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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It was long after the chequered flag was waved at the Red Bull Ring on Sunday when Lando Norris, buoyed by a positive weekend in his upgraded McLaren, posted a selfie of his bare hand. A high-five for P5. Little did he know that, in the end, a finger needed to be withdrawn. Another Instagram picture comically corrected the initial post. Because Norris had actually recorded his best result of the season in claiming fourth, after a shaking-up of the final classification of Sunday’s Austrian Grand Prix due to a raft of time penalties. Twelve drivers – including Lewis Hamilton and Carlos Sainz – were punished retrospectively, after 83 lap times in Sunday’s race were deleted due to the exceeding of track limits. The scenario, which only concluded five hours after the race finished, has once again placed the spotlight on the FIA, the governing body of Formula 1. An appeal from Aston Martin triggered the farcical scenes to sign off a weekend in Spielberg typified by the absurdity of the track-limits issue at the final two corners of the track. The only salvation was that the podium and Max Verstappen’s win remained unchanged. Qualifying on Friday was dominated by cars continuously extending the limits of the car beyond the white line. Sergio Perez, incredulously, fell foul three times in Q2, even after a host of warnings from his engineer and subsequently missed out on the top-10 shootout. Sprint day on Saturday seemed less impacted by the issue, but only because of the wet conditions resulting in the drivers being more conservative in their driving style on the approach to turns 9 and 10. Come the grand prix a day later, the number of warnings, black-and-white flags and then time penalties rather overshadowed what was actually an enthralling 71-lap race. Hamilton, exuding disbelief at the situation over team radio, was aghast at the notion that only he was being punished. Ultimately with the late result change, nobody escaped. Esteban Ocon, for instance, had an astonishing 30 seconds added to his final time, seemingly driving a completely different configuration altogether. There are a few problems at play here. Firstly, the issue of cars consistently crossing the white line at the end of the lap. The Red Bull Ring, which has been a fixture on the F1 schedule since 2014 and on Sunday extended its contract until 2030, is the shortest track on the calendar. A fact which should encourage captivating battles, both on track and on the timesheets. Instead, it is the circuit most prone to ignominy with the deletion of lap times. Practically, it can be avoided too. Last year, a gravel trap on the outside of the final turn – as opposed to sections of run-off area – was recommended by the race director. Such an addition would encourage drivers to be more cautious on the approach and thus more likely to stay within the white lines. Such an improvement must be made next year. Yet more so than the track-limits discussion itself, what is particularly concerning for the sport in the long-term is the changing of the result hours after the race has ended. We have been here before, too. In March, the second race of the season in Saudi Arabia saw Fernando Alonso’s third place reinstated past midnight local time, rendering George Russell’s experience on the podium redundant. A fortnight later in Australia, a chaotic race saw post-race appeals drag the race result into uncertainty for a matter of weeks, with Ferrari appealing a late penalty for Sainz. The FIA and F1, two distinctly different enterprises but reliant in many ways on one another, are not the best of friends at the moment. Ideally, they would work perfectly in harmony but on the contrary, the divide is stark, as illustrated by Formula 1 calling out FIA president Mohammed Ben Sulayem in the off-season for opining on F1’s market value in the wake of takeover rumours from Saudi Arabia. All of it points towards a situation where the whole operation and system of work must improve. There is an argument that it could be completely scratched and revamped – and perhaps both parties could work towards this after the 2023 season. But something has to change. The net result of more ridiculous scenes such as Sunday night’s result change will be spectators turning away from the sport. The influx of fans in the past few years, due to Netflix, the 2021 season and more races than ever before, will be completely undone if those watching cannot fully trust the finality of the chequered flag. The sport’s marketeers have done so well to be ahead of the curve as it enjoys a period of unprecedented popularity. 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Max Verstappen produced another emphatic performance to complete a home win for Red Bull at the Austrian Grand Prix. The double world champion was made to work for his seventh victory from nine rounds so far after he passed Charles Leclerc and Carlos Sainz on track. But after manoeuvring himself ahead of both Ferrari drivers, Verstappen raced off into the distance to the delight of his 70,000-strong travelling army from Netherlands. Leclerc crossed the line five seconds behind Verstappen in Spielberg, with Sergio Perez recovering from his lowly grid slot of 15th to finish third. The Mexican fought his way past Sainz with 10 laps remaining following a nip-and-tuck duel. Sainz took fourth after he served five-second penalty for exceeding track limits. The Spaniard was among six of the 20-strong field to be sanctioned by race director Niels Wittich, with Lewis Hamilton also punished. Hamilton finished an underwhelming seventh, while Lando Norris ended the day in fifth to record his best result of a difficult season for his under-performing McLaren team. Aston Martin’s Fernando Alonso finished between Norris and Hamilton. George Russell made up three places from his starting spot of 11th to finish eighth. Verstappen heads Perez in the standings by 81 points – the equivalent of more than three victories – heading into next weekend’s British Grand Prix. A day after taking the sprint race spoils, Verstappen was celebrating his fifth consecutive win on his unstoppable march to a hat-trick of world titles. Verstappen fended off an aggressive Leclerc on the opening lap before he fell to third after the Ferrari drivers stopped for tyres under the Virtual Safety Car. It ended Verstappen’s run of 249 consecutive laps at the head of the field. However, the Dutchman required just 11 laps before he was back in charge. After he left the pits on lap 25, Verstappen moved ahead of Sainz a couple of laps later, and then fought his way past Leclerc on lap 35 of 71. From there, the Dutchman cruised to the flag – even stopping for tyres on the penultimate lap in order to set the fastest lap and take a bonus point. For Hamilton, the seven-time world champion endured a difficult day in his Mercedes. Hamilton started fifth and leapfrogged Norris at the start of the race, but soon faced the wrath of the stewards for putting all four wheels of his Mercedes over the white line. A black-and-white warning flag was served to Hamilton before he was hit with a five-second penalty on lap 17. Sainz, Alex Albon, Pierre Gasly and Logan Sargeant were also handed five-second penalties, while Yuki Tsunoda saw his initial five-second sanction upgraded to 10 for driving off the track. Hamilton served his penalty at his second pit stop on lap 43, dropping him to eighth place. He moved up one spot when Gasly stopped for tyres but he failed to make any impression on Aston Martin’s Alonso. The Briton was on the radio several times asking why other drivers had not been penalised. Team principal Toto Wolff first came on with a word of encouragement for his superstar driver. “They are all going to get penalties in front of you, Lewis.” he said.” Keep going.” But following another frustrated radio message from Hamilton, Wolff was back on to his driver with a firmer message. “The car is bad, we know,” said Wolff to the Briton: “Please drive it.” Hamilton finished 39.1 seconds behind Verstappen and is no closer to ending his 18-month losing streak in Formula One. Read More Charity boss speaks out over ‘traumatic’ encounter with royal aide Ukraine war’s heaviest fight rages in east - follow live Austrian Grand Prix to remain on F1 calendar until at least 2030 Lewis Hamilton to start sprint race from 18th at Austrian Grand Prix Made us look like amateurs – Max Verstappen hits out over raft of deleted laps