Guidelines for Smoking Cessation During Pregnancy
When President Obama signed the Tobacco Control Act into law on June 22, 2009, he called attention to the importance of smoking cessation in Americans. Smoking results in more than 400,000 deaths annually in the United States from cancer, emphysema and other respiratory illnesses, cardiovascular disease, and spontaneous abortions or miscarriages during pregnancy. In the United States, there is an increased risk for premature birth in the fetus of pregnant women if the mother smokes, as well as growth retardation of the fetus. Over 1,000 infants die annually because the mother smokes.
Because of this, the U.S. Preventive Services Task Force has been active in evaluating the interventions appropriate to preventing tobacco use and tobacco related diseases in adults and now especially in pregnant women. The results of their recommendations were published in the Annals of Internal Medicine (Volume 150, page 551, 2009). The task force evaluated all prior publications on smoking cessation and has determined what is the standard of care in the United States.
You can discuss each of these recommendations with your physician to make certain that if you or a family member or friend is smoking, you can use the most important components of these recommendations to be certain all possible help is being given.
The task force indicated that the most important support for an individual is counseling. This counseling consists of five steps: 1. The physician should ask you about your use of tobacco, and you should be telling your physician that you smoke. 2. You should receive a clear message from the physician that advises you to quit smoking. 3. You should express a willingness to stop your smoking. 4. The physician and the physician’s office should tell you how they are going to assist you in quitting your smoking addiction. 5. The office should be certain that it arranges a follow-up visit for you to be certain that your smoking is stopped or reduced, and continued support and follow-up visits need to be scheduled.
In addition, if a person is not pregnant, additional smoking interventions in addition to counseling are important and more effective than counseling or using medications alone. Medications include: nicotine patches, nicotine inhalers, nicotine gum, anti-depression medication such as bupropion, and smoking drive reducers such as varenicline.
However, if a woman is pregnant, use of medications may be questionable. The task force in looking at pregnant women, regardless of age, strongly recommended counseling with a physician, but did not find adequate studies to determine the safety of medications during the course of a pregnancy. Therefore, pregnant women who smoke particularly need more intensive counseling by their physician and more intensive support by their family. The American College of Obstetrics and Gynecology has suggested standards for gynecologists which are available through their website.
If you are pregnant, smoking cessation is important to reduce risks to your developing infant. Not only should you not smoke, but you should not be exposed to environmental tobacco smoke. Take every step with your obstetrician to reduce smoking.
If you are a smoker of any age and not pregnant, be certain to engage your physician in helping you to stop smoking. Smoking is a danger to American men and women, and to the infants of pregnant women.
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