What should you do if you are pregnant and smoke?

There are many consequences to smoking during pregnancy, including:

  • Reduced growth of your unborn baby (low birth weight)
  • Premature delivery
  • Increase risk of birth defects
  • Increased risk of autism
  • Increased childhood asthma
  • Poor lung development
  • Behavioral problems after delivery

About 17% of pregnant women smoke and almost half stop while they are pregnant.  The good news is that as long as you quit early, by the end of your first trimester, your unborn child is usually unaffected.  However, quitting smoking is never easy and many mothers need help.  What help is available?

A good place to get started is at www.smokefree.gov a website run by the U.S. government.  The site has a collection of telephone helplines, programs to help you quit, and mobile tools that may help.  We call this approach behavioral therapy because it helps you change your behavior without the use of medications or nicotine replacement therapy.  This is clearly the best way to quit because it exposes you child to no drugs. If you cannot quit in this fashion is the nicotine patch an option?

The simple fact is that there is no definitive answer on nicotine replacement therapy during pregnancy because not enough studies have been done.  The nicotine patch seems to reduce but not eliminate the problems with smoking.  The unborn baby’s lung growth is still reduced by the nicotine patch but probably not as much as if you smoke.  Clearly the amount of nicotine you take in each day by cigarettes or the patch matters.  If you use the patch, stick with the 7mg per day dose.

An antidepressant, bupropion, is also prescribed to help stop smoking.  It is possible that this drug is better than smoking, but there are no studies that show it is safe in pregnancy.  We know that antidepressants are linked to cleft palate, heart problems and learning delays when used during pregnancy.  We do not know if these risks are greater or less than smoking.  Nonetheless we can make a recommendation.

What is clear is that the risks of smoking during pregnancy increase with the number of cigarettes you smoke per day and if you continue smoking after your second trimester begins.  The cutoff point seems to be 10 cigarettes and the critical time to stop is before week 15.  However if you continue to smoke at a very low rate of 5 cigarettes, that would probably be less risky than taking an untested prescription drug.  If you cannot quit by week 15 then please quit by week 24 because that is when lung development really kicks into high gear.  If during your last trimester you cannot quit entirely you can still do your child a great deal of good by restricting your cigarettes to less than ten per day.  Once you get to ten, try to cut back to no more than five per day.

If you are smoking more than ten cigarettes per day, and cannot cut back, ask your OB about bupropion or the nicotine patch.  They are both probably better than heavy smoking but you must discuss this with your doctor and let her know what you are doing.  Since organ formation takes place in your first trimester, and smoking causes less injury in the first trimester, I would not recommend taking prescription medication to stop smoking until after week twelve.

Long term help is on the way.  Experts from all over the world meet periodically to pool their ideas on how to help young women stop smoking during pregnancy.  At a recent conference, Ailsa Rutter, one of the directors noted “Smoking can compromise the capacity to have a family, and parental smoking can have long term and serious consequences for child health.  Exposure to secondhand smoke is a risk during pregnancy, and harms infants and children, but the good news is that quitting smoking reduces or eliminates many of the risks to reproductive life and health.”

One final recommendation to help young women would be for notable female celebrities who smoke to set an example and give up smoking and publicize it.  Ben Affleck recently announced he gave up smoking when his wife Jennifer Garner became pregnant.  Ellen Degeneres also recently quit to much fanfare.  In our media driven, celebrity obsessed culture; it is very helpful when people we admire lead by example.


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