Smoking Cessation in Pregnancy

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Key points

  • More than 400,000 deaths occur per year in the United States that are attributable to cigarette smoking, and the risks to the general public are widely known.

  • The risk to women, especially those who are pregnant, is less commonly known.

  • During pregnancy, smoking increases the risk of low birth weight infants, placental problems (previa and/or abruption), chronic hypertensive disorders, and fetal death.

  • Cessation of smoking during pregnancy can decrease or eliminate the risk for these complications.

Management goals

The intent of intervention is to cease smoking not only for the duration of the pregnancy but permanently. If this is not successful, decreasing the number of cigarettes used and exposure to secondhand smoke can provide some benefit for both a woman and her infant.5

The problem with intervention is that the most robust studies have been conducted in the nonpregnant population. Studies during pregnancy are small, often qualitative and descriptive, and difficult to generalize to the pregnant

Nonpharmaceutical strategies

The critical step to helping a pregnant smoker is to ask the question regarding smoking and nicotine use correctly. In the past, almost all women acquired their nicotine through smoking cigarettes. There seems to be a 25% nondisclosure rate during pregnancy. Now with the option of snuff, hookahs and e-cigarettes, the question has to be more open ended to include these “non-smoking” options. Since these alternatives are being advertised as a safe alternative to smoking, many women may not admit

Pharmacologic strategies

In nonpregnant smokers, both NRT and antidepressants approximately double cessation rates compared with nonpharmaceutical methods (Table 1). There are no existing studies in which the safety or efficacy of either NRT or antidepressants has occurred with sufficient numbers of pregnant subjects to determine what might occur with large-scale use.5 Studies have shown that only about 30% of obstetric providers discuss medication for cessation with smokers.17 They then typically recommend NRT over

Self-managed strategies

Given the high rates of nicotine use in the United States and the desire by many to stop smoking (one of the more common New Year resolutions), it is not surprising that there are several strategies for an individual to use. None of these have been confirmed to be effective in the nonpregnant population, much less during pregnancy.

Evaluation, adjustment, recurrence

Before starting a smoking cessation/nicotine reduction program within a clinical practice, several steps should be taken38:

  • 1.

    Identify resources within the community, such as hospital-based counseling, 1-800-QUITNOW help line, or cancer society.

  • 2.

    Encourage office staff and other providers to engage with the program. Everyone in the office needs to be committed to helping a woman’s cessation efforts. Having posters with information and resources helps stress the importance of cessation. The office

Summary/discussion

Recently, a comprehensive review of the literature and strategies proposed for cessation in pregnancy attempted to identify the most effective and feasible interventions.5 Their conclusions included

  • Combined multiple components have the best likelihood of success (90% probability).

  • Selection of the components used should be based on the particular considerations of the clinical setting, patient characteristics, and resource allocation.

  • Incentives work well but can be financially costly, and

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