The Impact of Smoking on Pregnancy: Factors and Interventions

Desklib provides solved assignments and past papers to help students succeed.

To explore the reasons, why women
smoke during pregnancy despite the
health impacts
1

Table of Contents
Chapter1 Introduction to the research........................................................................................4
1.1 Introduction..........................................................................................................................4
1.2 Background to the problem..................................................................................................4
1.3 Statement to the problem (Rational)....................................................................................5
1.4 Research aim........................................................................................................................6
1.5 Research objectives..............................................................................................................6
1.6 Research questions...............................................................................................................6
1.7 Significance of the research.................................................................................................7
1.8 Summary of the chapter.......................................................................................................7
1.9 Operational definition..........................................................................................................7
Chapter 2: Literature review......................................................................................................9
2.1 Introduction..........................................................................................................................9
2.2 Effects of smoking over pregnant women...........................................................................9
2.2.1 Social cognitive theory....................................................................................................10
2.3 Reasons of smoking by pregnant women...........................................................................11
2.4 Intervention process to smoking cessation.........................................................................12
2.4.1 Theory of planned behaviour..........................................................................................13
2.4.2 Health belief model.........................................................................................................14
2.5 Influencing factors to smoke during pregnancy.................................................................15
2.6 Conceptual framework.......................................................................................................16
2.7 Literature gap.....................................................................................................................18
2.8 Summary............................................................................................................................18
Chapter 3: Research Methodology...........................................................................................19
3.1 Introduction to the chapter.................................................................................................19
3.2 Philosophical aspect of the research..................................................................................19
2

3.3 Data collection...................................................................................................................21
3.4 Data sources.......................................................................................................................21
3.5 Key terms...........................................................................................................................21
3.6 Criteria for literature..........................................................................................................21
3.7 Data analysis......................................................................................................................22
3.8 Data summary....................................................................................................................22
3.9 Research Ethics..................................................................................................................25
3.10 Limitations of the research...............................................................................................25
3.11 Timeline...........................................................................................................................25
3.12 Summary..........................................................................................................................27
Reference list............................................................................................................................30
3

Chapter1 Introduction to the research
1.1 Introduction
Smoking during pregnancy can affect both women and infants. It causes adverse effects
during pregnancy or after pregnancy. Infants are at higher risk and it increases likelihood of
complications such as placental abruption, preterm birth, miscarriage and others. The women
in nowadays are becoming aware that smoking is risky during pregnancy (Crawford-
Williams et al., 2015). Therefore, beliefs and knowledge are needed to explore the reasons
during pregnancy despite of health impacts. It influences the women regarding own health
and safety. The research will investigate influences of smoking and adverse effects over own
health and safety. Despite the health impact over women, they are smoking during and after
pregnancy. It is associated with health risks and adverse effects of smoking with attitudes and
beliefs of pregnant women. In the relation to maternal socio-demographic characteristics,
morbidity, health literacy, and pregnancy related factors are considered so that the women
can be more aware. Prenatal smoking has several risk factors that deal with smoking in
pregnancy time (Tsakiridis et al. 2018). The result can be considered to associate with
decreased birth weight of the baby. With regards to health effects, Sudden Infant Death
Syndrome (SIDS) is reported among the women who have smoked during pregnancy. The
research will investigate the reasons of why women smoke during pregnancy and its adverse
effects.
1.2 Background to the problem
Since 1965, smoking prevalence has declined among the women in the reproductive age. It
has been evidenced that 40% of white pregnant women and 33% of black pregnant women
smoke during and after their pregnancy (Annualreviews.org, 2019). Smoking prevalence
decreases during pregnancy as education and maternal age increase. Among the pregnant
women, prevalence of smoking is higher towards white women rather than black women.
Regardless of marital status, 25% or above mothers quit smoking after learning about
smoking later. 21-35% women may relapse who are pregnant due to adverse effects of
maternal smoking (Annualreviews.org, 2019). Due to spontaneous quitters, it maintains the
insights regarding quitting smoking during pregnancy. The increase rate in smoking
prevalence consider the expansion of women’ smoking rate during designing to appeal to
women. It has been found that smoking has increased level of addictions during pregnancy
and some studies suggest that smoking educes anxiety and negative effects in order to
4

