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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.
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The risk to women, especially those who are pregnant, is less commonly known.
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During pregnancy, smoking increases the risk of low birth weight infants, placental problems (previa and/or abruption), chronic hypertensive disorders, and fetal death.
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Cessation of smoking during pregnancy can decrease or eliminate the risk for these complications.
Smoking Cessation in Pregnancy
Section snippets
Key points
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:
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Identify resources within the community, such as hospital-based counseling, 1-800-QUITNOW help line, or cancer society.
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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
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Combined multiple components have the best likelihood of success (90% probability).
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Selection of the components used should be based on the particular considerations of the clinical setting, patient characteristics, and resource allocation.
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Incentives work well but can be financially costly, and
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Cited by (26)
Peripheral neuroplasticity of respiratory chemoreflexes, induced by prenatal nicotinic exposure: Implication for SIDS
2023, Respiratory Physiology and NeurobiologyEffects of active and/or passive smoking during pregnancy and the postpartum period
2021, Anales de PediatriaNational Quality Measures in Perinatal Medicine
2017, Clinics in PerinatologyCitation Excerpt :Counseling data are important to reduce the risk of associated congenital anomalies in women taking antiepileptic medications13 and potential adverse neurocognitive outcomes particularly with valproate exposure.14 Similarly, smoking cessation is important both for the health of the woman,15 and to reduce the risk of fetal death,16 preterm birth, and intrauterine growth retardation.17 Adequate prenatal care has strong face validity as evidenced by publications such as Healthy People 2020.18
Exploring health education with midwives, as perceived by pregnant women in primary care: A qualitative study in the Netherlands
2017, MidwiferyCitation Excerpt :There is ample and growing evidence that a woman's health behaviours during pregnancy have a life-long influence, not only on her own health, but that of her children. Alcohol consumption, smoking, maternal overweight or underweight are known potentially modifiable risk factors for unfavourable pregnancy outcomes, such as giving birth to a preterm, or small for gestational age infant (Han et al., 2011; Jones, 2011; Cnattingius et al., 2013; Phelan, 2014). Long-term effects on children of suboptimal health behaviours in pregnancy include asthma, cognitive defects, obesity, type 2 diabetes and cardiovascular diseases (Vieau, 2011; Balbus et al., 2013; Banderali et al., 2015; Kapur, 2015).
The significance of base deficit in acidemic term neonates
2015, American Journal of Obstetrics and GynecologyCitation Excerpt :Further analysis of cord gas values may determine the best predictor of outcome or improve understanding of the mechanism and timing of damage. This would be aided by close correlation with clinical events13,19 although these are often poorly understood too. We also need to better understand why neonates with similar cord gases may have very different outcomes and this is likely to involve further elucidation of the mechanisms of injury: the role of the hydrogen ion, glutamate receptors, oxygen, and nitrogen reactive species.
Birth weight is associated with inner cell mass grade of blastocysts
2015, Fertility and Sterility
The author has nothing to disclose.