In Reply.—An adequate reply to Dr Cunningham would involve citing several hundred articles on the effects of maternal smoking, including a dozen of our own. It would also involve consideration of the thesis that it is not cigarette smoking during pregnancy that affects the fetus and the placenta, but some other attribute of women who smoke.
Mothers who smoke, we find, weigh slightly less prior to pregnancy, gain a little less during pregnancy, and retain slightly less weight as the result of pregnancy.1 Yet pound for pound, and weight gain for weight gain, the neonates of smoking mothers are smaller and more often premature, even at constant socioeconomic status.2
In a quasi-experimental design, it is possible to compare successive pregnancy outcomes of women who gave up smoking between pregnancies and women who started the smoking habit between pregnancies. Giving up smoking is associated with a larger neonate,