Tong, V. T., England, L. J., Dietz, P. M., & Asare, L. A. (2008). American Journal of Preventive Medicine, 35, 327-333.

Although extensive research has demonstrated the adverse effects of smoking on pregnancy outcomes, little is known about how many pregnant women are offered or use interventions for smoking cessation. The purpose of this study was to describe women's smoking patterns and the use of cessation services during pregnancy. The investigators analyzed population-based surveillance data from the 2004 and 2005 New Jersey Pregnancy Risk Assessment Monitoring System (PRAMS) (n=4473). Sixteen percent of women who delivered a live infant reported smoking in the 3 months before pregnancy. Of these women, 50% quit before or when they found out they were pregnant, 5% quit later in pregnancy, 20% reduced their smoking, and 25% smoked the same or more. Women who continued to smoke during pregnancy were more likely to be younger, nulliparous, less educated, have more stress, and have late entry to prenatal care. Among women who smoked during the last 3 months of pregnancy, 52.4% tried to quit or cut back on their own, and only 11.5% used a method of smoking cessation, including self-help materials, medications, counseling, or a class or program.

The most frequently reported barriers to quitting were cravings for a cigarette, losing a way to handle stress, and having other people around who smoke. Although almost all women (92.7%) reported that their prenatal care provider asked if they smoked, only 57% of women who were smoking when they entered prenatal care reported that a provider spent time discussing how to quit. These results suggest that providers need to more consistently counsel pregnant women to quit smoking, provide information on smoking cessation methods, and refer women to evidence-based cessation services. All prenatal care providers, including nurses, should intensify their efforts to help pregnant smokers quit in order to reduce the harmful impact of smoking on the health of women and their newborns.

Commentary by

Maureen Heaman