The pregnant smoker: Improving success rates and preventing postpartum smoking relapse

Pregnant women are highly motivated to stop or suspend smoking once they learn they are pregnant. Many women resume smoking following delivery and the reasons that they relapse are often linked to stress, sleep deprivation, lack of motivation and confidence to remain smoke free, and lack of alternative strategies for stress reduction. Programs targeting new mothers and their spouses as a couple have a more beneficial impact on reducing postpartum smoking relapse rates than merely focusing on the mother. More strategies are needed to support mothers long-term to remain tobacco smoke free and no single strategy works for every women. Although pharmacologic interventions may assist women to stop smoking, few women wish to take medications during pregnancy, and nicotine patch use during the postpartum period may transfer nicotine in smaller amounts into the breastmilk. Effective strategies that minimize pregnancy weight retention during the postpartum period need to be developed to assist women not to return to smoking to lose weight after delivery. More emphasis on coupling smoking cessation during pregnancy and promotion of breastfeeding will prolong the period of postpartum freedom from smoking. Well-established and effective programs are available to obstetricians, neonatologists and pediatricians to provide parents stop-smoking and counseling and other supportive therapies, but they must be offered and used in order to be effective. As emphasized above, these programs must become the standard of care for any women found to be smoking at anytime during pregnancy and to all family members who continue to smoke during the postpartum period or while an infant may remain hospitalized in the post birth period. Although current gaps do exist in translating research-based programs into routine clinical practice, use of information technologies, through the use of the internet, social media, text messaging, short videos on mobile telephones, makes it possible to reach nearly every women who smoke and to provide meaningful information that should provide some protection for her newborn and growing infant. Public health efforts to 'glamorize' smoking in the media, restrict or ban smoking in public places, ban smoking in multidwelling apartments, in restaurants, and at social gatherings where children may be present provide normative behavioral cues to pregnant women and new mothers, as well as their families. Minimizing social cues associated with smoking relapse are critical if we are to have continued success.