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November 23, 1994

Smoking Makes Knaves Little. Kills Them, Too.

JAMA. 1994;272(20):1577. doi:10.1001/jama.1994.03520200033026

To the Editor.  —In 1547, Thomas Seymour gave the following advice to his pregnant wife, Queen Catherine (widow of Henry VIII): "I do desire your Highness to keep the little knave so lean and gaunt with your good diet and walking, that he may be so small that he may creep out of a mousehole."1 If Thomas Seymour were alive today, perhaps he would also recommend that his wife smoke. Cigarette labels carry the message that "[s]moking by pregnant women may result in fetal injury, premature birth and low birth weight." Health professionals know low birth weight is associated with perinatal death, but a layperson can too easily misinterpret small fetal size as an advantage.The current warning to pregnant women is completely obsolete. It dates from an era when the effects of cigarette smoking during pregnancy were less clear. For a while, the picture was muddled by the paradoxical