A hookah (water pipe, shisha, or narghile) is an instrument used to smoke flavored or unflavored tobacco, where the smoke passes through a water basin before being inhaled. This smoking method, often a social activity, has seen a rise in popularity. While some mistakenly believe it is a safer alternative to cigarettes, medical consensus confirms that smoking hookah presents significant health risks. For pregnant individuals, using a hookah is strongly discouraged because the smoke contains toxic chemicals that can harm both the mother and the developing fetus.
Understanding the Hookah Safety Myth
Many individuals believe hookah use is less harmful than smoking cigarettes, especially during pregnancy. They often cite the water in the pipe’s base as a natural filter that removes harmful substances and toxins. However, scientific analysis has repeatedly demonstrated that this water filtration is largely ineffective at removing the majority of toxic compounds.
Another common myth is that “herbal” or non-tobacco shisha is a safe option. Even tobacco-free shisha is often heated using charcoal, which produces its own toxic byproducts. The intense heat and combustion process still produce smoke containing high levels of carbon monoxide and other harmful chemicals. Even infrequent use is misleading, as a single session exposes the user to a massive volume of smoke and concentrated toxins.
Toxic Components in Hookah Smoke
Hookah smoke contains many of the same toxic agents found in cigarette smoke, plus unique pollutants derived from the heating process. A primary concern is carbon monoxide (CO), a colorless, odorless gas produced when the charcoal combusts. This gas is absorbed into the bloodstream, where it interferes with the oxygen-carrying capacity of red blood cells.
Hookah smoke also delivers significant quantities of nicotine, the highly addictive substance present in tobacco. Even low-nicotine shisha ensures substantial nicotine exposure due to the extended duration of a typical session. Other harmful constituents include heavy metals like lead and arsenic, along with cancer-causing chemicals such as polycyclic aromatic hydrocarbons (PAHs) and volatile aldehydes. The water does not effectively filter out these compounds, meaning the user directly inhales a complex mixture of toxicants.
Exposure Levels: Hookah Session Compared to Cigarettes
The mechanics of hookah smoking lead to a much greater overall exposure to smoke and specific toxins compared to a single conventional cigarette. A typical session lasts between 45 to 60 minutes, significantly longer than smoking one cigarette. During this extended period, users take deep, prolonged puffs to draw smoke through the water pipe.
As a result of this deep inhalation and session length, a single hookah session can involve inhaling about 90,000 milliliters of smoke, which is 100 to 200 times the volume inhaled from one cigarette. This massive volume translates to a higher intake of pollutants. Users can be exposed to nearly nine times more carbon monoxide and significantly higher levels of tar than from a single cigarette. This quantitative increase in toxin load makes the practice dangerous.
Pregnancy and Fetal Health Risks
The high level of toxic exposure from hookah use threatens a developing fetus, primarily through oxygen deprivation and chemical interference. Carbon monoxide exposure is concerning because it binds to hemoglobin in the mother’s blood, creating carboxyhemoglobin, which reduces the amount of oxygen available to cross the placenta. This fetal oxygen deprivation can lead to complications, including reduced growth. Nicotine and other toxins can also affect the placenta, restricting blood flow and nutrient delivery to the fetus.
The most consistently reported adverse outcome is Intrauterine Growth Restriction (IUGR), resulting in low birth weight (LBW), where babies are often born lighter than those born to non-smokers. Exposure also increases the risk of premature birth (delivery before 37 weeks of gestation). Premature babies face a heightened risk of serious health complications, including problems with breathing and feeding. Exposure is linked to long-term developmental issues, including childhood asthma and neurological delays, as toxins directly interfere with the development of the fetal brain and lungs. The risks mirror those of cigarette smoking, pointing to an increased risk of miscarriage, stillbirth, and Sudden Infant Death Syndrome (SIDS).
Steps for Cessation and Medical Consultation
For pregnant individuals, the immediate and complete cessation of hookah use is the most effective step to protect fetal health. Quitting at any point during pregnancy will improve the baby’s chances of a healthy outcome, though stopping early yields the greatest benefits. It is also important to avoid all forms of smoke exposure, including secondhand smoke from both cigarettes and hookah.
Individuals should schedule a consultation with their healthcare provider, such as an obstetrician or midwife, as soon as possible. The medical team can provide counseling and discuss safe, effective strategies for quitting. Behavioral therapies and support groups have proven successful, and a healthcare professional can determine if nicotine replacement therapies are a viable option. Practical steps in the cessation process include avoiding places and people associated with hookah use, and planning alternatives for managing stress or cravings.