Smoking and Pregnancy
Smoking during pregnancy is an important problem for obstetricians and gynecologists to tackle.
- 13% of women use tobacco during the last three months of pregnancy.1
- Only 30% of women quit smoking when they find out they are pregnant.1
- Pregnant women are 1.8 times more likely to be abstinent than when not pregnant2
- However, 60% of women relapse within 6 months and 80% by 12 months2
- Smoking in pregnancy accounts for an estimated 20-30% of low birth weight babies, up to 14% of preterm deliveries, and 10% of all infant deaths.3
- If all pregnant women in the United States stopped smoking, there would be an estimated 11% reduction in stillbirths and a 5% reduction in newborn deaths.3
Action regarding these issues is clearly needed. Presented below is a comprehensive guide outlining:
- Maternal health effects
- Health effects on fetus
- Issues specific to pregnant women
- Addressing smoking myths with patients
- Overcoming cessation challenges
- Teachable moments, and
- Recommendations for obstetricians and gynecologists
- Fetal growth retardation
- Small for gestational age
- Increased fetal heart rate
- Chronic fetal anoxia (an extreme decrease in the amount of oxygen)
- Preterm delivery
- Low birth weight
- Fetal artery constriction
- Lessened amounts of oxygen and nutrients in the fetus
- Perinatal death
Please visit our “Pregnancy” page (under Special Populations) to learn about…
- More effects of tobacco use on the mother and baby
- Characteristics of mothers who relapse after giving birth
- Treatment considerations for mothers during both their pregnancy and following birth
Providers can follow the 5 A’s method to address smoking with their patients.
There are several treatment recommendations specific to pregnant women.
- Emphasizing cessation to women who are considering pregnancy can help maximize the protection of the infant from the harmful effects of smoking. By talking with a patient who is considering childbearing, obstetricians and gynecologists may be able to help increase the patient’s motivation to quit for her own health along with the health of the baby.4
- Newly pregnant women may be quitting for the baby and not for themselves. “Spontaneous quitters” quit smoking as soon as they learn they are pregnant. Most spontaneous quitters are able to maintain cessation throughout pregnancy, but up to 70% of these quitters resume smoking by six months after the birth of the baby. It is important to assist these women in the cessation process.4
- Having a partner who smokes appears to make a significant contribution to a woman’s continued smoking during pregnancy as well as the return to smoking postpartum for spontaneous quitters. It is important to involve partners in the process of smoking cessation during and after pregnancy.4
Question: Why should I quit smoking during pregnancy?
Answer: Chemicals in tobacco smoke are passed from the mother to the fetus through the placenta. Some of these chemicals are carcinogens.6 Smoking during pregnancy increases the risk of stillbirths, spontaneous abortions, premature births, and low birth weight babies.7 Women are believed to reduce risk the most if they stop smoking by sixteen weeks gestation.8
Question: Can I use nicotine replacement therapies?5
Answer: It is preferred to quit through counseling and behavioral modification, however, you can talk to your doctors about using any nicotine replacement therapies to find out if they are safe for you and your baby.5
Question: Is it okay if I just cut down on smoking?
Answer: There is no safe level of smoking. Quitting smoking should be your overall goal. Cutting back on cigarettes offers some protection, but does not compare to the benefits of completely quitting smoking.4
Question: Is it too late to quit smoking?
Answer: There are benefits to quitting smoking at any stage during pregnancy. If you quit now, you will be less likely to have a low birth weight baby. You will also increase the chance that your baby’s lungs will work well.
Question: Will quitting smoking be stressful for my baby?
Answer: Quitting smoking will not have any negative effects on your baby. Quitting smoking is one of the best things you can do for your health and the health of your baby. If you quit smoking, you will protect your baby from SIDS and reduce the dangers of secondhand smoke.
Challenges and Barriers
Strategies to suggest to patients
Being around other smokers
Table Abstracted from: Smoking Cessation During Pregnancy: A Clinician’s Guide to Help Patients Quit Smoking9
The United States Public Health Service Guidelines state that behavioral interventions should always be the first line of treatment for pregnant smokers.7
There are health concerns about the use of pharmacotherapy during pregnancy. It is also not clear if pharmacotherapy is effective during pregnancy. Use of nicotine replacement therapies result in nicotine passing into breast milk.10 The highest dose of the nicotine patch (21 mg) results in the equivalent of 17 cigarettes in breast milk.11
Pharmacotherapy is a good option for post-partum women who are not lactating and for whom behavioral interventions have not worked.10
Points to Reinforce
Points to Reinforce
Points to Reinforce
Points to Reinforce
Please see our “Pediatrician” page for more information on working with parents of babies and young children
If the woman was able to quit during pregnancy:
If she was able to cut down during pregnancy:
If the woman still smokes:
Newly pregnant women may be quitting for the baby and not themselves. It is important to assist these women in the cessation process.
