokers and passive smokers.

The greater the exposure the more the likely hood of harm

Risk –High

Re circulating ventilation

Eliminate the risk-ban smoking, assist smokers to quit through various methods such as rehabilitation

Sudden illnesses e.g. asthma attacks in those already affected

Children, born and unborn, customers and staff, relatives and friends

Severity can lead to hospitalization. To the unborn, it can lead to light weight birth and mortality. Likely hood of asthma and cancer


Risk- high

Re circulating ventilation

Eliminate the risk-ban smoking, assist smokers to quit through various methods such as rehabilitation


Any other person in proximity to the smoker

Likely hood-medium

Risk- high

Establish a smoke alarm.

Install fire extinguishers.

Establish evacuation procedures.

Eliminate the risk-ban smoking, assist smokers to quit through various methods such as rehabilitation


Children, born and unborn, customers and staff, relatives and friends

Children at higher risk especially walking on a lit stump of cigarette on the floor

Likelihood- Low

Risk- Low

Establish a smoke alarm.

Install fire extinguishers.

Establish evacuation procedures

Eliminate the risk-ban smoking, assist smokers to quit through various methods such as rehabilitation

Riskassessment: Smoking