A mother’s decision to smoke while she is pregnant has definite health consequences for the developing fetus and eventual newborn. These adverse effects continue to become apparent once she has given birth and can become manifest well into the adult propensities and problems of the once-exposed fetus in the form of attention, hyperactivity, greater risk of experimentation with nicotine and adaptability to it, and other related problems that invade the entire lifecycle.

While most people are aware that smoking during pregnancy can have significant health implications, another important problem is that of neurological development of fetuses that are exposed to cigarette smoke while they are still developing. Children born to mothers who smoke are at a distinct disadvantage in terms of prenatal neurological development and the effects of a mother’s decision to smoke during her pregnancy can be seen in the behavior of their children. While the bulk of research in the latter half of the last century was aimed at exploring in detail the physical effects of smoking on fetal development, the last decade in particular has provided a wealth of new evidence pointing to distinct development differences between the children of smokers versus those of non-smokers. These differences can become manifest from the stage of infancy far into adulthood and this information should become part of new anti-smoking literature for women who smoke and may become pregnant, especially since exposed children will be at a much higher risk level for becoming smokers themselves as they progress into early adulthood (Cornelius, 2006).

The absolute consensus among medical professionals is that smoking during pregnancy results in a number of potential health problems for the infant ranging from the relatively minor to the unimaginable. There are numerous lists that discuss the many negative health consequences of smoking during pregnancy and common items on such a list include “increased risk for ectopic pregnancies, spontaneous abortion, and preterm delivery. Infants born to women who smoked during pregnancy have lower birth weights, are more likely to be small for gestational age, are at increased risk for prenatal mortality (both from neonatal deaths and from risk for sudden infant death syndrome) and are at increased risk for a number of negative health outcomes" (Willoughby, 2007, p. 212). While it would be possible to spend several pages detailing these and other complications caused by a mother’s continued smoking during her pregnancy, less public attention has been paid to the many studies that draw clear lines between smoking during pregnancy and neurological development. Many developmental problems such as attention deficit or hyperactivity disorder have been characterized as neurological or behavioral problems, but too little attention has been provided about the proven links between a mother’s smoking during pregnancy and onset rates of these disorders. In addition to these disorders is a higher chance that the child will also become a smoker (Cornelius, 2006) so when one examines the issue in total, the neurological and behavioral risks are just as important as the physical issues.

Smoking during the period of fetal development carries obvious great risk to the infant, but the problems from do not disappear when the infant is born. Several studies have successfully found correlations between neurological and behavioral problems when comparing the children of non-smoking mothers. According to one study that examined the behavior patterns of children who had been exposed to a mother who smoked during her pregnancy, there were marked differences in mood and more general development, especially for boys. Willoghby et al. state that, “on average, infants who were exposed to higher levels of prenatal smoking exhibited less positive affect and greater irritability. Moreover, among male infants, elevated levels of prenatal exposure to smoking were associated with lower levels of approach, gross motor movement, reactivity, and attention" (Willoughby et al., 2007, p. 210).

Developmental problems associated with maternal smoking begin early and can be seen in the reactivity levels of fetuses in tests involving ultrasound and other imaging techniques. These problems and differences between these and health fetuses are the beginning of a complex chain of differences that carry well into early adulthood. Many studies take a critical look at infant and early childhood development in the context of exposure to maternal smoking and have found that there are differences throughout the stages of development in how these problems manifest. Willoughby et al. (2007) stated that “Studies examining fetal and early infant development suggest that smoking is associated with a neurobehavioral profile that is characterized by atypical arousal…[this is] related to reduced fetal movement, less variation in heart rate, disruptions in fetal habituation, and less reactivity during nonstress tests" (p. 213) but as the child moves through stages of development, the opposite of this becomes true and a child can become irritable and agitated than others. Furthermore, this agitation and inability to concentrate can be characterized as attention deficit disorder or general hyperactivity, thus turning the tables on the initial problem of a lack of reactivity.

Several studies have indicated the infants of mothers who smoked during pregnancy had markedly less responses to stimuli of various kinds and had the observable effect of lessened sensitivity and affect, but interestingly, these reactions began to morph as a child hit a new stage of development—adolescence. For this age group, there was a new pattern emerging that moved away from the lower heart rate as a noticeably larger number of exposed children exhibited signs of hyperactivity disorder. According to one study that is aligned with several others (according to the results of a search of peer-reviewed medical and social science journal abstracts) children who were born to mothers who smoked during pregnancy had a far higher chance of having hyperactivity and attention problems. As one set of researchers stated, “Prenatally exposed children are most prone to follow a path of high levels of ADHD symptoms and associate elevated risk of early-onset experimentation with smoking, which is unreceptive to universal preventative intervention" (Vuijk, 2006, p. 891). With these issues in mind, it becomes clear that a mother’s decision to smoke does not simply have the immediate negative health impact on her unborn child, but the consequences of this decision can extend far into childhood, adolescence, and then finally, into the adult’s reliance on nicotine. The decision on the part of the mother to smoke can influence critical aspect of the child’s life by proxy—whether or not he or she becomes a lifelong smoker, or whether or not he attends a different school than his peers because of a problem with maintaining a level of attention and concentration that is parallel to that of others in his class—even if he is just as intelligent.

One of the most important issues that emerges when examining fetal development and maternal smoking is that this exposure can have an effect on the entire lifecycle of the woman’s fetus. The risks while the fetus is developing in terms of physical dangers, the higher instances of hyperactivity and increased chances of becoming a smoker show how the effects of smoking can influence every aspect of the child’s life eventually. The attention problems can lead to issues at school that prevent success and the higher chance that the child might begin to smoke means that the child too will be plagued with the negative health impacts of smoking. Another matter that is striking is how the wealth of literature on the subject of maternal smoking and its neurological and physical health effects on the fetus (and eventually fully-grown person) is how consistent it is. There is little scholarly contention about these facts and in fact, a search of what exists shows that new research on these topics emerges with each new issue of many academic journals.

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Cornelius, M. D., Leech, S. L., Goldschmidt, L., & Day, N. L. (2000). Prenatal tobacco exposure: is it a risk factor for early tobacco experimentation? Nicotine & Tobacco Research, 2(1), 45-52

Vuijk, P., Van Lier, P. A. C., Huizink, A. C., Verhulst, F. C., & Crijnen, A. A. M. (2006). Prenatal smoking predicts non-responsiveness to an intervention targeting attention-deficit/hyperactivity symptoms in elementary schoolchildren. Journal of Child Psychology & Psychiatry,47(9), 891-901.

Willoughby, M., Greenberg, M., Blair, C., & Stifter, C. (2007). Neurobehavioral Consequences of Prenatal Exposure to Smoking at 6 to 8 Months of Age. Infancy, 12(3), 273-301.