Smoking cessation in pregnancy: An update for maternity care practitioners
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School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Department of Midwifery, University of West Attica, Athens, Greece
Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
Center for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
1st Department of Respiratory Medicine, ‘Sotiria’ Chest Disease Hospital, Athens, Greece
Evgenidio Hospital, Athens, Greece
First ICU, Evangelismos Hospital, Athens, Greece
Paraskevi A. Katsaounou   

First ICU, Evangelismos Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Publish date: 2019-08-02
Tob. Induc. Dis. 2019;17(August):57
This paper provides an up-to-date summary of the effects of smoking in pregnancy as well as challenges and best practices for supporting smoking cessation in maternity care settings.

We conducted a qualitative review of published peer reviewed and grey literature.

There is strong evidence of the effects of maternal tobacco use and secondhand smoke exposure on adverse pregnancy outcomes. Tobacco use is the leading preventable cause of miscarriage, stillbirth and neonatal deaths, and evidence has shown that health effects extend into childhood. Women who smoke should be supported with quitting as early as possible in pregnancy and there are benefits of quitting before the 15th week of pregnancy. There are a variety of factors that are associated with tobacco use in pregnancy (socioeconomic status, nicotine addiction, unsupportive partner, stress, mental health illness etc.). Clinical-trial evidence has found counseling, when delivered in sufficient intensity, significantly increases cessation rates among pregnant women. There is evidence that the use of nicotine replacement therapy (NRT) may increase cessation rates, and, relative to continued smoking, the use of NRT is considered safer than continued smoking. The majority of women who smoke during pregnancy will require support throughout their pregnancy, delivered either by a trained maternity care provider or via referral to a specialized hospital or community quit-smoking service. The 5As (Ask, Advise, Assess, Assist, Arrange) approach is recommended for organizing screening and treatment in maternity care settings. Additionally, supporting smoking cessation in the postpartum period should also be a priority as relapse rates are high.

There have been several recent updates to clinical practice regarding the treatment of tobacco use in pregnancy. It is important for the latest guidance to be put into practice, in all maternity care settings, in order to decrease rates of smoking in pregnancy and improve pregnancy outcomes.

The authors declare that they have no competing interests, financial or otherwise, related to the current work. S. Papadakis reports grants from Global Bridges (Pfizer Education and Change), outside the submitted work. The rest of the authors have also completed and submitted an ICMJE form for disclosure of potential conflicts of interest.
There was no source of funding for this research.
Based on an initial review of the literature, A.D. and P.K. produced a first draft of the review paper. The manuscript was circulated among all the authors. Each author provided further comments and suggestions on the manuscript. An updated draft was produced by P.A.K. and S.P. The revised manuscript was then circulated to all authors for final comments and approval.
Not commissioned; externally peer reviewed.
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