Smoking Cessation in Pregnant Women

Interventions for Smoking Cessation

The American College of Obstetricians and Gynecologists (ACOG) recommends that nicotine replacement therapy (NRT) should be considered only after a detailed discussion of the known risks of continued smoking, the possible risks of NRT, and need for close supervision 2
Provide more intensive behavioral counseling with multiple sessions, as behavioral interventions are more effective when they provide intensive counseling augmented with pregnancy-specific materials and messages about effects on both maternal and fetal health 1, 3
Refer to support groups or specialized cessation programs, as group behavioral interventions and counseling with cessation specialists are effective modalities 4, 5
Utilize telephone counseling or quitlines, which are as effective as face-to-face counseling and remove barriers such as cost and time 6
Behavioral counseling is the only intervention with established safety and effectiveness in pregnancy, making it the foundation of treatment 7, 1
NRT should be considered only after behavioral interventions alone prove insufficient and following detailed discussion with the patient about the known risks of continued smoking versus the possible risks of NRT 2
NRT is FDA-approved for smoking cessation and increases cessation rates in the general population, though evidence specific to pregnancy is more limited 7, 1
When considering NRT, start with short-acting forms (gum, lozenges) rather than patches, as these allow for more controlled nicotine exposure 6

Combine behavioral counseling with NRT for maximum effectiveness, as combination therapy is superior to either alone in non-pregnant populations 8, 5
Emphasize that quitting early in pregnancy provides the greatest benefit to the fetus, though cessation at any point yields substantial health benefits 1, 3
Inadequate follow-up is a common pitfall to avoid, as smoking cessation requires ongoing support and monitoring, with repeated quit attempts encouraged 6
Underestimating the importance of intensive behavioral support is a common pitfall to avoid, as brief counseling alone may be insufficient for heavy smokers; multiple sessions with pregnancy-specific materials are more effective 1, 3