According to a recent review of maternal and infant wellbeing, “smoking in pregnancy constitutes the largest remediable risk factor for maternal and child health.”1 Because smoking is a risk factor that can be altered, cessation initiatives for those who are pregnant have the potential to positively impact both maternal and child health. Approximately 16% of women and birthing persons in the United States smokes tobacco2.

Obstetrical complications including placental abruption, fetal growth restriction, hemorrhage, and ectopic pregnancy are among the most common complications for birthing people during pregnancy. Pulmonary conditions such as asthma, birth defects of the mouth, increased irritability, bone fractures, breastfeeding difficulties, childhood obesity, and sudden unexpected infant death syndrome (SUIDS) are among the most common birth and health complications for children with nicotine exposure.1  Parents from lower socioeconomic backgrounds, who are unmarried or has a partner who smokes, who are heavy to moderate smokers, and who have a high school diploma or less are more likely to use nicotine during pregnancy. Those most likely to continue smoking during the postpartum period are parents who have exposure to second-hand smoke in the home, are formula feeding, did not intend to quit smoking long-term prior to pregnancy, have concerns about weight gain, and have stressors during pregnancy that worsen due to a lack of support.4

The American College of Obstetrics and Gynecology suggests that successful nicotine cessation strategies for those who are pregnant and postpartum will require providers to address these factors and the psychosocial stressors occurring during pregnancy and after birth.5 There is a myriad of stressors that can present for mothers and pregnant people that are specific to the perinatal period including circumstances of their pregnancy, risks for interpersonal violence, financial readiness to support a child, and status of parental leave benefits. Cessation programming and interventions that are specifically designed to support those who are pregnant in trying to quit nicotine must take these things into consideration.

We can improve perinatal nicotine cessation outcomes for moms, birthing people, and babies by doing the following:

  1. Engage in universal screening for nicotine and perinatal mental health conditions that co-occur in those who smoke, vape, or dip.
  2. Offer tangible resources that address psychosocial stressors.
  3. Connect parents with culturally responsive education and treatment options.

Let us work together to partner with organizations who can support this collective effort for the betterment of moms, birthing people, and babies in our community.

References:

  1. Gould, G. S., Havard, A., Lim, L. L., & Kumar, R. (2020). Exposure to Tobacco, Environmental Tobacco Smoke and Nicotine in Pregnancy: A Pragmatic Overview of Reviews of Maternal and Child Outcomes, Effectiveness of Interventions and Barriers and Facilitators to Quitting. International Journal of Environmental Research and Public Health, 17(6), 2034. https://doi.org/10.3390/ijerph17062034
  2. Azagba, S., Manzione, L., Shan, L., & King, J. L. (2020). Trends in smoking during pregnancy by socioeconomic characteristics in the United States, 2010–2017. BMC Pregnancy and Childbirth, 20(1). https://doi.org/10.1186/s12884-020-2748-y
  3. Magee, S. R., Bublitz, M. H., Orazine, C. I., Brush, B., Salisbury, A. L., Niaura, R., & Stroud, L. R. (2014). The Relationship Between Maternal–Fetal Attachment and Cigarette Smoking Over Pregnancy. Maternal and Child Health Journal, 18(4), 1017–1022. https://doi.org/10.1007/s10995-013-1330-x
  4. Levine, M. D., Cheng, Y., Marcus, M. D., & Kalarchian, M. A. (2012). Relapse to Smoking and Postpartum Weight Retention Among Women Who Quit Smoking During Pregnancy. Obesity, 20(2), 457–459. https://doi.org/10.1038/oby.2011.334
  5. American College of Obstetricians and Gynecologists. (2020). Tobacco and nicotine cessation during pregnancy. ACOG Committee Opinion No. 807. Obstetrical Gynecology, 135, e221–9.