Ob-Gyns Urged to Screen Pregnant Women for Smoking

The American College of Obstetricians and Gynecologists (ACOG) has issued a committee opinion calling for all pregnant women to be screened for smoking, from the first office visit to term.

About 13 percent of US women smoke during pregnancy — a health risk linked to a number of fetal and infant problems including low birth weight, placenta previa, preterm delivery, and sudden infant death syndrome. (Secondhand smoke, or “passive smoking,” also poses risks; for example, women exposed to environmental tobacco smoke are 20 percent more likely to have a low birth-weight baby.)

Quitting substantially reduces these risks, said the college. Cutting down helps too, although the benefits are less clear.

To help pregnant women kick the habit, ACOG is recommending that health-care providers ask pregnant women about smoking at each visit, and provide ongoing support — including education, counseling, self-help programs, and referral to quit lines — to smokers throughout the pregnancy.

Drug therapy, such as nicotine patches or buproprion, may also help, but there?s not enough evidence for their safety and effectiveness in pregnancy for the ACOG to recommend them unless quitting is a patient’s clear goal and the potential risks of medication, compared with continued smoking, have been fully discussed.

Under health-care reform, physicians will be reimbursed for smoking cessation counseling, with no cost for patients.

“Pregnancy is a big motivator for many women to quit smoking,” said Maureen Phipps, MD, chair of ACOG’s Committee on Health Care for Underserved Women. “Almost half of women quit smoking right before or during pregnancy.”

Yet, 50 to 60 percent of them are smoking again within a year.

“The best thing a woman can do is to quit entirely during pregnancy and stay quit postpartum, both for her own health and her baby’s health,” said Phipps.

It remains to be seen whether the new recommendations help women who smoke achieve this goal.

The committee opinion, “Smoking Cessation During Pregnancy,” appears in the Nov. 2010 issue of Obstetrics and Gynecology.