Having a baby is a very special event.  No one would suggest, including smokers' rights advocates, that anyone take any chances that might result in the loss of a baby -- even if it's a million to one shot.  But for all practical purposes, how many women work until their ninth month of pregnancy instead of staying home and taking it easy?  Surely that is the safer alternative, is it not?  But no one is bombarding pregnant women with commercial messages that say if they work they risk miscarrying.  Why not?  We'll tell you why.  Because the risk is so minimal and there is no one who will or nothing to gain from scaring women with a message like that.

Unlike the deafening silence you hear about being pregnant and working, the paid advertisements from the American Legacy Foundation, a unit of the American Cancer Society, an organization with a greater agenda than to just warn women about smoking and pregnancy, works hard to scare the pants off of women.

Now, we probably wouldn't have a problem with ads that inform women that smoking while pregnant may increase the risk for miscarrying. But when they resort to their historical fear-mongering tactics, using numbers that they grab out of thin air, then it's just another occassion to denounce and expose them for unethical practices.  It's rampant in the anti-tobacco campaign. Even now, when the message has enough merit on its own they continue to mar their own credibility.  We don't condemn the message, just their manipulation of facts and figures to send the message.

In the end the final decision should be left up to the pregnant woman and not thrust upon her with guilt that alone could cause a miscarriage.

This is what their ad says:



First we called the hotline number provided in the ad (1-866-66-START).  The operator who answered the phone spent 10 minutes trying to track down the source and she couldn't.  So next we emailed both the American Legacy Foundation AND the American Cancer Society and asked them the same question.

The American Cancer Society's reply:

The statistic from our ad campaign that stated that "that smoking causes 18,000+ miscarriages" was quoted from a study authored by Joseph DeFranza and Robert Lew which was published in the Journal of Family Practice on 4/1/95. The title of their study was "Effect of Maternal Cigarette Smoking on Pregnancy Complications and Sudden Infant Death Syndrome"

The American Legacy Foundation's reply:

The statistic used in the Great Start ads you referred to comes from a study authored by Joseph DiFranza and Robert Lew and published in the Journal of Family Practice on 4/1/95. The title of the study was 'Effect of maternal cigarette smoking on pregnancy complications and sudden infant death syndrome.'

Anyone familiar with the weight of evidence that is usually necessary to support such claims will understand that one study by one team is hardly convincing.  Their study was conducted in 1995.  Are there no others before or since that they deem worthy of citation?  According to the responses, no.

And what of the particular "study?"  What exactly does it say?


"Effect of Maternal Cigarette Smoking on Pregnancy Complications and Sudden Infant Death Syndrome"
J Fam Pract 1995 Apr;40(4):385-94   (ISSN: 0094-3509)

Di Franza JR; Lew RA
Fitchburg Family Practice Residency Program, University of Massachusetts 01420, USA.

BACKGROUND. The purpose of this study was to estimate the annual morbidity and mortality among fetuses and infants that can be attributed to the use of tobacco products by pregnant women. METHODS.Published research reports identified by literature review were combined in a series of meta-analyses to compute pooled risk ratios, which, in turn, were used to determine the population attributable risk.RESULTS. Each year, use of tobacco products is responsible for an estimated 19,000 to 141,000 tobacco-induced abortions, 32,000 to 61,000 infants born with low birthweight, and 14,000 to 26,000 infants who require admission to neonatal intensive care units. Tobacco use is also annually responsible for an estimated 1900 to 4800 infant deaths resulting from perinatal disorders, and 1200 to 2200 deaths from sudden infant death syndrome (SIDS). CONCLUSIONS. Tobacco use is an important preventable cause of abortions, low birthweight, and deaths from perinatal disorders and SIDS. All pregnant women should be advised that smoking places their unborn children in danger. The low success rate of smoking cessation among pregnant women suggests that efforts to reduce the complications of pregnancy attributable to tobacco use by pregnant women should focus on preventing nicotine addiction among teenaged girls.

Publication Types: Meta-Analysis

PMID: 7699353 [PubMed - indexed for MEDLINE]

As noted in the study, it was the result of meta-analysis, the pooling of many reports, not independent research, to reach a conclusion.  What reports did they identify by literature review?  Where is the peer review?  How do we know they didn't cherry-pick literature that supported a preconceived notion and ignore those that did not?

And notice the estimated spread: 19,000 to 141,000

Then recall the American Foundation Legacy's ad:  "SMOKING WHILE PREGNANT WILL CAUSE 18,925

Funny how they chose a number that falls below the lowest estimate of the study.  But why not choose a number closer to the higher estimate?  Why not 131,295 miscarriages a year?

This is our argument.  The deception and manipulation that is pervasive throughout the health organizational industry is abhorent. Their ultimate goal, ALL those involved in anti-tobacco initiatives, is to end smoking for good.  Not just pregnant women but everyone.  They have dug their deceptive hole so deep that they are mired in it even when the message has some worthiness.  It leaves you with a sense of incredibility on their part no matter what it is they say.  Nothing can be taken at face value.  Everything must be questioned.  And when the questions start flying, the answers are far from sufficient.

