Approaches to smoking cessation before and during pregnancy

What is the role of the obstetrician in identifying nicotine and tobacco exposure in their patients and encouraging cessation or reduction prior to and during pregnancy?

The first responsibility is to screen pregnant women. A recent survey study suggests that 40% of the responding ob.gyns. never screened pregnant patients for use of noncombustible tobacco products such as e-cigarettes (Am J Obstet Gynecol. 2014 Dec;211[6]:695.e1-7). In the United States, an analysis of the Pregnancy Risk Assessment Monitoring System data collected across several states from 2009 to 2010 suggests that about a quarter of 3,559 pregnant women who reported smoking in the 3 months before pregnancy did not receive any interventions to stop smoking (Prev Med. 2015 Sep;78:92-100). In addition, four out of five ob.gyns. surveyed in 2012 were unaware of the Affordable Care Act provision that requires states to provide tobacco cessation coverage for pregnant Medicaid beneficiaries (Prev Med Rep. 2015;2:686-88).

Dr. Chambers is professor of pediatrics and director of clinical research at Rady Children’s Hospital, and associate director of the Clinical and Translational Research Institute at the University of California, San Diego. She is director of MotherToBaby California, past president of the Organization of Teratology Information Specialists, and past president of the Teratology Society. She reported having no financial disclosures relevant to this column, but has received research funding from GlaxoSmithKline and Pfizer for unrelated products.