Tobacco Use During Pregnancy

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Tobacco Use During Pregnancy

• Janis Biermann, M.S.
• March of Dimes

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Surgeon Generals Report, 2004

• Smoking harms nearly every organ of the body and
  generally diminishes the overall health of
  smokers

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Who smokes?

• Between 13 and 17 of pregnant women smoke in the
  United States
• Only 18-25 of all women quit smoking once they
  becomes pregnant

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Causal Relationship between Smoking and.

• Premature rupture of membranes
• Placenta previa
• Placental abruption
• Premature delivery and shortened gestation
• Fetal growth restriction and low birth weight
• Reduced Fertility
• Sudden Infant Death Syndrome

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Impact Prematurity

• Smokers are more likely to experience preterm
  delivery (less than 37 weeks) than non-smokers.
• Estimates range from smokers being 1.2 to more
  than 2 times more likely to deliver preterm.
• Smoking cessation during pregnancy reduces the
  risk for preterm delivery.
• Women who stopped smoking during the first
  trimester reduced their risk for preterm delivery
  to nearly that of nonsmoking women.

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Impact Birth Defects
Most studies have not demonstrated a clear
association between cigarette smoking during
pregnancy and the overall risk for birth defects.
Smoking may be modestly related to increased
risk for certain birth defects such as oral
clefts, limb reductions and urogenital or
gastrointestinal defects
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Impact Preterm Premature Rupture of Membranes
(PPROM)
Smoking is associated with PPROM. Smokers are
between 2 to 5 times more likely to experience
PPROM than nonsmokers.
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Impact Low Birth Weight

• Approximately 20 of the incidence of LBW can be
  attributed to smoking.
• Babies born to mothers who smoke weigh less than
  babies born to mothers who do not, with the
  average difference in birth weight being about
  250 grams. The difference increases with the
  amount smoked.

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Impact Low Birth Weight

• Most studies suggest that infants of women who
  stop smoking in the 1st trimester have weight and
  body measurements comparable to those of
  non-smokers.

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Impact Breastfeeding

• Maternal milk production of smokers is at least
  250 ml/day (8.45 oz.) less than nonsmokers.
• The duration of breastfeeding decreases with the
  increasing amount of cigarettes smoked per day.

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Impact Sudden Infant Death Syndrome (SIDS)

• The risk for SIDS increases three-fold for
  mothers who smoke during and after pregnancy
  two-fold for mothers who smoke only after
  delivery.
• Risk increases with increase in tobacco dose.

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Impact Perinatal Mortality

• Smokers are 20 to 30 more likely to have a
  stillbirth or neonatal death (death in the 1st
  month of life).
• Studies estimate that 3.4 to 8.4 of perinatal
  deaths may be attributed to maternal smoking
  during pregnancy.

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Spontaneous Quitting and Maintenance of Cessation

• Research has helped us identify those most likely
  to quit on their own. Women
• With higher income/education
• Who are married or have partners
• Having first child
• Having a wanted pregnancy
• Entering prenatal care early
• Experiencing nausea during first trimester
• Intending to breastfeed

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Quitters

• Are light to moderate smokers
• With fewer smokers in their social circle
• With stronger belief that smoking can harm their
  developing fetus

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Interventions--Provider

• The 5 As

An approach to smoking cessation counseling 5
- 15 minutes of counseling by a trained clinician
Can improve cessation rates by 30 to 70 among
pregnant smokers Melvin
et al. Tobacco Control 2000.
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Best Practice Intervention The 5 As

• ASK the patient about her smoking status
• ADVISE to quit smoking with personalized messages
  for pregnant women
• ASSESS her willingness to quit in next 30 days
• ASSIST with skills building, self-help materials
  and social support
• ARRANGE to follow-up during subsequent visits

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http//iml.dartmouth.edu/education/cme/Smoking
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Pharmacologic Intervention

• Behavioral intervention is first-line treatment
  in pregnant women
• Pharmacotherapy has not been sufficiently tested
  for efficacy or safety in pregnant patients
• It may be necessary for heavy smokers (gt1
  pack/day)

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Resources for Women

• Quitlines1-800-QUIT-NOW
• www.quitnet.com
• www.smokefree.gov
• Counseling
• Brochures March of Dimes, American College of
  Obstetricians and Gynecologists,
  NationalPartnership to Help Pregnant Smokers Quit

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The National Partnership to Help Pregnant Smokers
Quit

• Comprehensive, national approach
• Six evidence-based aims
• Health care system
• Media
• Policy
• Communities and worksites
• State outreach and technical assistance
• Research, evaluation and surveillance

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The National Partnership to Help Pregnant Smokers
Quit

• www. helppregnantsmokersquit.org
• email prompts
• materials for consumers and providers

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Additional Resources

• marchofdimes.com
• smokefreefamilies.org
• acog.org
• awhonn.org
• iml.dartmouth.edu/education/cme/

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Cost Effectiveness

• Smoking cessation initiatives for pregnant women
  can save 2-3 in health care costs for each
  dollar spent on smoking cessation.

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The Call to Action