Tobacco smoking during pregnancy: risk assessment and its minimization
O.A. Sukhovskaya1,2
1St. Petersburg State Research Institute of Phthisiopulmonology
2I.P. Pavlov First St. Petersburg State Medical University
The review presents data from modern scientific studies showing that smoking during pregnancy is a risk factor associated with adverse pregnancy outcomes. The article describes the methods of assistance in smoking cessation in pregnant women. The results of key studies on the effectiveness and safety of smoking cessation strategies during pregnancy, including counselling and pharmacotherapy, are described. Consulting improves smoking cessation rates, especially when combined with pharmacological therapy. Pharmacotherapy is recommended for women who cannot quit smoking on their own. Nicotine substitution therapy is a reasonable choice of first-line drugs. Additional research is needed to assess their impact on the health of mother and fetus, for the effectiveness of their use in quitting smoking. A recurrence of smoking in the postpartum period is a serious problem. Approximately half of women who quit smoking have a relapse in the first 2 months after delivery.
Keywords: pregnancy, tobacco smoking, smoking cessation, nicotine addiction, tobacco smoking relapse.
For citation: Sukhovskaya O.A. Tobacco smoking during pregnancy: risk assessment and its minimization. RMJ. Medical Review. 2019;2(I):30–32.
References
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14. Maessen S.E., Ahlsson F., Lundgren M. et al. Maternal smoking early in pregnancy is associated with increased risk of short stature and obesity in adult daughters. Sci Rep. 2019;12;9 (1):4290–4292. DOI: 10.1038/s41598-019-39006-7.
15. Tappin D. The importance of permanent cessation for pregnant smokers. Addiction. 2016;111(6):991–992. DOI: 10.1111/add.13325.
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17. Суховская О.А. Табакокурение: оценка распространенности и мотивации к отказу от курения. Новые Санкт-Петербургские врачебные ведомости. 2007;2:61–64. [Sukhovskaya O.A. Tobacco smoking, assessment of the prevalence and motivation to quit smoking. New St. Petersburg medical registers. 2007;2:61–64 (in Russ.)].
18. Bérard A., Zhao J.P., Sheehy O. Success of smoking cessation interventions during pregnancy. Am J Obstet Gynecol. 2016;21(5):611.e1–611.e8. DOI: 10.1016/j.ajog.2016.06.059.
19. Haddad A., Davis A.M. Tobacco smoking cessation in adults and pregnant women: behavioral and pharmacotherapy interventions. JAMA. 2016;315(18):2011–2012. DOI: 10.1001/jama.2016.2535.
20. Oncken C., Dornelas E., Greene J. et al. Nicotine gum for pregnant smokers: a randomized controlled trial. Obstet Gynecol. 2008;112(4):859–867. DOI: 10.1097/AOG.0b013e318187e1ec.
21. Leung L.W., Davies G.A. Smoking cessation strategies in pregnancy. J Obstet Gynaecol Can. 2015;37(9):791–797. DOI: 10.1016/S1701-2163 (15) 30149-3.
22. Chamberlain C., O’Mara-Eves A., Oliver S. et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev. 2013;23(10): CD001055. DOI: 10.1002/14651858.CD001055.pub4.
23. Титова О.Н., Суховская О.А., Козырев А.Г. и др. Опыт оказания медицинской помощи при отказе от курения больным заболеваниями органов дыхания. Академический журнал Западной Сибири. 2015;11(3):35–38. [Titova O.N., Sukhovskaya O.A., Kozyrev A.G. et al. Experience in rendering medical assistance in quitting smoking to patients with respiratory diseases. Academic Journal of Western Siberia. 2015;11(3):35–38 (in Russ.)].
24. Яблонский П.К., Суховская О.А. Актуальные вопросы здорового образа жизни (по результатам опросов граждан России, обратившихся на горячую линию по здоровому образу жизни). Медицинский альянс. 2018;4:92–98. [Yablonsky P.K., Sukhovskaya O.A. Topical issues of a healthy lifestyle (based on surveys of Russian citizens who applied to the hotline for a healthy lifestyle). Medical Alliance. 2018;4:92–98 (in Russ.)].
25. Cahill K., Stevens S., Perera R., Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev. 2013;5: CD009329. DOI: 10.1002/14651858.CD009329.pub2.
26. Myung S.K., Ju W., Jung H.S. et al. Korean meta-analysis (KORMA) study group efficacy and safety of pharmacotherapy for smoking cessation among pregnant smokers: a meta-analysis. BJOG. 2012;119(9):1029–1039. DOI: 10.1111/j.1471-0528.2012.03408.x.
