Pregnant and smoking - what are your options? Part One
Smoking during pregnancy causes up to 2,300 premature births, 5,000 miscarriages and 300 perinatal deaths every year in the UK. It also increases the risk of developing a number of respiratory conditions, is a factor in attention and hyperactivity disorders, learning difficulties, problems of the ear, nose and throat, obesity and diabetes.
That’s the bad news.
The good news, however, is that smoking is the single biggest modifiable risk factor for poor birth outcomes.
In this two-part blog, I will cover various options; research can be complex to take in, therefore I am happy to provide more in-depth information on those areas which interest you.
The prevalence of smoking at time of delivery is currently 10.5%, down just over 2% in the past four years. The new national ambition set by the Smoking in Pregnancy Challenge Group is to bring this to less than 6% by 2020.
For many women, falling pregnant is a big enough incentive to stop smoking, even if only for the duration of the pregnancy. For some, however, family history, social background, personal circumstances and other factors mean that stopping can seem like an almost impossible feat.
The fact remains, that quitting while pregnant will measurably improve the likelihood of having a complication-free pregnancy and birth, and producing a healthy child.
So what are the options if you’re pregnant and wanting to quit?
1. THE COLD TURKEY APPROACH
Not for everyone, but it works for some. Around one in 20 of the non-pregnant population achieve success with this and it is more successful amongst pregnant women. Plus, it’s free and will bring an immediate end to the toxins reaching your unborn baby. You may feel lousy for a day or two, but maybe you won’t, and there is no evidence that stopping smoking in this way increases stress on the body or foetus.
If this is for you, then root out any remaining cigarettes and bin them. Change your habits and routines as much as you can to break any associations that you have made between smoking and activities, places or times of the day. Don’t assume you will feel lousy – rather accept any sensations of withdrawal as signs of your body healing. It is making a safe space and environment for your unborn baby to grow.
If you like it, you can combine this approach with another stop smoking intervention, like nicotine replacement or a hypnotic recording, or do it with someone for mutual support. See my blog Ready to Quit? on how to prepare to stop.
2. REDUCE THE AMOUNT YOU SMOKE BY DEGREES
If ‘cold turkey’ is not for you, then you could take a more moderate approach and set yourself targets for reducing the amount you smoke until you are completely smoke-free. As above, it works for around one person in 20 of the non-pregnant population and does not put the body under stress. You will also start to feel the economic benefits from day one.
Whilst a pregnant mother should aim to stop smoking as early in her pregnancy as possible, according to the British Medical Journal, if you are smoke-free before your 15th week of pregnancy, you will cut the risk of spontaneous premature birth and having a small baby to that of a non-smoker.
The greatest benefit is that your body will have time to adjust to having less nicotine. The downside is that you may feel less inclined to give up the smokes completely. But smoking even just one or two cigarettes a day after 15 weeks of pregnancy may damage your baby’s growth and lead to complications of pregnancy and birth.
3. USE A NICOTINE REPLACEMENT ALTERNATIVE
Nicotine is the addictive element in cigarettes, the chemical which narrows your blood vessels, reducing the amount of oxygen and nutrients reaching your baby via the placenta.
Patches, gums, lozenges, micro tabs, inhalators and nasal sprays act to reduce the nicotine withdrawal symptoms when you stop smoking. Although using nicotine replacement products is not contraindicated for pregnant women, advice should be sought from a qualified medical practitioner before use, as nicotine gum and patches increase the mother’s blood pressure, heart rate and, to a lesser extent, the foetal heart rate. It’s not likely to increase it any more than the smoking itself, however. This applies equally to anyone with heart or circulatory issues or who is on regular medication.
There are conflicting reports about the efficacy of nicotine replacement interventions though it has been said that nicotine replacement can increase an individual’s success rate from one in 20 to around one in 10. Current evidence suggests that nicotine replacement in pregnant women may not work as well as in the general population and that it has no advantage over counselling and behavioural change interventions. Part of the reason may be that in the studies, women were reluctant to use nicotine replacement and either used only a low dose or for a short time, which may have adversely affected results.
In the largest trial, women using a nicotine patch had a higher quit rate after four weeks, but had a similar quit rate to those who had used a placebo (a patch without nicotine) by the end of their pregnancy. Don’t underestimate the power of mind over matter!