Women who smoke during pregnancy are at greater risk for certain complications, including placental previa, placental abruption, and premature rupture of the membranes, and premature delivery.  Furthermore, infants of mothers who smoke during pregnancy are more likely to be small for gestational age and are at greater risk of sudden infant death syndrome (SIDS).

In the United States, the prevalence of smoking in pregnant women has declined; however, according to data gathered  from 29 states by the Pregnancy Risk Assessment Monitoring System (PRAMS), about 13% of women smoked during the last 3 months of pregnancy.  The prevalence varied according to state, with the highest rates reported in West Virginia(28.7%),Arkansas(24.0%),Tennessee(19.7%), and Maine(19.5%).

Certain groups of women were more likely to smoke during pregnancy. These high risk groups included women aged 20–24 years (19.3% smoked during pregnancy), Alaska Native women (30.4%), women with < 12 years of education (22.5%), and women who were Medicaid-insured (22.1%).

The American College of Obstetrics and Gynecology (ACOG) now recommends that clinicians ask all pregnant women about tobacco use and to provide counseling to pregnant smokers.  However, it turns out that only about of pregnant smokers receive counseling, and only a third of prenatal care providers report that they deliver smoking cessation interventions in their clinical practices.

Why are so few women receiving the recommend smoking cessation interventions?  The reported reasons include providers’ self-reported lack of awareness of or disagreement with guidelines, lack of formal training in smoking cessation interventions, lack of systems to support counseling activities, and lack of patient and provider materials.

In order to help healthcare professionals improve their skills in helping patients to quit smoking during pregnancy and the postpartum period,  an interactive online training developed by Dartmouth College Interactive Media Laboratory in collaboration with ACOG and the Centers for Disease Control and Prevention (CDC).  The curriculum teaches a best practice approach for smoking cessation and is based on current clinical recommendations, including the five A’s of smoking cessation, a process that includes:

  1. Asking every patient about tobacco use,
  2. Advising all smokers to quit,
  3. Assessing smokers’ willingness to quit,
  4. Assisting smokers with treatment and referrals,
  5. Arranging follow-up contacts.

The program offers interactive case simulations and comprehensive discussions of the cases, short lectures on relevant topics from leading experts, interviews with women who have quit smoking, and a dedicated website of pertinent links and office resources. The training is accredited for up to 4.5 hours of continuing education credits.  Clinicians can access the training, by visiting www.smokingcessationandpregnancy.org.

By not encouraging smoking cessation in women who are pregnant or planning to conceive, we are potentially missing an ideal opportunity.  Women who are pregnant or planning to conceive are highly motivated with regard to smoking cessation. The authors also note that while quitting smoking before 15 weeks of gestation carries the greatest health benefits for the pregnant mother and her fetus, quitting at any point can be beneficial.

Ruta Nonacs, MD PhD

Tong VT, Dietz PM, England LJ.  “Smoking Cessation for Pregnancy and Beyond: A Virtual Clinic,” an Innovative Web-Based Training for Healthcare Professionals.  Journal of Women’s Health. October 2012, 21(10): 1014-1017.

To access the training, please visit www.smokingcessationandpregnancy.org.

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