Smoking and women's health: opportunities to reduce the burden of smoking during pregnancy

• Published in: Canadian Medical Association journal (CMAJ) 2000-08, Vol.163 (3), p.288-289
• Main Authors: Ebrahim, S H, Merritt, R K, Floyd, R L
• Format: Article
• Language: English
• Subjects: Data Collection - methods; Female; Health aspects; Humans; Nova Scotia - epidemiology; Population Surveillance - methods; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications - epidemiology; Pregnancy Complications - prevention & control; Prevalence; Smoking; Smoking - epidemiology; Smoking Cessation - methods; Smoking Prevention; Women; Women's Health
• ISSN: 0820-3946; 1488-2329

Smoking cessation is one of the most important actions a woman can take to improve the outcome of her pregnancy, and most women who stop smoking during pregnancy do so on their own. Because women know about the adverse effects of smoking on their health and that of their fetuses, pregnancy may be a time when smoking cessation efforts and interventions are potentially effective.1,2 Nevertheless, most smokers do not stop smoking during their pregnancy. Tobacco addiction is progressive and chronic and, in consequence, smoking cessation interventions focusing on the prenatal period have failed to achieve long-term abstinence among the majority of pregnant smokers. Two-thirds of women who smoke during their first pregnancy also smoke during their second, exposing their first infant to tobacco smoke both in utero and after delivery.3 Although the mean number of cigarettes smoked daily before pregnancy and during pregnancy in this study of women in Nova Scotia in 1997 is similar to that reported for the United States, the prevalence of smoking in this population of pregnant women (25.5 % at delivery) is about twice the US rates.' Given the social desirability of nonsmoking status, which is greater during pregnancy, the actual prevalence of smoking may be even higher. Information on the rate of postpartum return to smoking is not reported by Kirkland and coworkers, but there is no reason to assume that it will be lower than the rates in other populations. In their study population some women who were nonsmokers before their pregnancy apparently began smoking during pregnancy; this result may be explained by earlier nondisclosure of their smoking habits rather than initiation of smoking during pregnancy. In the United Kingdom 16% of respondents to a survey reported that they did not admit to their doctors that they smoked.8 A study in the United States found nondisclosure rates of 28% at enrolment into prenatal care and 35% at followup.9 Therefore, biochemical verification of smoking status is needed to evaluate cessation interventions. The need to assess the smoking habits of each woman during each contact with a clinician is clear, as is the case for assessing other vital signs.