enhance pleasure and relax (Vivilaki et al., 2016). Smoking helps women to control weight,
concerning for body weight through cigarette has long been issue for women.
1.3 Statement to the problem (Rational)
The health issues regarding epidemiologic follow up associates with depression and smoking
that is related to extensive information based availability. 10%-27% pregnant women
continue using smoking during pregnancy (Annualreviews.org, 2019). Social norms and
family factors are the source to focus on exploring the reasons for establishing prevalence of
smoking effects during pregnancy. Cigarette smoking has declined among women of
reproductive age (WRA) as the age of 18-44 years aged women are declining habit of
smoking in recent times (Annualreviews.org, 2019). Prevalence of daily smoking is
increasing among the young aged girls. There are some increased chances of diseases that can
be found among the newborn babies as well as the mothers. The issues are mainly found due
to lack of awareness, depression or other psychological conditions, improper decision-making
process for the research.
It is found that over 8344 women, 35.3% were reported smoking before pregnant and 26.2%
continued during pregnancy (Smedberg et al., 2014). Woman, who smokes 10 cigarettes or
more per day, has higher prevalence of unhealthy pregnancy and some defects in new-borns.
Women living in Eastern Europe have higher rate cigarette consuming during pregnancy due
to lack of education and awareness. Smoking harms nearly every organ while it causes
serious health conditions among the pregnant women including cancer, addiction, diabetes,
heart disease, eye problem and others (Coleman-Cowger et al., 2017). Preterm labour ectopic
pregnancy and bleeding problem from vagina, placental abruption and placental previa are
found during pregnancy in some cases. The placenta grows in uterus and it is used to supply
oxygen to baby through umbilical cord. Due to smoking, the oxygen has become polluted.
Chemicals like carbon monoxide ad nicotine pass through umbilical cord to the baby.
The issues are identified as high area of concerns regarding presenting pregnancy. Some
studies have found that smoking habit by the women is initiated to reduce stress and relax as
coping mechanism. According to Tsakiridis et al. (2018), the issues regarding health impact
during pregnancy are found to relate with both physical and mental condition. During
pregnancy, it is found that health issues are found for direct smoking and second hand
smoking. The issues are considered as valuable appeal for perceiving the self-confidence and
motivation regarding smoking initiation regarding pregnancy complications. Smoking
5

behaviour is found regarding focusing on adverse smoking outcome and health affects during
pregnancy (Vivilaki et al., 2016).
The research will shed light on establishing experiences over smoking habit and behaviour
during pregnancy. During pregnancy, it is effective to quit smoking during pregnancy. The
adverse health impact due to smoking is related to experience the healthy pregnancy. The
research is effective to focus on adverse health impact over pregnancy and after pregnancy.
The research will establish effective focuses and health impact regarding experiencing the
healthy pregnancy for the women.
1.4 Research aim
The aim of the research is to explore the reasons, why women smoke during pregnancy
despite the health impacts.
1.5 Research objectives
The research objectives are:
 To investigate factors that influence women to smoke during pregnancy
 To focus on reasons of smoking prevalence among the pregnant women
 To evaluate the family, societal level factors of smoking during pregnancy
 To recommend the pregnant women regarding health education and knowledge
regarding adverse effects of smoking
1.6 Research questions
The research questions are:
 What are individual level factors that influence women to smoke during pregnancy
despite health impacts?
 What are the family, societal level factors that influence women to smoke during
pregnancy?
Sub questions:
 What are reasons of smoking prevalence among the pregnant women?
 What are the recommendations to pregnant women regarding health education and
knowledge regarding adverse effects of smoking?
6

1.7 Significance of the research
Smoking has extreme effects in both personal health and psychological condition of the
individual. It is important to focus on identifying reasons to overcome the issues for
individual. The research is considered significant as smoking has shown adverse effects
during pregnancy and prevalence of smoking is increasing in nowadays in spite of increased
awareness. It is important to focus on implementing the research aim to link with literature
over identifying the issues (Rockhill et al., 2016). The issues regarding research topic is
important to focus on establishing the basic intervention process implementation in stating
the healthy pregnancy by avoiding smoking. Hence, the study is focused simultaneously on
smoking during pregnancy across world. In most of cases, knowledge and awareness are
relevant for offering the smoking cessation support and therapy to the pregnant women. The
purpose of the research is to shed light on prevalence and extent of smoking during
pregnancy that affects both mothers and new-borns (Drake et al., 2018).
1.8 Summary of the chapter
The chapter introduced the research topic with research aim and objectives. It identified the
key operations and interventions of the topic effects of smoking over pregnancy. This chapter
has identified the key issue and research background to interpret and involve the smoking
effects regarding pregnancy and intervention process in pregnancy. It is important to
introduce the relevant research on supporting pregnancy cessation and clear understanding on
why pregnant women smoke during pregnancy. The reasons of smoking are clearly
interpreted in the chapter. It has introduced the risk factors and issues regarding reasons of
women smoking during pregnancy.
1.9 Operational definition
Smoking:
Smoking refers to active smoking of cigarette or hand rolled tobacco in cigars, pipes or
others. Cigarette smoking behaviour is considered to addiction and psychological conditions
of individual that become addiction to them (Weinberger et al., 2017).
Pregnancy:
7

