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Women who smoke during pregnancy are 2.6 times more likely to give birth prematurely compared with non-smokers – more than double the previous estimate, new research suggests. The University of Cambridge study also found smoking meant the baby was four times more likely to be small for its gestational age, putting it at risk of potentially serious complications including breathing difficulties and infections. There was no evidence caffeine intake was linked to negative outcomes. We’ve known for a long time that smoking during pregnancy is not good for the baby, but our study shows that it’s potentially much worse than previously thought Professor Gordon Smith, University of Cambridge Professor Gordon Smith, head of the department of obstetrics and gynaecology at the University of Cambridge, said: “We’ve known for a long time that smoking during pregnancy is not good for the baby, but our study shows that it’s potentially much worse than previously thought. “It puts the baby at risk of potentially serious complications from growing too slowly in the womb or from being born too soon. “We hope this knowledge will help encourage pregnant mums and women planning pregnancy to access smoking-cessation services. “Pregnancy is a key time when women quit and if they can remain tobacco free after the birth there are lifelong benefits for them and their child.” The NHS recommends that women who are pregnant should stop smoking and limit their caffeine intake because of the risk of complications to the baby. When the toxins from smoke travel through the bloodstream to the baby, it struggles for oxygen. When this happens it affects their development, and is linked to premature birth and low birthweight, though it has also been linked to a reduced risk of pre-eclampsia (high blood pressure during pregnancy). High caffeine intake has also been linked to lower birthweight and possibly foetal growth restriction. But caffeine can be more difficult to avoid than cigarette smoke as, as well as being found in coffee and tea, it can be found in chocolate, energy drinks, soft drinks and certain medications. Researchers say studies looking at the links between smoking and caffeine and their impact on pregnancy tend to rely on people reporting how much they have consumed, or exposure to smoke, data which is not always reliable. Blood tests for metabolites – chemical by-products created when substances such as tobacco and caffeine are processed in the body – might be more accurate. Researchers at Cambridge and the Rosie Hospital, part of Cambridge University Hospitals NHS Foundation Trust, recruited more than 4,200 women who attended the hospital between 2008 and 2012 as part of the Pregnancy Outcome Prediction (POP) study. The team analysed blood samples taken from a group of these women four times during their pregnancies. To assess exposure to cigarette smoke, the team looked at levels of cotinine, which can be detected in blood, urine and saliva. Only two out of three women with detectable levels of cotinine in every blood sample were self-reported smokers, showing that this measure is a more objective way of assessing smoking behaviour, researchers say. A total of 914 women were included in the smoking analysis. Of these, 78.6% were classified as having no exposure to smoking while pregnant, 11.7% as having some exposure and 9.7% as having consistent exposure. The study, published in the International Journal of Epidemiology, found that compared with those without smoke exposure while pregnant, those with consistent exposure were 2.6 times more likely to experience spontaneous preterm birth. According to the researchers, this is more than double the previous estimate of 1.27 from an analysis of multiple studies. They were also 4.1 times as likely to experience foetal growth restriction. Additionally, babies born to smokers were found to be on average 387g lighter than babies born to non-smokers – that is, more than 10% smaller than the weight of an average newborn. This increases the risk that the baby will have a low birth weight (2.5kg or less), which in turn is linked to an increased risk of developmental problems as well as poorer health in later life. Unlike in previous studies, the team found no evidence that smoking reduced the risk of pre-eclampsia. To assess caffeine intake, researchers looked for the metabolite paraxanthine in 915 women. Of these women, 12.8% had low levels of paraxanthine throughout pregnancy (suggesting low caffeine intake), 74.0% had moderate levels and 13.2% had high levels. The researchers say there was little evidence of an association between caffeine intake and any of the negative outcomes. However, because the researchers did not study all possible adverse outcomes of pregnancy, and some of the outcomes not studied – such as stillbirth – have been associated with higher caffeine intake in previous studies, they cannot interpret the findings as indicating that current recommendations around caffeine intake should be changed. The work was supported by the National Institute for Health and Care Research (NIHR), Cambridge Biomedical Research Centre and the Medical Research Council. 