27. Coleman T., Chamberlain C., Davey M.A. et al. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev. 2015;12: CD010078. DOI: 10.1002/14651858.CD010078.pub2.
28. Coleman T., Cooper S., Thornton J.G. et al. Smoking, Nicotine, and Pregnancy (SNAP) Trial Team A randomized trial of nicotine-replacement therapy patches in pregnancy. N Engl J Med. 2012;366(9):808–818. DOI: 10.1056/NEJMoa1109582.
29. Vaz L.R., Aveyard P., Cooper S. et al. SNAP Trial Team The association between treatment adherence to nicotine patches and smoking cessation in pregnancy: a secondary analysis of a randomized controlled trial. Nicotine Tob Res. 2016;18(10):1952–1959. DOI: 10.1093/ntr/ntw080.
30. Swamy G.K., Roelands J.J., Peterson B.L. et al. Predictors of adverse events among pregnant smokers exposed in a nicotine replacement therapy trial. Am J Obstet Gynecol. 2009;201(4):354.e1–7. DOI: 10.1016/j.ajog.2009.06.006.
31. Bar-Zeev Y., Lim L.L., Bonevski B. et al. Nicotine replacement therapy for smoking cessation during pregnancy. Med J Aust. 2018;208(1):46–51. PMID: 29320660.
32. Cooper S., Taggar J., Lewis S. et al. Effect of nicotine patches in pregnancy on infant and maternal outcomes at 2 years: follow-up from the randomised, double-blind, placebo-controlled SNAP trial. Smoking, nicotine and pregnancy (SNAP) trial team. Lancet Respir Med. 2014;(9):728–737. DOI: org/10.1016/S2213-2600 (14) 70157-2.
33. Dhalwani N.N., Szatkowski L., Coleman T. et al. Nicotine replacement therapy in pregnancy and major congenital anomalies in offspring. Pediatrics. 2015;135(5):859–867. DOI: 10.1542/peds.2014-2560.
34. Chan B., Einarson A., Koren G. Effectiveness of bupropion for smoking cessation during pregnancy. J Addict Dis. 2005;24(2):19–25. DOI: 10.1300/J069v24n02_02.
35. Vlachopoulos C., Ioakeimidis N., Abdelrasoul M. et al. Electronic cigarette smoking increases aortic stiffness and blood pressure in young smokers. J Am Coll Cardiol. 2016;67(23):2802–2803. DOI: 10.1016/j.jacc.2016.03.569.
36. Turner E., Jones M., Vaz L.R., Coleman T. Systematic review and meta-analysis to assess the safety of buproprion and varenicline in pregnancy. Nicotine Tob Res. 2018. DOI: 10.1093/ntr/nty05.
37. Fokina V.M., West H., Oncken C. et al. Bupropion therapy during pregnancy: the drug and its major metabolites in umbilical cord plasma and amniotic fluid. Am J Obstet Gynecol. 2016;215: 497.e1–497.e7. DOI: 10.1016/j.ajog.2016.05.016.
38. Hendrick V., Suri R., Gitlin M.J., Ortiz-Portillo E. Bupropion Use During Pregnancy: A Systematic Review.Prim Care Companion CNS Disord. 2017;19(5): pii:17r02160. DOI: 10.4088/PCC.17r02160.
39. Richardson J.L., Stephens S., Yates L.M. et al. Pregnancy outcomes after maternal varenicline use; analysis of surveillance data collected by the European network of teratology information services. Reprod Toxicol. 2016;67:26–34. DOI: 10.1016/j.reprotox.2016.11.010.
40. McLafferty L.P., Becker M., Dresner N. et al. Guidelines for the management of pregnant women with substance use disorders. Psychosomatics. 2016;57(2):115–130. DOI: 10.1016/j.psym.2015.12.001.
41. Tousoulis D. Tobacco smoking and electronic cigarette: two sides of the same coin? Hellenic J Cardiol. 2017;58(4):253–255. DOI: 10.1161/JAHA.117.006353.
42. Ioakeimidis N., Vlachopoulos C., Tousoulis D. Efficacy and safety of electronic cigarettes for smoking cessation: a critical approach. Hellenic J. Cardiol. 2016;57(1):1–6. PMID:26856194.
43. Mark K.S., Farquhar B., Chisolm M.S. et al. Knowledge, attitudes, and practice of electronic cigarette use among pregnant women. J Addiction Med. 2015;9(4):266–272. DOI: 10.1097/ADM.0000000000000128.