The DiFranza "study" is no study at all and their use of a number in their miscarriage commercial that is attributed to his work is simply an exercise in propagating an uncertainty as fact.


Back in the early 90s the Environmental Protection Agency used his kiddie figures, too, in their so-called Cost/Benefit report on
Environmental Tobacco Smoke (ETS).  The figures came from a study he had submitted to JAMA but wasn't yet published.  Turns out it was rejected by JAMA  He then submitted it elsewhere and it was published.

In a communication to his cronies he said something like "We have the conclusion, now all we need is the data."  Not his exact words, but you get the picture.  It was all written up in the Washington Times.  In the end he managed to escape any real


A piece by dismisses the hysteria surrounding associations leveled at cocaine, tobacco use and miscarriage.

In addition to dispelling the accusations, it is pointed out that "miscarriage is far from understood and flaky associations are easy to come up with." A 1996 American Journal of Epidemiology study (Nov. 15, 1996) reported that:

               Carrying 20-pound loads on the job at least once per day was associated with a statistically
               significant 70 percent increase in miscarriage.

               Reaching over the shoulders at least once daily was associated with a statistically significant 35
               percent increase in miscarriage.

               Drinking 3 or more cups of coffee daily in the first month of pregnancy was associated with a
               statistically significant 134 percent increase in miscarriage.

Junk Science concludes:
"Finally, existing studies on smoking and miscarriage have mixed results. Given the weakness in the current study's results, the split in studies is a sign that, in fact, no association exists.

"I'm surprised this study didn't spontaneously abort during peer review."


Their problem rests with their idea that you won't listen unless they exaggerate or outright lie.  So maybe their problem isn't so much the juggling of numbers but that by juggling the numbers they seek to have greatest control over your life and your personal choices. Their true concern, thus influence, evaporates and the insatiable urge to force conformity grows larger than life.

Should you smoke while pregnant?  We'll only say that it is an unnatural source being introduced into your body.  But so are the ingredients in much of the food you choose to put into your mouth.  You know the basics. You decide.

While you make your decision...

Let's look at other opinions and accused culprits of miscarriage, 
otherwise known as spontaneous abortion.


Family Physician Jane Forester has some information about this sad event

As far as we are able to determine, it can be approximated that in the first 8 weeks of pregnancy, the miscarriage rate is about 10-15 per cent of a clinically recognizable pregnancy. Often a woman may not know that she is pregnant, and after being slightly late for her period, get a heavier than usual menstrual cycle. This is often not recognized as a miscarriage but instead just a late, heavy period. That's why in the earliest part of pregnancy it is difficult to quantify actual percentages of miscarriages.

NYC C.L.A.S.H. Note: This is counter to what Dr. DiFranza and the American Legacy Foundation will have you believe. Remember, they state as fact the exact number of miscarriages due to smoking.

Even now, there is still much confusion about the various causes of miscarriage. Women who smoke 20 cigarettes daily and consume more than seven standard alcoholic drinks per week have a fourfold increase in their risk of miscarriage.

NYC C.L.A.S.H. Note: A doctor's opinion wouldn't be complete if they didn't stay true to the anti-tobacco philosophy.  But one needs to wonder if a pregnant woman cut out either smoking or drinking would that decrease the risk to twofold?  The statistics is fancy footwork on their part.  They give no explanation because there is no reasonable explanation for their conclusion.

In addition, women who are over 40 years old have a 10 percent chance of miscarriage, in comparison to a 2 percent chance in someone less than 30 years old.

The most common cause of miscarriage is a significant genetic abnormality of the fetus. In miscarriages in the first trimester, approximately two thirds have significant chromosomal anomalies, with about half of these being Down's Syndrome. This is not an inherited trait from the mother or the father; it is usually one single nonrecurring event.
Common causes of pregnancy loss
According to Dr. John Sussman, MD, co-author of Trying Again, the fact remains that doctors can't always offer conclusive explanations for pregnancy loss.

Here's a look at some of the most common causes of miscarriage.

Chromosomal abnormalities
Maternal disease
Hormonal imbalances
Rhesus (Rh) disease
Immune system disorders
Allogeneic factors
Anatomical problems of the uterus
*Drug abuse and exposure to harmful substances: Alcohol,
caffeine, smoke (first or second hand), chemicals used by dry
cleaners, photofinishers, and radiation all pose risks to your
unborn child.
Increasing maternal age: According to Sussman, "While
women in their 20s have a 10 percent chance of experiencing a
miscarriage, the risk for women in their forties is believed to be
approximately 50 percent."

*A recent study completed on the effects of chemotherapy given to mothers while pregnant after following their children into adulthood, and even parenthood themselves, reveals no harm.  Thus, the claim that "harmful substances" such as dry cleaner chemicals and radiation is not so convincing anymore:

Clin Lymphoma 2001 Dec;2(3):173-177

Hematological Malignancies and Pregnancy: A Final Report of 84 Children
Who Received Chemotherapy In Utero. [FULL TEXT]

Aviles A, Neri N.

