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Tips on getting pregnant smokers to quit

Tips on getting pregnant smokers to quit – Nicotine Replacement, Support Groups

Sharon Worcester

SARASOTA, FLA. — Only 20%-40% of smokers quit smoking during pregnancy, which means up to 25% of American women smoke while pregnant, Dr. Haywood L. Brown said at a perinatal symposium sponsored by Symposia Medicus.

Convincing smokers to stop during pregnancy can be a challenge, but there are smoking cessation methods that work so it’s worth the effort, said Dr. Brown, who is professor and chair of the department of obstetrics and gynecology at Duke University in Durham, N.C.

One key to success is to address the psychological addiction as well as the physical addiction. Self-help interventions are the most commonly used methods for quitting smoking; 90% of successful quitters use these methods, which can include telephone calls from a supportive source, taped messages, and videotapes.

Physician interventions can also be useful. Patient education about the risks of smoking and the benefits of quitting, negotiation of a quit date, and behavioral support groups are among interventions that can be offered or recommended by physicians.

Keep in mind that physician training in smoking cessation methods can be very helpful: Patients of specially trained physicians are up to six times more likely to stop smoking than those of physicians who have no training in promoting smoking cessation, Dr. Brown said.

Clinical interventions might include nicotine tapering, aversion stimulation (rapid smoking and smoke holding to create an aversion to smoking), and nicotine replacement. While nicotine medications can double or even triple cessation success rates-with short-term success rates in the 20%-40% range-remember that nicotine gum is pregnancy category C and transdermal patches are category D because they cause vasoconstriction.

According to a 1993 technical bulletin (No. 180) from the American College of Obstetricians and Gynecologists, patches may be reasonable in pregnant patients who smoke at least 20 cigarettes daily and are unable to quit by other methods, Dr. Brown said. He added that he prescribes patches, along with behavioral modification, in those who smoke at least 10 cigarettes daily, because he feels continued smoking poses a greater threat to maternal and fetal health than nicotine patches.

Nonnicotine drugs such as Zyban can also be used. Zyban is pregnancy category B and is “fairly safe” during the first trimester, he said. “The problem is that many patients continue to smoke while taking this, but it’s not unreasonable to try” prescribing Zyban, he said.

The Philip Morris Web Site (www.philipmorrisusa.com) provides links to good sources with information about quitting, he noted.

RELATED ARTICLE: Risks of smoking and benefits of quitting

* Maternal Risks. These include poor weight gain and nutrition, placental abruption, placenta previa, premature placental calcification, and premature delivery

* Fetal/Neonatal Risks. These include prematurity, fetal growth restriction, perinatal death, sudden infant death syndrome, intellectual impairment, and sleep disturbances. Smoking is the single most common cause of impaired fetal growth.

* Effects on Child Development. These include decreased height and physical growth, decreased cognitive abilities, and increased respiratory illnesses.

* Benefits of Quitting Early. About 30% of smokers who quit for pregnancy do so by the first prenatal visit; only 6% do so later in pregnancy More than 60% who stop will relapse within 3 months, but only 3% of those who quit for 6-12 months will return to smoking.

* Cost of Smoking. At approximately $3/pack, those people who smoke one pack per day spend $ 1,095/year.

Over 20 years, that adds up to $21,900. Those who smoke three packs per day spend about $3,285/year and about $65,700 over 20 years.

Source: Dr. Haywood L. Brown

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