Smoking while pregnant is like playing Russian roulette: A mother never knows which cigarette will cut the oxygen supply to her baby enough to harm its development. If oxygen is depleted, the baby may be born premature and underweight, which may result in

Those are just a few of the problems that may occur if the low birth-weight baby even makes it to term. Studies show that smoking while pregnant increases a mother's chance of miscarrying her baby. And once low birth-weight babies are born, their risk of dying the first year is 20 times greater than that of full-term babies, studies show. "Low birth-weight babies tend to be sicker and need more care in the first year of life," said Dr. Maria Del Rio, a neonatologist at St. Mary's Hospital in Evansville who specializes in chronic care of newborns. "But we truly don't know the long-term outcomes." Not all mothers who smoke will have a low birth-weight baby, Del Rio said. But the risks are so great, pregnant women are taking a chance if they do. Exposure to cigarettes was seen in 44 percent of infant deaths in a study to determine reasons for infant mortality in Elkhart and St. Joseph counties in Indiana, she said. "Smoking and nicotine and inhalants compete with oxygen in the mother's blood stream," Del Rio said. "Oxygen is food for the baby." Even with the high risk, pregnant mothers continue to smoke cigarettes. In the Green River Area Development District -- Daviess, Ohio, McLean, Hancock, Union, Webster and Henderson counties -- 27 percent of women reported they smoked during pregnancy, according to a recently released health assessment conducted by researchers at the University of Kentucky. Other factors may cause low birth-weight babies, Del Rio said. Mothers may have medical problems that may prevent fetal development, they may lack prenatal care or the baby may just be small. If the baby is small for no particular reason, no major medical problems may surface, Del Rio said. But smoking is a major contributor, if not the most common factor, to low birth-weight babies, according to information provided by Del Rio. If mothers smoke 10 cigarettes a day, their babies may weigh 6 ounces less. If they smoke 15 cigarettes a day, the babies may weigh 10.7 ounces less. Risks are higher for older mothers, according to information provided by Del Rio. Rates of low birth-weight babies known for years The high incidence of low birth-weight babies in the area has been known for several years. A health report the Green River Regional Health Council prepared in 1996 indicated high rates. And last year, the Owensboro and Daviess County 1999 Community Report Card, funded by the Hager Educational Foundation, reiterated the high rates. "We know that smoking contributes to low birth-weight babies," said Angela Woosley, nursing supervisor for the perinatal home visiting program and prenatal clinics at the Green River District Health Department. "You just about have to be under a rock to not know it causes health problems." The perinatal home visiting program is working to curb the numbers of smoking pregnant women by providing information to them on the dangers. The health council, including its Prenatal-to-Five subcommittee, began a campaign this summer and has been setting up informational booths at the health departments in GRADD's seven counties, health fairs, school readifests and other events. But more work is needed, Woosley said. The health council, of which the health department is a partner, applied for a grant of which a portion will be used to offer incentives to pregnant mothers if they cut back on their cigarettes. The Prenatal-to-Five subcommittee of the health council, which applied for the $14,390 state grant, will learn in September if the proposal was accepted, said Linda Wahl, director of the Building Stronger Families program at GRDHD. Wahl said pregnant women enrolled in the Fresh Start Family Program will receive vouchers for haircuts, groceries, body lotions and makeovers. "A lot of it is esteem building," Wahl said. The program's goals are to reduce the number of smokers, cut the numbers of cigarettes smoked per day, increase awareness of smoking's dangers and motivate family members to smoke outside their homes and away from children. By January, program administrators hope to see 20 percent fewer pregnant women in the program smoking and another 25 percent decreasing the number of cigarettes they smoke. Wahl said money will be available to help mothers buy nicotine replacement patches or gum to keep them from lighting up once the baby is born. Babies near second-hand smoke are at greater risk of developing upper-respiratory problems, such as ear infections, asthma, pneumonia and bronchitis, Woosley said. Even parents who smoke outside the home may be unintentionally harming their infants, she said. Clothing and skin absorb nicotine and when babies are held against the parent who has been smoking, they still may be exposed to second-hand carcinogens, she said. For that reason, she advises parents to wash their hands before handling the infant. "Just the smell of the smoke on the clothes can be damaging," Del Rio said. "We even tell them if you're going to hold the baby to put on a coat or covering to cover your clothes while you smoke." Cutting the number of cigarettes smoked during pregnancy may produce positive results. If a woman quits early in her pregnancy, her baby may weigh similar to that of a nonsmoker's baby. "If they cut back on cigarettes, they'll be able to see a difference," Woosley said. Low Birth-weight Babies in Region The number of low-birth weight babies born in the Green River Area Development District, is high, a recent health assessment of the area says. The Green River area includes Daviess, Ohio, McLean, Hancock, Union, Webster and Henderson counties. One reason might be the number of pregnant women who smoke, says the study, performed by researchers at the University of Kentucky. Twenty percent of the women surveyed said they smoked while pregnant. Of the total women who gave birth, 17 percent had low birth-weight babies, defined as 51/2 pounds or less. Here are the percentages of low-birth weight babies that are being born in the region, according to the national Health Resources and Services Administration. The HRSA says all counties except Muhlenberg County and Perry and Spencer counties in Indiana need to reduce their numbers of low birth-weight babies. Daviess -- 8.5 percent Hancock -- 8.0 percent McLean -- 9.7 percent Muhlenberg -- 6.5 percent Ohio -- 9.2 percent Perry County, Ind. -- 5.6 percent Spencer County, Ind. -- 6.0 percent

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