Heavy smoking birthmother entering 3rd trimester

Patient

Q: We are adopting a child and have discovered that the birth mother is a heavy smoker. She is 2/3 through pregnancy. We would like a clear picture of what the baby has been exposed to. Given we can not control the final trimester. I would like to know what potential problems we can expect from a heavy, full term smoker. Lastly, is there a test for either the fetus, or the birth mother, that could demonstrate the degree to which the fetus has been exposed to smoke. Thank you.

Respectfully, I know I can Google this data. I am seeking a well informed, nuanced answer. Thanks in advance for your help with this difficult problem.

Symptoms:  My question does not qualify.
Doctor

A:   Hello,
Thanks for the query.
Smoking can have a significant effect on the pregnancy as well as the fetal outcome. Smoking from a long time has more impact than a recent onset smoking.

Smoking can lead to constriction of the blood vessels and reduce the utero placental blood flow, that is the blood flow between the mother and the fetus. It leads to reduced oxygen supply to the growing fetus, leading to chronic hypoxia. This will hamper the growth of the baby physically and mentally. It can lead to intra uterine growth restrictions as well as low birth weight of the newborn. In view of this, the baby may need neonatal Intensive care for many days and can have a low immunity.

Smoking also leads to premature births or preterm deliveries, as it can cause hypoxia and instigate labor to set in early. As a result of this, the baby suffers and is born with growth retardation. Smoking produces harmful toxins like carbon monoxide, tar and nicotine which can have a detrimental effect on the development of the fetus in early pregnancy and can lead to complications.
In few cases, there can be a sudden loss of baby's heartbeat, leading to an intrauterine demise. This generally happens due to reduced blood supply to the fetus from the maternal placenta.

Sudden abruptions, that is shearing of the placenta and leading to heavy blood loss is a known complication of smoking. This will lead to fetal distress, indicating danger to the baby and need for immediate delivery. It may also lead to fetal death and maternal bleeding.
Placenta previa or the low-lying placenta is also associated with smoking, this may lead to severe bleeding during pregnancy which in turn raises a threat to the fetus and continuation of pregnancy.
Smoking has also known to cause hearing and visual impairments in the fetus, mental disorders, delayed milestones, behavioral disturbances in the baby. It can also lead to anomalies of the heart, cleft lip and cleft palate if the mother is a smoker.

There are tests to determine the extent of the damage to the baby due to maternal smoking. They are:
1. Early ultrasound tests like an NT scan and early anomaly scan to determine any skeletal defects and abnormal pregnancy.
2. A detailed level two ultrasound for screening any anomalies around 18 to 20 weeks of gestation.
3.Serial growth scan every 2 weeks or 4 weeks after 28 weeks of gestation until delivery
4. Doppler ultrasound for the blood flow to the fetus
5. Biophysical profile with non-stress test after 34 weeks.

Maternal tests include
1. Pre pregnancy chest X-ray or Chest X-ray with abdominal shield if done during pregnancy
2.2D echo to check the cardiac function
3. ECG
4.Pulmonary function tests to detect any obstructive pathology in breathing
5.Blood counts, liver and renal function tests.

Consult a gynecologist for follow ups and plan the delivery.

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