Oncology Diseases Research Unit, Oncology Hospital, National Medical Center, IMSS,
Mexico, D.F., Mexico.

To evaluate the risk of acute and late side effects in children whose mothers received chemotherapy during pregnancy for hematological malignancies, we performed an analysis of 84 children with a long-term follow-up.

Some of these patients have become parents, and their children were also considered in this analysis. In all of the children studied, including the 12 second-generation children, the birth weight was normal; learning and educational performance were normal; and no congenital, neurological, or psychological abnormalities were observed. With a median follow-up of 18.7 years (range, 6-29 years), no cancer or acute leukemia has been observed. These results confirm our previous reports, suggesting that if a pregnant patient has an aggressive hematological malignancy, chemotherapy at full doses can be safely administered, even during the first trimester, if cure of the hematological malignancy is considered reasonable.

PMID: 11779294 [PubMed - as supplied by publisher]

Stress and Early Miscarriage [full text]

Fox News Network
June 3, 1997

NEW YORK: Women who log many hours at the office during the first trimester of pregnancy may have a greater risk of miscarriage compared with women who work fewer hours, a new study in lawyers suggests.

And stress may be the culprit: The more hours a woman worked, the more likely she was to report feeling stressed, although there was no direct connection between stress level and miscarriage, according to a report in the Journal of Occupational and Environmental Medicine.

"Working more than 45 hours per week on the job was a strong predictor of stress and was associated with a three-fold higher rate of miscarriage, even after taking into account other factors such as age, smoking, alcohol intake, and previous miscarriage," said lead study author Dr. Marc B. Schenker of the University of California-Davis School of Medicine in Sacramento.

NYC C.L.A.S.H. Note: The study is of working women but the issue is stress.  How much stress does the American Legacy Foundation put on pregnant women who smoke with their ad?

Caffeine Intake and the Risk of First-Trimester Spontaneous
The New England Journal of Medicine

Among nonsmokers, more spontaneous abortions occurred in women who ingested at least 100 mg of caffeine per day than in women who ingested less than 100 mg per day, with the increase in risk related to the amount ingested (100 to 299 mg per day: odds ratio, 1.3; 95 percent confidence interval, 0.9 to 1.8; 300 to 499 mg per day: odds ratio, 1.4; 95 percent confidence interval, 0.9 to 2.0; and 500 mg or more per day: odds ratio, 2.2; 95 percent confidence interval, 1.3 to 3.8). Among smokers, caffeine ingestion was not associated with an excess risk of spontaneous abortion. When the analyses were stratified according to the results of karyotyping, the ingestion of moderate or high levels of caffeine was found to be associated with an excess risk of spontaneous abortion when the fetus had a normal or unknown karyotype but not when the fetal karyotype was abnormal.

Conclusions The ingestion of caffeine may increase the risk of an early spontaneous abortion among
nonsmoking women carrying fetuses with normal karyotypes.

NYC C.L.A.S.H. Note: This is enough to confuse anyone.  If you don't smoke but drink a certain amount of coffee per day you're at a higher risk for miscarriage than if you smoked.  And if you smoke, drink all the coffee you want without fear of the caffeine putting you at risk of a miscarriage.  Do they imply that smoking protects pregnant coffee drinkers from miscarriage?  If so, then how is it that smoking is blamed for miscarriage at all?

Hint:  Researchers looking to assign the blame to a substance will be able to do so in contradiction to other studies.  That negates credibility and reliability of any produced study on the subject.

Appliances May Increase Miscarriage Risk
Exposed Women Twice As Likely To Miscarry

Everyday electrical appliances may prove risky to pregnant mothers, according to researchers in California.

The strong magnetic fields produced by some electric appliances and vehicles increase the risk of miscarriage,
researchers said.

And let's not forget what other risks noted and attacked:

Carrying 20-pound loads on the job at least once per day was associated with a statistically significant 70 percent increase in miscarriage.

Reaching over the shoulders at least once daily was associated with a statistically significant 35 percent increase in miscarriage.


An editorial addressing the study on cocaine, tobacco use and miscarriage had this to say:

"Spontaneous abortion is particularly difficult to study.  Very early spontaneous
abortions often go unrecognized; women mistake them for 'late periods.'
Trying to study the incidence or cause of early spontaneous abortions by
using women who seek care at a hospital is also problematic because not all
women go to the hospital when early abortion is imminent, and those who do
are probably not representative of all women who have early spontaneous

And it goes on with further qualifications about how difficult it is to determine the CAUSE of spontaneous abortion even when the aborted fetus and placenta are physically examined and analyzed...

...But the American Legacy Foundation will quote you an EXACT number of miscarriages due to smoking.

We are in no way telling pregnant women to smoke.  Our intent is to provide further evidence that those involved in anti-smoking activities do not care what methods they use to get their mission accomplished.

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