Pregnant Mom: Please, Don’t Smoke for Two!

Don’t Smoke

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Nothing like getting pregnant, or thinking about getting pregnant, to motivate you to quit smoking.

Chances are you’ve heard all the ways that smoking is bad for you and your baby, including raising the risk of miscarriage, premature birth, low birth weight, sudden infant death syndrome (SIDS) and birth defects such as cleft lip or palate. And if you’re not pregnant but you’d like to be, smoking can make it harder to achieve that goal.

Only about 10% of pregnant women surveyed said they had smoked during the last three months of pregnancy, according to 2011 data collected in 24 states by the Centers for Disease Control and Prevention.

Of course, considerably more women—nearly 23%–reported smoking during the three months before they got pregnant, but 55% of them said they quit after they conceived, according to the CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS). But, unfortunately, of those who quit smoking during pregnancy, 40% were back at it within six months of giving birth.

New guidelines from the US Preventive Services Task Force, an independent panel of experts sponsored by the federal Agency for Healthcare Quality and Research, recommend that doctors and nurses who care for pregnant women always ask them about tobacco use and advise them to quit.

Pregnant women don’t have as many choices as non-pregnant smokers when it comes to help quitting, according to the task force. As is often the case with medications, the panel said it found inadequate or no scientific evidence about the harms of nicotine replacement therapy, bupropion (an anti-depressant sold as Zyban for smoking cessation), varenicline (Chantix), or electronic nicotine delivery systems (a.k.a. electronic cigarettes) in pregnant women. Yet, the task force concluded that all of those aids except electronic cigarettes “substantially improve” the chances of quitting in non-pregnant adults.

The Food and Drug Administration classified nicotine replacement therapy (NRT) as pregnancy category D medication, which means that there is evidence of fetal risk in humans, although some people think the risks associated with smoking during pregnancy outweigh the possible risks of using a nicotine patch or nicotine gum.

A just-published analysis of 2009-2010 PRAMS data found that the doctors and nurses who cared for pregnant smokers offered NRT to one in five of them, while a quarter of pregnant smokers didn’t receive any help with stopping. “There may still be reluctance to provide NRT to pregnant women, despite known harms of continued smoking during pregnancy,” according to the authors of the study.

But all of the US studies of NRT during pregnancy have been stopped early, either because it didn’t appear to help women quit smoking or because it caused ill effects, according to the American College of Obstetricians and Gynecologists (ACOG). Pregnant women should use NRT only if they’ve made up their minds that they truly want to quit smoking and have discussed the known risks of smoking and the possible risks of the patch or gum with their doctor, ACOG advises.

You still have places to turn for help if you’re trying to quit smoking without NRT or medication. Task force members found “convincing” evidence that behavioral interventions, including intensive in-person and telephone counseling and self-help materials, can increase quit rates during pregnancy from about 11% to 15%. That might not sound like much, but remember, 15% is more than a third greater than 11%. While acupuncture is less effective than NRT, the limited research data that are available suggest that acupuncture improves short-term success with smoking cessation. Longer and larger clinical trials are needed to assess its long-term effects.

The CDC has compiled a list of a number of resources that could help you quit smoking, including SmokeFreeMOM, a free service that will send you text messages with tips and encouragement.

And remember, the sooner you quit, the better for you and your baby.

“Although smoking cessation at any point during pregnancy yields substantial health benefits for the expectant mother and baby, quitting early in pregnancy provides the greatest benefit to the fetus,” according to the task force guidelines.

Rita Rubin
An ob-gyn's daughter and the mother of two teenage daughters, Rita Rubin has covered medicine ever since earning a BSJ from Northwestern. Based in Washington, D.C., Rita has written for WebMD, JAMA, POZ, and NBCNews.com and previously worked for USA TODAY. She has won numerous awards for her stories and authored What If I Have a C-Section? Rita earned an MA in writing from Johns Hopkins and spent a year as a fellow at the Harvard School of Public Health. You can follow her on Twitter @RitaRubin.

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