The fetal tobacco syndrome.

THE ADVERSE effects of substance abuse during pregnancy have been increasingly well documented. During the past decade, the term "fetal alcohol syndrome" was coined to refer to a constellation of adverse effects due to alcohol abuse during pregnancy. This was an important step in relating preventable maternal behaviors to adverse outcomes of pregnancy. Almost three decades ago, cigarette smoking during pregnancy was reported to affect birth weight adversely. 1 Although a very large number of studies have subsequently confirmed those findings and have further identified a broad spectrum of additional adverse consequences, 2 no diagnostic term analogous to fetal alcohol syndrome has been available to relate maternal smoking behavior to these adverse outcomes. Cigarette smoking during pregnancy is clearly associated with birth weight deficits of up to 250 g for full-term newborns. 3 A clear dose-response relationship exists between the number of cigarettes smoked and the birth-weight deficit. 4 Compared