SEATTLE - Trish Kump enjoyed working behind the bar at the Tides Tavern in Gig Harbor, Wash., pouring drinks in front of a lineup of ashtrays - and the smoking customers who used them.
An air purifier helped suck up some of the errant smoke, but not all of it. Newly pregnant, Kump began thinking about a story told to her by a pregnant co-worker at the Tides: After her first visit to her obstetrician, the doctor was convinced that Kump's co-worker was a smoker, when in fact she had never touched a cigarette in her life.
Kump began eyeing those ashtrays more perilously, concerned about her exposure to secondhand smoke and the consequences to her health and that of her unborn child.
"It's not like I could just walk away from the smoke," Kump said. "The bar, where most people smoke, was my designated area to work."
Doctors routinely warn expectant mothers about the dangers of secondhand smoke - that it can increase the risk for miscarriage, sudden infant death syndrome, low birth weight and premature birth. Now, new research suggests that secondhand smoke might be every bit as damaging to a fetus as if the mother were inhaling the smoke directly from a cigarette.
"The perception has been that smoking is the major problem and secondhand smoke is something we deal with down the road," said Stephen Grant, author of the study and an associate professor of environmental and occupational health at the University of Pittsburgh. "But here we have absolute evidence that passive exposure to cigarette smoke can cause just as much damage as if the mother was doing the smoking herself."
Fearing that, Kump thought about quitting her job at the popular waterfront tavern and restaurant until after her baby's birth, but she did not have to. Management at the Tides had approached owner Peter Stanley about turning his place into a smoke-free establishment. Customers were demanding it. Instead of enduring the smoke, some were leaving if they could not be seated in the nonsmoking area, which often was full.
Stanley's desire to give his customers what they wanted compelled him to ban smoking at the Tides in 2002. But something else was nagging at him, too.
"I had three staffers who were pregnant, and that was a very important part of the deliberation," Stanley said. "It was on my mind a lot. So when my manager said it was time to go smoke-free, I said, 'Great!'
"We've known for generations that cigarettes are bad for you, so it's not too much of a leap of faith to believe that secondhand smoke also is bad. I can't quote the science behind it, but it's logical."
Grant, the Pittsburgh scientist, discovered that secondhand smoke can cause genetic mutations - those that can lead to leukemia and lymphoma - that are indistinguishable from those found when the mother is the smoker.
His research, published earlier this summer in the online journal BMC Pediatrics, is based on the examination of umbilical-cord blood samples from newborns. The research is a reanalysis of three studies that downplayed or ignored the effects of secondhand smoke.
Grant said he hopes the study will alter the mind-sets of pregnant women, motivating them to be even more cautious, while also encouraging smokers to be more conscientious of those around them. And if the research is used to toughen laws on public smoking, so be it, Grant said.
Like the dangers of drinking alcohol while pregnant, expectant mothers - and their partners - also are getting the message on secondhand smoke. When women visit obstetricians at Swedish Medical Center for the first time, they leave with a notebook on what to anticipate during their pregnancy and once the baby is born. The information includes a list of things to avoid, with secondhand smoke high on the list.
"We don't soft-pedal the message; we reinforce it," said Katy Brock, a perinatal clinical nurse specialist at Swedish. "The way we present the information is that smoking is a definite risk and that secondhand smoke is also a risk and causes significant problems. We don't frame it as if one is less risky than the other."
At a childbirth-preparation class at Swedish's campus in Ballard, Wash., couple Lindsay Woltjer and Greg Rauch said they significantly changed their lifestyles once Woltjer became pregnant.
"The facts are out there," Rauch said. "She was a smoker, as was I. That stopped. And we don't go out to smoky bars or restaurants anymore."
The couple seeks out places that do not allow smoking anywhere in the building.
"You can only avoid so much," Rauch said. "I've had a couple barbecues at the house this summer. If my buddies light up, Lindsay will go to the other side of the patio or go inside."
Grant said he hopes his research sends a message to parents - and to smokers who puff in public.
"A woman who goes to great lengths to quit smoking, trying to protect her baby, may think she has done 90 percent of the job by quitting," he said. "Unfortunately, if we as a society don't address that other 10 percent that reaches her through passive exposure, then that mother hasn't protected her baby like she thinks."
New research suggests that a pregnant mother's exposure to secondhand smoke can be just as harmful to her fetus as if she were the one smoking.
Pregnancy dangers: According to the Centers for Disease Control and Prevention, smoking during pregnancy is considered the single most preventable cause of illness and death among mothers and infants.
̢ۢ Women who smoke during pregnancy are more likely than nonsmokers to have a miscarriage or ectopic pregnancy, which is when a fertilized egg is implanted outside the uterus, usually in the fallopian tubes.
̢ۢ Up to 8 percent of all babies who die less than a week after birth die because of problems caused by their mothers' smoking during pregnancy.
̢ۢ Babies born to smokers are 1.5 to 3.5 times more likely to have low birth weights than babies born to nonsmoking mothers. Low-birth weight babies are at risk for serious health problems throughout their lives.
Increased risks: According to an article in the online journal Pregnancy Today, studies have shown that smoking during pregnancy can increase the baby's risk of developing meningitis; asthma; oral cleft; stomach difficulties; sleep problems; and attention, motor control and perception disorders.
