One out of five women in Los Angeles currently smoke; some of these women are pregnant or attempting pregnancy. Because smoking is harmful to both the mother and her developing fetus, most pregnant smokers make an effort to quit. A new study has reported that counseling alone is inadequate for helping most pregnant women quit smoking. The study, published online August 22 in the British Journal of Obstetrics and Gynaecology, concluded that more research on the use of nicotine replacement and other therapies during pregnancy may be needed. The study reviewed eight clinical trials comprised of a total of almost 3,300 pregnant women. The investigators evaluated whether counseling helped pregnant women quit smoking after six months.
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Four of eight trials showed no difference between groups of pregnant women who got smoking-cessation counseling and those who did not; the other four studies reported just a slightly lower quit rate in women who did not receive the counseling. For example, in the study with the highest success rate, only 24% of women who received counseling were able to quit, compared to 21% who did not receive counseling. Thus, three out of four pregnant women in that study continued to smoke whether they had counseling or not, noted lead author Dr. Kristian Filion from the University of Minnesota in Minneapolis. He explained, “We were a little surprised by the small number of women that remained abstinent and by the small effect of counseling.” He does not recommend abandoning counseling as an intervention; however, he does see a need to study more effective approaches. “Evidence regarding the safety and effectiveness of nicotine replacement therapies in pregnant women is limited,” he said. “More research in this area is needed so that we can better understand the risk-benefit ratio of nicotine replacement therapies in pregnant women.” Using counseling, nicotine replacement and other therapies that might help in a quit attempt before getting pregnant is a woman’s best bet, said Dr. Filion. U.S. Public Health Service guidelines recommend nicotine replacement therapies and drugs such as Wellbutrin (bupropion) and Chantix (varenicline) to help people stop smoking; however, these medications also have a negative effect on the fetus. For example, nicotine constricts arterial blood vessels; thus, the fetus receives less oxygen when nicotine is in the blood stream. However, nicotine alone avoids exposing the fetus to the numerous toxic substances contained in tobacco.
Take Home Message:
It is best to stop smoking without the aid of any substances that can be harmful to the fetus; however, it is better to apply a nicotine patch than light up a cigarette.