A pregnant woman who smokes asks about risks to her fetus. What is the most significant risk?

The most significant risk associated with maternal smoking during pregnancy is low neonatal birth weight. Smoking during pregnancy is linked to various adverse effects on fetal growth and development. Nicotine and other harmful substances in cigarettes can restrict blood flow to the placenta, impairing nutrient delivery and oxygen supply to the developing fetus. This can lead to intrauterine growth restriction, resulting in lower birth weight.

Low birth weight is a critical concern because it is associated with a range of short-term and long-term health complications for the neonate, including an increased risk of neonatal mortality, developmental delays, and various chronic health issues later in life. Moreover, low birth weight infants are often more vulnerable to complications such as respiratory distress and infections.

While other risks like respiratory distress at birth, severe neonatal anemia, and neonatal hyperbilirubinemia can occur in infants born to mothers who smoke, low neonatal birth weight remains the most significant and established risk due to the direct impact of cigarette exposure on fetal growth.