Project TEAM

Two subgroups approach or surpass the national rate. A subgroup of Hispanics, Puerto Ricans, represents a spike in the rates, with 10.5% of this group smoking during pregnancy, seven times the low 1.4% found among other Hispanic subgroups (Central and South Americans). Rates were also high in Hawaiian women, 14.7% of whom smoked during pregnancy (Fig. 2).

Other factors affecting maternal smoking include residence in a tobacco- producing state and education level. Maternal smoking rates were highest among those without a high school education (29%) and lowest among those with four or more years of college (2%). The two states with the highest maternal smoking rates were West Virginia and Kentucky (26.1% and 24.5%, respectively), both tobacco-producing states.

To combat the ills that affect the unborn because of smoking during pregnancy, the federal government recommends interventions throughout the life course of women. This is because months can pass before a woman knows she is pregnant and becomes willing to quit to protect her baby even if she was formerly unwilling to quit to protect herself.

Interventions for women who are of child-bearing age or are pregnant should take into account these differences. Behavioral approaches to tobacco cessation are preferred for pregnant women because clinical studies of bupropion in pregnant women have not been done. Classified as a category B drug, bupropion is recommended by its manufacturer for use in pregnancy only if clearly needed (Table 1).

Table 1: U.S. Department of Health and Human Services Clinical Practice Guideline, Treating Tobacco Use and Dependence Recommendations During Pregnancy Recommendation: Because of the serious risks of smoking to the pregnant smoker and the fetus, whenever possible pregnant smokers should be offered extended or augmented psychosocial interventions that exceed minimal advice to quit. (Strength of evidence = A) Recommendation: Although abstinence early in pregnancy will produce the greatest benefits to the fetus and expectant mother, quitting at any point in pregnancy can yield benefits. Therefore, clinicians should offer effective smoking cessation interventions to pregnant smokers at the first prenatal visit as well as throughout the course of pregnancy. (Strength of evidence = B) Recommendation: Pharmacotherapy should be considered when a pregnant woman is otherwise unable to quit, and when the likelihood of quitting, with its potential benefits, outweighs the risks of the pharmacotherapy and potential continued smoking. (Strength of evidence = C)

For children whose parents' tobacco habit persists into their early years, the consequences can be serious. Smoking while breastfeeding exposes infants to harmful chemicals. Effects of heavy smoking during breastfeeding can include reduction of the mother's milk supply and nausea, abdominal cramps, vomiting, and diarrhea in the infant.

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