Pregnant Women

If all pregnant women stopped smoking it is estimated that the number of
infant deaths would decrease by 10%.¹

• Concerns
• Needs

Concerns

Many pregnant women smoke during all or some of their pregnancy:

• Overall, it has been estimated that 22% of women in the United States smoke tobacco products. As many as 13 to 22% smoke while they are pregnant.¹
• A decline in the percentage rate of pregnant smokers by only one point would save over $20 million worth of medical services and would prevent 1,300 cases of low birth weight each year.²
• Some estimates suggest that only about one quarter of women who smoke will quit while preparing for a pregnancy or once they learn that they are already pregnant.³

Smoking puts both mother and baby at greater health risks:

• Babies born to smokers are almost 60% more likely to die as an infant than babies born to nonsmokers.¹
• Some of the risks to the mother include: menstrual and reproductive problems, infertility, conception delay, ectopic pregnancy, and spontaneous abortion.⁴ Additionally, mothers who breastfeed and smoke produce almost half the breast milk that non-smoking mothers produce (and the milk contains less calories and fat, which are important for the baby).⁵
• Some of the risks to the baby occur during the pregnancy: death, low birth weight, placenta previa, premature birth and placental abruption.⁶
• There are additional risks to the baby that show up after birth: Sudden Infant Death Syndrome (SIDS), childhood obesity, otitis media, respiratory infections, infantile colic, poor learning skills, problems processing sound⁷, asthma, and some babies may experience withdrawal symptoms like those babies who are addicted to illicit drugs their mother ingested.⁸
• These problems are believed to result from being exposed to carbon monoxide, toxicity from the over 2,500 substances in cigarettes, damage to genetic material and lessened amounts of oxygen that reaches the baby.⁶

Contributing factors for tobacco use among pregnant women:

• The decision for pregnant women to quit is influenced by a number of experiences and factors: guilt, social influence, morning sickness, whether or not the pregnancy was planned, visible signs of pregnancy, breastfeeding choices, health of the mother, health of the baby, having other children with breathing problems, getting advice from a health care provider, involvement with a cessation program and finding a good time to stop smoking.⁹
• Rates of smoking during pregnancy are highest for women with low income, who are white (non-Hispanic), between 15 and 19 years old, who did not complete high school, and who did not plan to become pregnant.³

While many women will quit at some point during their pregnancy, only about 33% of these women will continue to abstain from tobacco product use a year after the baby is born.^{1, 4} 

This puts both the mother and her family at risk for tobacco-related health problems.

• Women who return to smoking after the birth of their baby tend to be younger women who were heavy smokers prior to quitting, and who did not quit until much later in their pregnancy.⁹
• Women who remain abstinent from cigarettes after the baby is born tend to be married, young, white, educated and those who had smoked only lightly or moderately before quitting.⁹
• One reason women may go back to smoking is to lose weight. One helpful way to lose weight after delivering the baby is to breastfeed. Not only will breastfeeding help her lose weight, but it is very beneficial to the baby and for the mother's breast health.¹ Women who do not smoke are more likely to breastfeed their baby than women who smoke tobacco products.⁴
• Other reasons women begin to smoke again include having only planned to quit for the pregnancy, influence from other people, and stressful events such as medical or relationship problems.⁹

Needs

Due to the unborn fetus, interventions must be tailored to the specific needs of the pregnant women:

• The use of pharmacological interventions must be considered carefully. While some argue that the medications are not as bad as tobacco products, the nicotine is still not healthy for the fetus. If the mother is willing to attempt to quit using only behavioral techniques, this is ideal. If the mother makes continued failed quit attempts or smokes very heavily, SOME pharmacological interventions may be warranted. The type of pharmacological method used should be taken under the care and guidance of a physician.
• Interventions should examine the woman's motivation and reasons for quitting. Women differ greatly in why, when and how they quit smoking. Interventions should work to help the woman quit as soon as possible, help her find reasons to quit not only for her baby but also for herself, and to find a quit plan that meets her individual needs.
• Women who quit before becoming pregnant are sometimes seen as nonsmokers and, as a result, are not offered counseling and support to maintain their quit attempt. While these women are more likely than other pregnant smokers to maintain abstinence even after the baby is born, their ultimate success depends on how motivated they are to quit and how dependent they were on cigarettes. Therefore, these women should be offered support and counseling to help them maintain their quit attempt, even if they quit before becoming pregnant.⁹
• Women who quit only after learning they are pregnant often have high rates of cessation (as high as 85%). However, these women do not look the same as planned pregnancy quitters in terms of demographics, how they view the risks of smoking and how they see their cigarette addiction. These women have a high rate of relapse (50-80%) within the 6 months after giving birth. Some believe this is because their quit attempt is mainly for the sake of the baby, and they may not know about the risks to themselves or see these risks as reason enough to quit. Providing this knowledge and motivating these women to quit not only for their babies, but also for their own health, is an important intervention component.⁹
• Women who continue to smoke when pregnant tend to be of lower socioeconomic status, have more problems with family members, greater stress, more emotional and psychological issues, have less housing security, and less social and monetary resources. Therefore, when intervening with the pregnant smoker who is not motivated to quit, some or all of these influences should be addressed on some level.⁹

The benefits of quitting tobacco use are undeniable, but many pregnant women need to be informed of them and need help battling what they see as the negative aspects of quitting:

• Quitting smoking should happen as soon as possible. Obviously the best choice is for woman to quit prior to becoming pregnant. However, if a woman smokes while she is pregnant, the sooner she quits, the more likely her baby is going to be born without tobacco-related health problems. In fact, if a woman stops smoking in the first trimester, her baby is likely to have similar body measurements and weight to those of children born to nonsmokers. Smoking during the third trimester is believed to be especially harmful to the baby.⁴
• A short 5 to 15 minute session about quitting with a trained provider, along with educational materials, is a cost-efficient and effective way to increase cessation rates.²

Helpful Links

Smoke Free Families:
"Smoke-Free Families is a national program supported by The Robert Wood Johnson Foundation working to discover the best ways to help pregnant smokers quit, and spread the word about effective, evidence-based treatments."
http://www.smokefreefamilies.org/quit/youknow.asp

American Lung Association (ALA):
The link below takes you directly to information on ALA's website about pregnancy and smoking.
http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=33573

Rocky Mountain Health Plans 5 A's and Stages of Change PDF File:
A document for this Colorado Health Plan's program "Stickers-Suckers-Smokers" that contains the 5 A's and Stages of Change for quitting smoking during pregnancy in an easy-to-read two page chart format.
http://www.rmhp.org/pdf//pregnancy/Ds50.pdf

Centers for Disease Control and Prevention:
The link below is for a pdf file entitled "Preventing Smoking Exposure to Secondhand Smoke Before, During, and After Pregnancy".
http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/smoking.pdf

WomensHealth.gov:
The link below is for the Smoking & How to Quit section of the Women's Health website created by the U.S. Department of Health & Human Services.  Some information on this site is specific to pregnant women who smoke. 
http://www.4woman.gov/QuitSmoking/index.cfm