Ob-Gyns Encouraged to Help Pregnant Women Kick the Habit

An office-based protocol that systematically identifies pregnant women who smoke and that offers them treatment or referral is a proven way to increase quit rates.

The rate of women in the US who smoke during pregnancy dropped from 18% in 1990 to just over 13% in 2006. A number of negative outcomes are associated with smoking during pregnancy, including ectopic pregnancy, intrauterine growth restriction, placental problems (placenta previa and abruption placentae), premature rupture of membranes, preterm delivery, and decreased thyroid function in women. An estimated 5-8% of preterm deliveries and 13-19% of term low birthweight deliveries are linked with smoking during pregnancy. In addition, about 23-34% of all sudden infant deaths (SIDS) and 5-7% of preterm-related infant deaths are related to maternal smoking. Babies whose mothers smoke also are at high risk for asthma, colic, and childhood obesity.

“Pregnancy is a big motivator for many women to quit smoking—almost half of women quit smoking right before or during pregnancy,” said Maureen G. Phipps, MD, chair of The College’s Committee on Health Care for Underserved Women. According to The College, smoking is one of the most important risk factors that women can change to avoid poor pregnancy outcomes. “We know that counseling pregnant smokers and offering cessation support increases the quit rate. Unfortunately, about half of the women who quit smoking during pregnancy start smoking again within a year after birth.”

The College says that getting a woman to quit smoking before she reaches 15 weeks gestation has the biggest benefit for her and the fetus. Women who quit smoking in early pregnancy will minimize the risk of having a low birthweight baby caused by smoking during pregnancy. “Cutting down on smoking during pregnancy is better than nothing, but the best thing a woman can do is to quit entirely during pregnancy and stay quit postpartum, both for her own health and her baby’s health,” Dr. Phipps said.

A short counseling session with pregnancy-specific educational materials along with a referral to a smokers’ quit line is an effective smoking cessation strategy, says The College. Intervention should begin at the first prenatal visit and continue throughout the pregnancy. Telephone quit lines offer information, direct support, and ongoing counseling and are very successful in helping pregnant women stop smoking and remain smoke-free.

Nicotine replacement aids and other medications for smoking cessation haven’t been sufficiently evaluated for their safety or efficacy during pregnancy. This does not rule out the use of nicotine replacement therapies, but they must be used under close medical supervision and only after weighing the known risks of smoking against the possible risks of the nicotine replacement therapy during pregnancy. There is limited evidence to support meditation, hypnosis, and acupuncture as effective smoking cessation methods.

Even secondhand smoke increases a woman’s risk of having a baby with low birth weight by 20%. Pregnant women who live with or are around people who smoke should be given advice on how to avoid exposure to secondhand smoke

Committee Opinion #471, “Smoking Cessation During Pregnancy,” is published in the November 2010 issue of Obstetrics & Gynecology.

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The American College of Obstetricians and Gynecologists is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 55,000 members, The American College of Obstetricians and Gynecologists strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care.