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Shakira has made a fashion statement while attending Paris Fashion Week in an over-the-top trench coat. The “Hips Don’t Lie” singer, 46, stepped out at the Viktor & Rolf Fall/Winter 2023 runway show in Paris on Wednesday 5 July wearing a white-and-gold-accented trench coat, with the word “NO” emblazoned on the front. The white, double-breasted coat featured the three-dimensional letters protruding from each side of the jacket, with gold embellishments along the trim. The statement coat also tied in the front, with Shakira pairing the bold look with large brown-tinted sunglasses and gold heels. The “NO” trench coat originally debuted during the Viktor & Rolf’s Fall/Winter 2008 collection in grey, before it was revived with a white version one decade later. In a video taken at the Paris fashion show, the Colombian singer revealed the inspiration behind her statement piece. “‘Yes’ is overrated,” she told a reporter. “I identify with ‘no,’ it’s a very powerful word.” Shakira later reiterated that “yes” is “overrated” in a clip shared to her Instagram account, in which she could be seen wearing the bold trench coat. The “Waka Waka” singer’s appearance at Paris Fashion Week comes after her highly-publicised split from ex Gerard Pique. In June 2022, Shakira and Piqué announced they were breaking up after nearly 11 years together. The former couple share two sons, Milan and Sasha. “We regret to confirm that we are separating,” a representative for the singer confirmed at the time. “For the well-being of our children, who are our highest priority, we ask that you respect our privacy. Thank you for your understanding.” Some fans have suggested the “NO” coat was a subtle reference to the former professional soccer player, who has since made his relationship with 24-year-old girlfriend Clara Chia Marti Instagram official. In a recent interview with People en Español, Shakira revealed that she learned Piqué had “betrayed” her while her father was hospitalised in the intensive care unit. She explained that her father, William Mebarak Chadid, was visiting her in Barcelona in the wake of her breakup when he suffered a bad fall. “He went to Barcelona to console me after I was consumed with sadness because of my separation,” she recalled. “While he was at Milan’s first communion, he was gravely injured in an accident. Everything happened at once.” As she reflected on her public breakup, Shakira continued: “My home was falling apart. I was finding out through the press that I had been betrayed while my dad was in the ICU.” It was initially speculated that Piqué had cheated on Shakira, after he was spotted with Marti in August 2022 months after the split. In January, reports claimed Shakira had found out about the alleged infidelity through a jar of strawberry jam. The rumours first stemmed from a music video for her and Rauw Alejandro’s song, “Te Felicito,” which was released in August 2022. “Shakira is having fun saying NO. To the ex, to the ex monsters-in-law ... to the PRESS. She didn’t choose that dress for nothing. She is saying no to all the BS!” one person tweeted. Others were simply amused by the unique outfit, with another fan writing: “Is Shakira just wearing a jacket or dress with a giant ‘NO’ on it? Sensational.” “Shakira is in her NO era,” someone else wrote. Shakira has shared that she’s been focusing on herself and her two children, amid their reported move from Spain to the United States. “I feel complete – because I feel like I can depend on myself and I have two kids who depend on me,” she said in an interview with En Punto con Enrique Acevedo last February. “I have to be stronger than a lion,” Shakira added. “That strength, in order for it to be real and not a facade, it needs to be the result of a great pain – accepting that pain and tolerating the frustration because there are things in life that don’t turn out the way we want them to.” Read More Shakira says she learned ex Gerard Piqué ‘betrayed’ her while her father was in ICU Tom Cruise and Shakira dating rumours spark confused reactions from fans Shakira took on the ‘scorned woman’ role, and promptly set fire to it Shakira learned ex Gerard Piqué ‘betrayed’ her while her father was in ICU Florence Pugh makes return to Paris Fashion Week in sheer dress following uproar As Katie Boulter takes Wimbledon by storm, we look at her best on-court fashion so far