Pregnancy is known as gestation in where offspring develops inside the woman. Offspring
from embryo is developing during first eight weeks and following fertilisation. Fetus is
known as until the birth.
Intervention:
Intervention process can be defined as combinations of program elements and strategies that
are designed to provide behaviour changes or health improvements status for individual ort a
selected population against any particular disease (Hall, 2015).
Smoking cessation:
Smoking cessation is associated by following health benefit by quitting smoking. It reduced
risks of several of diseases regarding heart disease, stroke and vascular disease that can be
caused due to smoking.
Depression:
Depression is a psychological condition that is common and serious regarding how people
feel, think and act in the low condition. It is a feeling in which people are sad, demoralised
and due to mental pressure or shock.
Decision-making:
The action or process of taking or concluding any decision in certain limit is defined as
decision-making process. This system encourages developing proper decisions in complex
situation of individual.
8

Chapter 2: Literature review
2.1 Introduction
The chapter develops knowledge on the existing literatures regarding adverse effects of
smoking during pregnancy. The chapter reviewed the several theories and concepts to
interpret sources of authors regarding the smoking effects and reasons for smoking by the
pregnant women. Credible sources from several literatures are taken into considerations by
establishing research questions and objectives. Basic concept of smoking effects and existing
literature on it would be discussed with critical review and arguments.
Tobacco smoking is a marker of pervasive cause of economic and social disavnategs. In
international context, smoking has link with social determinations with high impact over
populations in disadvantaged circumstances (Bradizza et al., 2017). While the context
education and health care, higher incarceration rates and lower socioeconomic level are
considered to represent the deprived areas of disadvantaged contexts for impact of smoking.
Several researches have been conducted to assess the research gaps and opportunities during
pregnancy and adverse effects of smoking. In the lower income countries, negative health
impact influences the tobacco control and smoking cessation (Passmore et al., 2015).
2.2 Effects of smoking over pregnant women
Smoking during pregnancy puts both pregnant woman and her baby at risks. During
pregnancy, individual has habit to smoke due to addiction. Smoking can prevent pregnancy
and causes cancer. Second hand smoking is equally dangerous for pregnant women and
newborns (Flemming et al., 2016). Negative effects have been identified as influencing
factors for low-income pregnant smokers. Young and urban pregnant smokers have been
identified to continue with significant higher levels of stress and other psychological effects
on her and her baby. Delivery complications and negative effects are found including
depressive disorders and smoking cessation in pregnant women. There are several effects of
smoking during pregnancy conditions like:
Miscarriage and stillbirth:
Unexpected loss of pregnancy can be caused due to smoking. It is found that dangerous
chemicals are found to blame complications during pregnancy (Bradizza et al., 2017). The
issues are found to cause miscarriage or stillbirth.
9

Ectopic pregnancy:
It is found to prevent embryo passing through contractions. This results into ectopic
pregnancy. It happens while fertilised egg implants outside of uterus (Lee et al., 2018). This
complex situation can harm and threaten mother. In this situation, embryo must be removed.
Placental abruption:
Placenta in lifeline forms during pregnancy during pregnancy while providing fetus with
oxygen and nutrition. Placental abruption can be found as result of smoking during
pregnancy. This is ever a condition to cause severe bleeding and threaten for reattaching it
(Forray, 2016).
Preterm birth:
Smoking during pregnancy can cause preterm birth. It is associated with placental
impairment that includes the numerous health risks regarding preterm birth. There may be
several conditions regarding hearing and visual impairments, mental disability and
behavioural problems of the new-borns (Estabrook et al., 2016).
There are other risk factors in pregnancy regarding low birth weight of new-borns, several
birth defects, low birth weight and others. The risk factors are focused to advance the medical
care and reduced birth numbers for establishing healthy delivery. The risk factors are
included with pregnancy regarding psychological and physical health impact. It is needed to
contribute with establishing health risks and other influential factors for the pregnant women.
2.2.1 Social cognitive theory
According to Melchior et al. (2015), social cognitive theory is stated to develop the unique
emphasis on external and internal social factors that initiates the unhealthy behavioural
practice. It is required to influence the specific behavioural impact and experiences to
perform the specific behavioural trends. The theory focuses to establish reciprocal
interpretation of individual regarding specific behaviour like smoking behaviour. As per the
theory, smoking behaviour for pregnant women engage specific factors regarding behavioural
development and initial changes regarding behavioural changes with this behavioural aspects
(McEvoy and Spindel, 2017). Health behaviour is considered to develop the self-efficacy
regarding dynamic and reciprocal interaction of those women regarding health impact during
pregnancy.
10

