A study released this week suggests women who smoke during pregnancy are more likely to rear children who are involved in delinquency.
The Australian Institute of Family Studies reports 12- to 13-year-olds whose mothers smoked frequently during pregnancy were 18% more likely to engage in crime than those whose mothers didn't smoke.
But studies such as these can only look at potential associations; they cannot show cause and effect. So the results must be interpreted with caution.
The researchers did adjust their analysis to account for a range of factors: child, maternal and household characteristics; pregnancy and birth complications; and parenting style. However, it could be that smoking is a marker for other things such as poverty, low socioeconomic status and vulnerabilities that could not be accounted for or accurately measured.
It's therefore likely that high levels of social disadvantage are actually being measured and smoking is a marker of this inequality.
It's well known that smoking in pregnancy is a risk factor for a range of complications for women and their babies. I co-chaired the development of the Australian antenatal clinical practice guidelines which included a module on tobacco smoking. We reviewed the literature and highlighted the complications including low birth weight, preterm birth, small-for-gestational-age babies and infant death during or after birth.
While the prevalence of smoking in pregnancy has declined in many high-income countries over the past decade, this decline has not been consistent across all sectors of society. People who are socially disadvantaged or vulnerable often have higher rates of smoking.
Midwives, obstetricians and general practitioners play an important role in working with and supporting women to quit. The guidelines recommend asking pregnant women about their own smoking status and their exposure to passive smoking (most commonly through a partner smoking) at their first antenatal visit. Women should be provided with information about the risks of smoking and passive smoking, and practitioners should emphasise the benefits of quitting.
Discussion about smoking should not stop at the first visit. The guidelines recommend that at each antenatal visit, women who smoke should be offered personalised advice on how to quit and when, where and how to access support services, along with support and encouragement.
Many women want to give up or reduce their smoking but the complexities of their lives and their social networks mean it's often difficult. There are women who are struggling with poverty, lack of employment or housing opportunities, problems with drug and alcohol use and domestic violence.
Research shows that for some women, smoking is an opportunity for "time out" from social pressures and for "sharing with others". For others, it's a way to reduce stress, ease social interaction, relieve boredom and control weight. Ultimately, smoking may be seen as a less immediate problem relative to other issues.
These challenges and others mean that quitting smoking is difficult for many, and impossible for some. These women need support and assistance, especially during their pregnancy, rather than more guilt.
The new Australian Institute of Family Studies research is important and useful. But it's not correct to take away the message that if you smoke in pregnancy, your children will be involved in delinquency. And we need to careful not to add unnecessarily to the guilt of mothers.
It is my experience that almost all women try and do the best during pregnancy and in the early weeks and months of their baby's life. As a society, supporting women who are experiencing inequalities or vulnerabilities is critical - not only to address issues such as smoking in pregnancy, but also to mitigate the longer-term effects of poverty and social disadvantage.
In order to reduce the risk of delinquency at any age, we need a public health approach to address the social determinants of health.