Smoking cessation in pregnancy: a continuing challenge in the United States

Abstract

Despite significant population level declines, smoking during pregnancy remains a major public health issue in the United States (US). Approximately 360,000-500,000 smoke-exposed infants are born yearly, and prenatal smoking remains a leading modifiable cause of poor birth outcomes (e.g. birth < 37 gestational weeks, low birth weight, perinatal mortality). Women who smoke during pregnancy are more likely to be younger and from disadvantaged socioeconomic and racial and ethnic groups, with some US geographic regions reporting increased prenatal smoking rates since 2000. Such disparities in maternal prenatal smoking suggests some pregnant women face unique barriers to cessation. This paper reviews the current state and future direction of smoking cessation in pregnancy in the US. We briefly discuss the etiology of smoking addiction among women, the pathophysiology and effects of tobacco smoke exposure on pregnant women and their offspring, and the emerging issue of electronic nicotine delivery systems. Current population-based and individual smoking cessation interventions are reviewed in the context of pregnancy and barriers to cessation among US women. Finally, we consider interventions that are on the horizon and areas in need of further investigation.

The impact of perinatal nicotine exposure on fetal lung development and subsequent respiratory morbidity

“…Despite the 55 years that have passed since the Surgeon General's landmark report on the dangers of smoking (Alberg, Shopland, & Cummings, ), its usage during pregnancy is still a major public health concern (Jamal et al, ; Scherman, Tolosa, & McEvoy, ) (http://www.who.int/tobacco/publications/surveillance/rep_mortality_attributable/en/; https://www.surgeongeneral.gov/library/reports/50-years-of-progress/index.html). Here we will first review the magnitude of this problem, highlight the emergence of new concerns, that is, an exponential increase in the use of electronic cigarettes (cigs), and the possibility of transgenerational transmission of smoke‐/nicotine‐induced pulmonary effects, and emphasize nicotine's major role in perinatal pulmonary morbidity.…”

“…Specifically in the United States, in 2015, there were 36.5 million smokers and almost half a million deaths were smoking related (Jamal et al, ) (https://www.surgeongeneral.gov/library/reports/50-years-of-progress/index.html). Moreover, approximately 10% of pregnant women reported smoking despite awareness of adverse effects to the fetus as well as to themselves, resulting in ~400,000 smoke‐exposed infants born yearly (Jamal et al, ; Scherman et al, ). Unfortunately, aggressive advertising strategies (especially toward the adolescent population with flavored products), the highly addictive quality of nicotine, and negative reinforcement of withdrawal symptoms (seen more commonly in women) (Aguirre et al, ; Rahmanian, Diaz, & Wewers, ), render the cessation extremely challenging.…”

“…Despite the 55 years that have passed since the Surgeon General's landmark report on the dangers of smoking (Alberg, Shopland, & Cummings, 2014), its usage during pregnancy is still a major public health concern (Jamal et al, 2016;Scherman, Tolosa, & McEvoy, 2018) (http://www. who.int/tobacco/publications/surveillance/rep_mortality_attri butable/en/; https://www.surgeongeneral.gov/library/reports/ 50-years-of-progress/index.html).…”

A Comprehensive Integrative Review of the Factors Associated with Spontaneous Preterm Birth, Its Prevention and Prediction, Including Metabolomic Markers

“…Although continuous effort and specific public policies are necessary, this is a good example of how identifying the risk associated with prevention strategies may result in more cost-effective and better maternal and perinatal outcomes. [50][51][52] The identification of factors associated with a higher risk of developing spontaneous preterm birth may be useful to help physicians understand its pathophysiology and identify women at higher risk who might benefit from prevention strategies. In the latter case, it may also possible to distinguish between screening for risk and prediction of preterm birth.…”

Opioid Addiction/Pregnancy and Neonatal Abstinence Syndrome (NAS): A Preliminary Open-Label Study of Buprenorphine Maintenance and Drug Use Targeted Psychotherapy (DUST) on Cessation of Addictive Drug Use

“…Tobacco use during pregnancy causes fetal loss, premature rupture of membranes, placental abruption, placenta previa, cleft lip/palate, cardiac, limb and gastrointestinal defects, low birth weight, and newborns with increased respiratory infections, bronchiolitis, otitis media, reactive airway disease, short stature, hyperactivity, obesity, decreased academic performance, and a 34% increase in unexpected infant deaths ( 7 ). Tobacco use in pregnant, opioid addicted women is high, between 88% and 95% ( 9 ). Tobacco cessation for opioid-maintained women is generally unsuccessful.…”