The theory considers several influential factors that level up the social conditions regarding in
developing focused public health intervention process. It addresses the behavioural changes
that are difficult to promote during any problematic phase. As argued by Lange et al. (2015),
several health programs are found to discuss and establish the minimal attention to risk
factors of individual in pregnancy. In regards to developing own considerations for
conducting more expectations in complex situation, it is important to focus on clarifying
focused public health impacts and campaigns. It is clear regardless of experience of addiction
for following the health promotion in developing the situation. It is needed to conduct the
health campaigns for developing and establishing entire operational development (Meernik
and Goldstein, 2015).
2.3 Reasons of smoking by pregnant women
Tobacco increases the risks related factors due to smoking. There are several reasons that are
responsible for complex condition during pregnancy (Bradizza et al., 2017). Smoking has
increased risk factors to develop and implement in neonatal or perinatal mortality. Smoking
has some intense increased risk related factors to many functions regarding asthma, lung
cancer and infant death. It is included regarding several risk factors that is determined and
included with smoking. Any particular reason is not enough to cause addiction to nicotine
(Passmore et al., 2015). Tobacco can be controlled as it became complex links with health
determinations from health disparities. As per the view of Gould et al. (2017), tobacco
smoking is one of the most significant reversible risks that have impact during delivery on
maternal, infant and fetal health. Babies are exposed to toxic effects that can experience
prenatal and inter-urines metabolites. Risks of prenatal smokeless tobacco are also high foe
sustaining chronic detriments and high prevalence of tobacco among the pregnant women.
Despite identified addiction of smoking, low and middle-income countries shave high
prevalence of smoking effects on their health.
Addictions:
People start smoking casually therefore, it becomes addiction. Addiction is the main reason
that people cannot quite smoking easily. Newer influences resulted to get addictions
regarding addiction to nicotine. It is influencing people by continuous estimation of smoking
in regular basis (Dietl et al., 2015). There are several reasons that nicotine absorbs through
lungs as cigarette smokers have health risks that is dependable upon direct emphasise on
quick approach especially in pregnancy. Personal feeling regarding low motivation,
11

depression and other psychological conditions are found as reason of addicting smoking.
Several psychological and genetic factors are responsible to influence the women smoking.
Patterns:
Smoking can be connected in daily life activities that are linked like watching TV, hanging
out with friends and others to relax (Vandenbroucke et al., 2016). It results smoking
addiction in later stages with starting as pattern ort relaxation.
Emotions:
As opined by Kirkegaard et al. (2015), emotional factors can be considered as another reason
of smoking. Many people cannot cope up with post-traumatic stress disorder (PTSD).
Smoking helps the people to cop up with the conditions. It helps to deal with emotional
attachment and supports that causes adduction of smoking.
Women begin to smoke for overcoming any critical situation or psychological conditions
regarding stressful and depression. During pregnancy, several health conditions affect during
pregnancy for establishing self-confidence and knowledge regarding health impact. Lack of
knowledge, confidence, low education level and other social factors are the main reasons for
establishing as significant reasons for smoking. As per the view of Aldinger and Schulze
(2017), smoking behaviour is considered to develop more knowledge and high stress risks
regarding perceiving knowledge and awareness. It needs to focus on delivering effective
health related treatments for smoking cessation.
2.4 Intervention process to smoking cessation
Tobacco is considered as leading reason of addictions of smoking. There are several
intervention processes regarding the smoking cessation and nicotine avoidances. Tobacco use
should be replaced as it causes several treatment process regarding long-term success rates.
Quitting smoking has significant effects regarding effective intervention process for
individual. As per the view of Kirkegaard et al. (2015), nicotine replacement therapy (NRT)
is considered as affecting smoking cessation for individual. NRT is significant intervention
process that sheds lights on overcoming the addictions. Again, pharmacotherapy and
combination of NRT are effective to process the long-term uses and effects for enhancing the
smoking cessation for healthy pregnancy (Crawford-Williams et al., 2015). Nicotine uses
should be reduced to overcome and avoid to adverse effects of smoking during pregnancy.
12