Smoking Cessation in Pregnant Women. Cheryl Oncken, M.D., MPH University of Connecticut School of Medicine. Risks of Smoking During Pregnancy (Surgeon General’s Report 2004). Maternal smoking is responsible for a number of poor pregnancy outcomes spontaneous abortion (RR=1.2-1.3 )
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Cheryl Oncken, M.D., MPH
University of Connecticut School of Medicine
25% spontaneously quit smoking after learning of pregnancy (Floyd et al., 1993; LeClere & Wilson, 1997; Severson et al., 1995)
Another 12% quit later on; however, the majority of pregnant smokers cut down, but do not quit(Fingerhut et al., 1991)
Of women who quit during pregnancy, about 70% relapse within 1 year following delivery(Fingerhut et al., 1991)
Fiore et al., 2008
Fiore et al., 2008 (Table 6.26)
“ Safety is not categorical… Although the use of NRT exposes pregnant women to nicotine, smoking exposes them to nicotine plus numerous other chemical that are injurious to the woman and the fetus. These concerns must be considered in the context of inconclusive evidence that cessation medications boost abstinence rates in pregnant smokers.”
Research is needed to better determine the risk/benefit profile
Intermittent vs. continuous delivery system may deliver a lower total dose
Pregnancy registries (prospective) would be useful to better determine the risk/benefit profile
Oncken CA, Hatsukami DK, Lupo VR, et al. Effects of short term nicotine gum use in pregnant smokers Clin Pharmacol ther 1996;59:654-1.
Peak Nicotine Concentrations Pregnant Women
Trough Nicotine Concentrations
Wisborg K, Henrikson TB, Jesperson LB, Secher N. Nicotine patches for Pregnant smokers. Obstet Gynecol 2000;96:967-71.
Randomized open-label two-arm design:
2:1 randomization with more in NRT group
Adjusted for number of completed counseling sessions
* indicates p<.05
Pollak KI, Oncken CA, Lipkus et al., AJPM 2007;33:297-305
Miller H, Ranger-Moore J, Hington M. et al. Bupropion SR for smoking cessation and reduction in pregnancy Am J Obstet Gynecol 2003:189: S133