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Thursday, September 29, 2011

Pregnancy is a Great Time to Quit Smoking

She showed up on the labor and delivery unit one Saturday morning on my watch, and I will never forget that day.  The woman was young, and her mother was with her for what they thought would be an ordinary labor - they could not have been more tragically wrong. She reported that she was having contractions but really hadn't felt the baby move for quite some time.  I noted that the chart said she smoked cigarettes throughout the pregnancy despite repeated counseling to quit.  It didn't take long for me to figure out why her baby hadn't been kicking...thank God her mother was there to bring an element of emotional support because this was likely going to be the worst day of their lives.

How do you tell someone that the baby they were so eagerly awaiting will be stillborn?  You cry and find a way to get them through it.  Perhaps tragedies like this one can be avoided with better education of young mothers-to-be regarding the very real and devastating effects of using tobacco products while pregnant.

Quitting smoking is no easy task, but it turns out that pregnancy is not only the most important time of a woman's life to quit, but it is also one of the easiest of times.  Every woman wants a great pregnancy outcome, and therefore, the motivation to quit is built-in.  Motivation to put that pack down is a major hurdle, and even people who have had major health issues such as a heart attack or stroke don't necessarily find that internal drive to stop what is clearly exacerbating their disease and risk of death.

Pregnant women can feel that motivational force literally kicking them in the gut every day.  Statistics show that 46% of women who smoke before they realize that they are pregnant can quit successfully such that the overall rate of smoking during pregnancy has declined from 18% in 1990 to about 13% in 2006.  Optimally, this should be zero.

There are important fetal and maternal health risks that can be directly attributed to the use of tobacco products including smokeless tobacco.  Babies rely on the placental blood flow for oxygen exchange, but that blood flow is compromised when nicotine is on board because of nicotine's effects on blood vessels.  The constriction of flow through the vessels can ultimately lead to restricted growth of the baby as well as sudden death in-utero.  No one wants to hear that their baby could die if they smoke during pregnancy, and I never enjoy talking about it...but the truth must not be suppressed.  Tobacco products during pregnancy are dangerous for both mother and baby.

The young woman in my story had actually suffered what is known as placental abruption, which translates into at least a portion of the life-giving placenta separating from the wall of the womb.  This results in loss of blood flow directly to the baby and subsequent loss of life.   Placental abruption can be equally catastrophic for the mother since major hemorrhage to the point of requiring blood transfusions is sometimes associated with these events.  The chance of abruption is hugely increased by smoking as is the risk of a very low birthweight baby and even sudden infant death syndrome (SIDS).  It is well known that children born to mothers who smoke have a much higher risk of asthma, colic and childhood obesity.

So what is the best way to quit?  Smoking cessation methods of all kinds are used in pregnancy including occasional need for medication (use must be balanced against the potential medication risks to the baby) along with counseling, cognitive and behavioral therapy sessions, hypnosis, acupuncture - the non-pharmacological measures clearly have no adverse affects on the baby.  But none of these adjuncts to quitting will work well without the motivation of the mother to be successful.  Want to quit?  No better time than when a baby's life is on the line.

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