There are several steps obstetricians and gynecologists can take to assist patients with smoking cessation.
- Emphasize cessation to women who are considering pregnancy to help maximize the protection of the infant from the harmful effects of smoking and help increase the patient’s motivation to quit for her own health along with the health of the baby.
- Reach out to the expecting mothers as early in the pregnancy to promote smoking cessation.
- Provide access to smoking cessation resources and medical care for all pregnant women.
- Offer intervention methods for women who continue to smoke throughout the pregnancy which enforce helpful behaviors including, smoking reduction, abstinence during critical periods of the pregnancy, and encouraging vitamins and exercise.
- Talk with the women’s partner about smoking cessation. Regardless of smoking status, the partner can be considered a major risk factor for the women’s behaviors and should be included in the interventions offered.
- Use the 5A's to help pregnant women quit smoking.
American College of Obstetricians and Gynecologists provides smoking cessation resources for patients and providers.
The State of Maryland's DHMH offers this easy to use toolkit for smoking and pregnancy, available here.
Smokefree Women provides information on smoking cessation specifically targeted to women.
Did you know that the Medicaid population is significantly more likely to use tobacco than the general population? Do you want to enhance your skills at reaching and intervening with Medicaid patients who use tobacco? MDQuit has an online training to teach you the strategies that can be utilized with all patients—regardless of their health insurance status. You can sign-up for this FREE self-paced online training by going to https://HABITSLabTraining.litmos.com/self-signup/ and entering the training code, "medicaid".
- AHRQ (2014). Smoking Cessation Interventions in Pregnancy and Postpartum Care. Evidence Report/Technology Assessment Number 214. Retrieved from http://effectivehealthcare.ahrq.gov/ehc/products/517/1871/smoking-pregnancy-infants-report-140226.pdf
Gadomski, A., Adams, L., Tallman, N., Krupa, N. & Jenkins, P. Effectiveness of a Combined Prenatal and Postpartum Smoking Cessation Program. Journal of Maternal & Child Health, 15:188–197 DOI 10.1007/s10995-010-0568-9
- Centers for Disease Control. (2004). Highlights: Smoking among adults in the United States: Reproductive health. Retrieved September 20, 2012 from http://www.cdc.gov/tobacco/data_statistics/sgr/2004/highlights/reproductive/index.htm
- United States Department of Health and Human Services. (2004). The health consequences of smoking: A report of the surgeon general. Retrieved September 20, 2012 from http://www.cdc.gov/tobacco/data_statistics/sgr/2004/pdfs/chapter5.pdf
- U.S. Department of Health and Human Services (n.d.).Prescription for Quitting. Retrieved from: http://women.smokefree.gov/smokefree-mom/prescription-for-quitting.aspx
- Health Canada. Risks of smoking. Retrieved September 25, 2012 from http://www.healthycanadians.gc.ca/init/quit-cesser/risks-risques-eng.php
- Fiore, M.C., Bailey, W.C., & Cohen, S.J. (2000). Treating tobacco use and dependence: Clinical practice guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.
- Society of Obstetricians and Gynecologists of Canada. Clinical Practice Guidelines. (1998). Healthy beginnings: Guidelines for care during pregnancy and childbirth. Journal of Obstetrics and Gynecology Canada, 20: 52-58.
- Smoking Cessation During Pregnancy: A Clinician’s Guide to Help Patients Quit Smoking (2011) Retrieved September 25, 2012 from http://www.acog.org/~/media/Departments/Tobacco%20Alcohol%20and%20Substance%20Abuse/SCDP.pdf?dmc=1&ts=20120925T1305085153
- University of North Carolina Center for Maternal and Infant Health. (2012). Smoking cessation: An essential women’s health intervention. Retrieved September 25, 2012 from http://YouQuitTwoQuit.com
- National Institutes of Health. (2011). Nicotine. LACTMED: Drug and Lactation Database.
- North Carolina Division of Public Health. (2008). A guide for counseling women who smoke. Retrieved from http://whb.ncpublichealth.com/provpart/pubmanbro.htm
- American College of Obstetricians and Gynegologists (2011). Smoking Cessation During Pregnancy A Clinician’s Guide to Helping Pregnant Women Quit Smoking. Retrieved from: https://www.acog.org