Smoking Cessation

Smoking cessation during pregnancy is the single most modifiable factor to improve maternal and child health outcomes (ACOG, 2011). New research has only added to the list of poor outcomes associated with tobacco dependence during the prenatal period. Maternal smoking can cause premature birth or intrauterine growth restriction and result in low birth weight. It is also associated with an increased probability for Sudden Infant Death Syndrome (USDHHS, 2004). Thus, smoking during pregnancy is directly linked to major causes of infant mortality. Pregnant women who smoke also face increased risk for life-threatening maternal conditions such as placenta previa, placental abruption, decreased maternal thyroid function and ectopic pregnancy (USDHHS, 2010). Equally concerning are the longer-term effects for children exposed to cigarettes in-utero, including a higher prevalence of asthma, obesity, oral clefts, behavioral problems, respiratory and ear problems, reduced lung capacity, language delay, learning disabilities and cognitive disorders including attention deficit disorder (USDHHS, 2004; USDHHS, 2008; Fiore, 2008; Wakschalg, 1997; Drews, 1996).

The large body of evidence linking maternal smoking to poor health outcomes has thus established a general consensus that pregnancy presents both an obligation and an opportunity to intervene to address women's tobacco dependence. The American Congress of Obstetricians and Gynecologists (ACOG) concluded that because clinicians see their patients regularly during their prenatal visits they are in a unique position to offer behavioral strategies designed to help pregnant women quit smoking and recommended the integration of evidence-based guidelines into routine prenatal care (ACOG, 2011). The Surgeon General noted that women of reproductive age average 6.4 healthcare visits a year, an opportunity to incorporate smoking cessation into preventative primary care and preconception counseling.

Smoking cessation counseling may increase the likelihood that a woman will stop smoking by 80% (OR 1.8, CI 1.4-2.3) (Fiore et. al, 2008). Smoking cessation interventions reduce the proportion of women who continue to smoke and implementation is recommended for all maternity care settings (Lumley et al., 2009). It is recommended that clinicians offer tobacco dependence interventions to pregnant smokers at the first prenatal visit and throughout the pregnancy (ACOG, 2010). Finally, the U.S. Preventative Services Task Force (USPSFT) ranks augmented (more than minimal advice to quit), pregnancy-tailored smoking cessation counseling as a grade A recommendation, or a classification that indicates a high certainty that the net benefit is substantial (USPSFT, 2009).