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Quitting Smoking During Pregnancy

Are you pregnant and can’t quit smoking cigarettes? Sometimes knowing the harm smoking can cause to a growing baby is not enough motivation to help a mother stop smoking, and stronger measures are required. If you are having trouble quitting smoking during pregnancy, there is help. But first, you have to make a commitment to quit.

Potential Consequences of Smoking During Pregnancy

Smoking exposes your body to a variety of chemicals, some of which are well-known toxins and carcinogens. Smoking when pregnant exposes your growing baby to those same toxic chemicals. Two of those chemicals are known to have a negative impact on the developing fetus: nicotine, which causes blood vessels to constrict so less oxygen and fewer nutrients reach the fetus; and carbon monoxide, which reduces the amount of oxygen the fetus receives.

Prenatal tobacco exposure has been linked to poor pregnancy outcomes. Women who smoke during pregnancy are more likely than other women to have the following:

  • Miscarriage
  • Ectopic pregnancy (pregnancy in which fertilized egg implants in location outside the uterus, often the fallopian tubes)
  • Bleeding within the uterus as a result of the placenta separating from the womb too early
  • Premature infant (born before 37 weeks of pregnancy) or low birth weight infant—making it more likely the baby will be sick and have to stay in the hospital longer
  • Stillbirth (delivery of baby that shows no sign of life)
  • Baby with birth defects, like a cleft lip or cleft palate
  • Baby at risk for sudden infant death syndrome (SIDS)

In addition, children of mothers who smoke during pregnancy are at greater risk for asthma during the first two years of life. Smoking during pregnancy may also cause the brain and central nervous system of the fetus to develop abnormally, and this could affect a child’s thinking and behavior.

Women Who Smoke During Pregnancy

Even knowing the potential consequences of smoking during pregnancy, many women still have difficulty quitting, and many resume smoking after giving birth. According to data collected from 29 states by the 2008 Pregnancy Risk Assessment and Monitoring System, “Of women who smoked three months before pregnancy, 45 percent quit during pregnancy. Among women who quit smoking during pregnancy, 50 percent relapsed within six months after delivery.” (Centers for Disease Control and Prevention, 2013)

Strategies for Quitting Smoking During Pregnancy

Quitting smoking before becoming pregnant is the best way to protect your baby’s health. Although not smoking at all is the most effective way to reduce the risks of exposure, cutting back on smoking can help.

Regardless of where you are in your pregnancy, your decision to quit smoking is an important first step. Quitting can be hard, but it is possible. Your doctor, nurse, or health care provider can provide you with strategies and resources to help you quit smoking.

Tips to help you quit:

  • Make a commitment: Write down your reasons for quitting and create a plan for how you will do it. Know your triggers for smoking and how you will handle each of them.
  • Get support: Set a day to quit then let family and friends know about it and ask them for their support. Also consider joining a support group. Keep numbers to support hotlines (1-800-QUIT-NOW [1-800-784-8669]; TTY 1-800-332-8615) available and find out what support services are available to you through your health insurance or employer.
  • Replace smoking with a new habit: Try filling the times when you would normally smoke with another activity. For example, instead of smoking after a meal, try doing something physical, like taking a walk, running, or biking. Start a new hobby, such as knitting or carpentry, to keeps your hands busy. Remove all smoking paraphenalia (cigarettes, ashtrays, and lighters) from your home, office, and car. Replace foods and beverages (such as alcohol and coffee) you would have when smoking with other foods and beverages, or chew sugarless gum.
  • Don’t get discouraged if you relapse: If you slip and start smoking again, consider it an opportunity to learn more about what motivates you to smoke. Review your reasons for quitting, your triggers for smoking, and your support system and make adjustments to help you achieve your goal. Although withdrawal symptoms are common in long-time smokers, they lessen after only one to two weeks of not smoking. Note that many of those who have successfully quit smoking have done so only after repeated attempts.
  • Speak with your doctor before using over-the-counter smoking cessation agents: Quitting aids, such as nicotine gum, patches, and lozenges, are available at drug stores. However, they are generally not recommended for use during pregnancy.

Resources for Women Who Want to Quit Smoking During Pregnancy

Smokefree.gov (www.smokefree.gov): provides support in quitting, including free quit coaching, a free quit plan, free educational materials, and referrals to local resources

Freedom From Smoking (www.ffsonline.org): a program to help you quit smoking

Smokefree Women (www.women.smokefree.gov): provides information and resources on quitting smoking targeted at women

Techniques for Quitting Smoking During Pregnancy

Some smokers, especially those who are heavily addicted to nicotine, need more structured intervention. For pregnant women who wish to quit smoking and need additional help, there are a variety of options. These include counseling, cognitive and behavioral therapy, hypnosis, acupuncture, and pharmacologic therapy. Although hypnosis and acupuncture have not been proven to be effective for smoking cessation in clinical studies, some people have found them helpful. Your doctor can help you choose which smoking cessation technique is right for you.

Regarding pharmacologic therapy, “The U.S. Preventive Services Task Force has concluded that the use of nicotine replacement products or other pharmaceuticals for smoking cessation aids during pregnancy and lactation have not been sufficiently evaluated to determine their efficacy or safety.” (American College of Obstetricians and Gynecologists, 2010). In other words, smoking replacement products like Nicorette gum or patches or lozenges have not been tested in pregnancy—but they are probably safer than smoking.

Your doctor will have to carefully consider whether you should use nicotine replacement therapy or medications, such as varenicline and bupropion, for smoking cessation during pregnancy. These agents must be used with caution. The medications, in particular, have warnings that their use may increase the risk of psychiatric symptoms and suicide.

Benefits of Quitting Smoking During Pregnancy

Quitting smoking will help you feel better and provide a healthier environment for your baby. Even after just one day of not smoking, the oxygen to your baby will increase. You will greatly reduce the risk of complications during pregnancy, and you will also reduce your risk of developing tobacco-related diseases, such as lung cancer and heart disease.

Expectant mothers who stop smoking have more energy and breathe more easily. This may help combat some of the fatigue and breathlessness normally experienced during pregnancy. The money saved from not buying cigarettes can be used on things for the baby. You can feel good about what you have done for yourself, your baby, and the people around you.

Medical References:

    Centers for Disease Control and Prevention, Tobacco Use and Pregnancy, April 11, 2013. http://www.cdc.gov/reproductivehealth/TobaccoUsePregnancy/ National Heart, Lung, and Blood Institute, Strategies to Quit Smoking, December 20, 2011, http://www.nhlbi.nih.gov/health/health-topics/topics/smo/strategies.html American Lung Association, Why Quit Smoking, http://www.lung.org/stop-smoking/how-to-quit/why-quit/ “Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement.” U.S. Preventive Services Task Force. (Annals of Internal Medicine, 2009), 150:551–555. “Smoking cessation during pregnancy.” Committee Opinion No. 471. American College of Obstetricians and Gynecologists. (Obstetrics & Gynecology, 2010), 116:1241–1244.
[Page updated June 2017]