Smoking during pregnancy causes long term effects on the unborn child. More than 10% of pregnant women smoke in the United States today (American Cancer Society, 2007), and in some geographical areas that number is as high as 39% (Bailey, 2006). Managing smoking cessation during the prenatal period is a challenge that health practitioners are faced with.
Different options are discussed herein, along with contributing factors to the success of smoking cessation in the child bearing population. Mothers who smoke during pregnancy place their unborn infants at increased risk for numerous irreversible health conditions. Smoking during pregnancy is the cause of 20% of all low-birth weight infants (American Cancer Society, 2007). For babies born to mothers who smoked during pregnancy, the risk of sudden infant death syndrome increases. As many as 10% of all infant deaths could be prevented if pregnant women did not smoke (American Cancer Society, 2007).
Maternal smoking is associated with many other long-term health problems in children, including attention deficit hyperactivity disorder, criminal behavior, and substance abuse (Mann, 2007). Childhood growth restriction, abnormal neuromotor tone, increased respiratory infections, asthma, otitis media, and obesity are other lasting effects of prenatal cigarette exposure (Bailey, 2007). Because of these acquired health delays, children grow to become smaller in height and sometimes weight than those children of women who did not smoke during the prenatal period (American Lung Association, 2007).
The unborn infant is not only put at risk if the mother smokes during pregnancy, but also if the nonsmoking mother is exposed to environmental tobacco smoke while pregnant. Infants born to women who are exposed to environmental tobacco smoke during pregnancy have lower birth weights and a slightly greater risk of intrauterine growth retardation, when compared to infants who are born to women who were not exposed to environmental tobacco smoke (Rosenthal, 2006). Just as adults are subject to poor health and disease from second hand smoke exposure, so is the unborn infant.
The nursing role in smoking cessation in pregnant women consists of the 5A’s approach to smoking cessation counseling. The 5A’s are: ask, advise, assess, assist, and arrange. The 5A’s method was adapted for use by the American College of Obstetricians and Gynecologists as a standard component of prenatal care. It was developed by the National Cancer Institute, the Public Health Service, and the American College of Obstetricians and Gynecologists to provide a systematic protocol for clinicians and health care professionals to use when counseling patients on smoking cessation (Jordan, 2006).
At the initial prenatal appointment, the nurse and/or clinician will ask about tobacco use including number of years the patient has smoked, the amount the patient smokes and the frequency of tobacco use. If the pregnant woman is a current smoker, the nurse then advises the patient to on the risks that tobacco use has on themselves and their unborn child. The nurse will assess the patient’s readiness to quit, whether they are willing or unwilling. If the pregnant woman is unwilling to quit then the nurse will provide resources and help the patient identify barriers to quitting.
If the patient is willing to quit then the nurse will provide resources and assist that patient in formulating a cessation plan. The last step in the 5A’s approach is arranging for follow-up appointments with the nurse and/or physician to encourage the cessation process (http://ahrq. gov/about/nursing/hlpsmksqt. htm). Assessing a pregnant woman’s willingness to quit requires assessing above and beyond their own desire to quit. Health professionals must also look at lifestyle and cultural aspects that contribute to the high percentage of women who continue to smoke during pregnancy.
The Centers for Disease Control and Prevention report smoking during pregnancy as being strongly related to the educational and racial/ethnic background of the mother (Department of Health and Human Services, 2002). Caucasian women with less than a high school education have the highest rates of smoking during pregnancy (Department of Health and Human Services, 2002). One study revealed that women who quit smoking early in their pregnancy were older, more educated and more likely to be married versus those who quit later in pregnancy or who did not quit at all during the pregnancy (Solomon, 2006).
Furthermore, religiosity and spirituality are associated with decreased levels of tobacco use in pregnant women (Mann, 2007). Pregnant women are less likely to quit smoking when they live with a partner who smokes, have lower income levels, and have a higher nicotine dependence level (Pollak, 2006). After identifying the patient’s personal and cultural barriers to smoking cessation the nurse aids in assisting the pregnant woman in identifying appropriate methods to quit smoking. Spousal and familial support is beneficial in the early stages of cessation.
When partners provide positive support and pregnant women acknowledge this support, women are more likely to quit smoking during pregnancy (Pollak, 2006). Assisting the patient in formulating a smoking cessation plan also consists of providing various resources for the pregnant women to utilize. A plethora of brochures on smoking cessation are available via the American Cancer Society. Information on state phone-based quitting programs can be obtained by calling 1-800-QUITNOW, or by visiting www. smokefree. gov (American Cancer Society, 2007).
Many local hospitals and public health departments offer smoking cessation counseling and support groups specific to pregnant women. The health professional can present a current listing of behavioral health programs that are offered in the community to aid in increasing compliance in smoking cessation of their pregnant patients. A last attempt effortby physicians to assist pregnant women with smoking cessation is the use of pharmacotherapy agents such as nicotine gum, nicotine inhalers and transdermal nicotine.
Many physicians are reluctant to use nicotine replacement therapy pregnant women for fear that the medications may have a negative effect on the pregnancy or the fetus. Many studies have shown that combining pharmacotherapy with counseling increases the chance of smoking cessation during pregnancy. One study points out that the use of nicotine replacement therapy is not completely without risk to the pregnancy or the fetus, however the risk is much less than that of cigarette smoking during pregnancy.
It is suggested that nicotine replacement therapy be delivered as an intermittent dose, such as nicotine gum, rather than continuous dosing given by transdermal route. This method would in turn administer a smaller daily dose of nicotine (Benowitz, 2004). In conclusion, this paper has addressed the topics of health risks of the infant associated with maternal smoking during pregnancy. Cigarette smoking is the largest modifiable risk factor for pregnancy related morbidity and mortality in the United States and other developed countries (Benowitz, 2004).
In spite of this, health professionals are practicing new methods in promoting compliance in smoking cessation in an effort to decrease the national statistic of pregnant women who smoke during pregnancy. The use of behavioral therapy versus pharmacotherapy is now being considered to increase compliance and ultimately decrease the risks associated with smoking during pregnancy.
References
- American Cancer Society (2007). You are Not Alone. American Lung Association (2007). Smoking & Pregnancy [Electronic version]. Retrieved January 23, 2008, from http://www. ungusa. org/site/apps/s/content. asp? c=dvLUK9O0E&b=34706&ct=66733. Bailey BA. (2006).
- Factors predicting pregnancy smoking in southern Appalachia. American Journal of Health Behavior, 30(4), 413-421.
- Benowitz, N. L. , & Dempsey, A. (2004). Pharmacotherapy for smoking cessation during pregnancy. Nicotine & Tobacco Research, 6, S189. Department of Health and Human Services (2002).