44. Jones M., Lewis S., Parrott S. et al. Re-starting smoking in the postpartum period after receiving a smoking cessation intervention: a systematic review. Addiction. 2016;111(6):981–990. DOI: 10.1111/add.13309.
45. Alves E., Azevedo A., Correia S., Barros H. Long-term maintenance of smoking cessation in pregnancy: an analysis of the birth cohort generation XXI. Nicotine Tob Res. 2013;15(9):1598–1607. DOI: 10.1093/ntr/ntt026.
46. Harmer C., Memon A. Factors associated with smoking relapse in the postpartum period: an analysis of the child health surveillance system data in Southeast England. Nicotine Tob Res. 2013;15(5):904–909. DOI: 10.1093/ntr/nts221.
47. Kendzor D.E., Businelle M.S., Costello T.J. et al. Breast feeding is associated with postpartum smoking abstinence among women who quit smoking due to pregnancy. Nicotine Tob Res. 2010;. 12 (10):983–988. DOI: 10.1093/ntr/ntq132.
48. Stevens A.W.M.M., Goossens P.J.J., Knoppert van der Klein E.A.M. et al. Risk of recurrence of mood disorders during pregnancy and the impact of medication: A systematic review. J Affect Disord. 2019;249:96–103. DOI: 10.1016/j.jad.2019.02.018.
2. Титова О.Н., Суховская О.А., Куликов В.Д. Гендерные различия в формировании и эффективности лечения табачной зависимости. Наркология. 2017;11:107–111 [Titova O.N., Sukhovskaya O.A., Kulikov V.D. Gender differences in the formation and effectiveness of treatment of tobacco dependence. Narcology. 2017;11:107–111 (in Russ.)].
3. Суховская О.А., Лаврова О.В., Шаповалова Е.А. и др. Социальные аспекты табакокурения женщин. Журнал акушерства и женских болезней. 2011; 60 (2):115–120. [Sukhovskaya O.A., Lavrova O.V., Shapovalova Ye.A. et al. Social aspects of smoking women. Journal of Obstetrics and Women’s Diseases. 2011;60(2):115–120 (in Russ.)].
4. Schultze A., Kurz H., Stümpflen I., Hafner E. Smoking prevalence among pregnant women from 2007 to 2012 at a tertiary-care hospital. Eur J Pediatr. 2016;175(6):833–840. DOI: 10.1007/s00431-016-2710-1.
5. Mazurek J.M., England L.J. Cigarette Smoking Among Working Women of Reproductive Age-United States, 2009–2013. Nicotine Tob Res. 2016;18(5):894–899. DOI: 10.1093/ntr/ntv292.
6. WHO recommendations for the prevention and management of tobacco use and second-hand smoke exposure in pregnancy. World Health Organization, 2014 (Электронный ресурс). URL: https://apps.who.int/iris/bitstream/handle/10665/94555/9789244506073_rus.pdf; jsessionid=1681BCC9994F8891F79FCA74FF2EB92A?sequence=5 (дата обращения: 03.02.2019).
7. Ioakeimidis N., Vlachopoulos C., Katsi V., Tousoulis D. Smoking cessation strategies in pregnancy: Current concepts and controversies.Hellenic J Cardiol. 2018; pii: S1109–9666 (18) 30205–7. DOI: 10.1016/j.hjc.2018.09.001.
8. Siu A.L. U.S. preventive services task force behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. preventive services task force recommendation statemen. Ann Intern Med. 2015;163(8):622–634. DOI: 10.7326/M15-0171.
9. Суховская О., Лаврова О., Петрова М. и др. Особенности статуса курения беременных с бронхиальной астмой. Врач. 2011;3:63–65 [Sukhovskaya O., Lavrova O., Petrova M. et al. Peculiarities of the smoking status of pregnant women with bronchial asthma. Doctor. 2011;3:63–65 (in Russ.)].
10. DiClemente C.C., Dolan-Mullen P., Windsor R.A. The process of pregnancy smoking cessation: implications for interventions. Tobac Contr. 2000;3(9): III16–III21 10.1136/tc.9.suppl_3.iii16.
11. Dietz P.M., England L.J., Shapiro-Mendoza C.K. et al. Infant morbidity and mortality attributable to prenatal smoking in the U.S. Am J Prev Med. 2010;39:45–52. DOI: 10.1016/j.
12. Pineles B.L., Hsu S., Park E. et al. Systematic review and meta-analyses of perinatal death and maternal exposure to tobacco smoke during pregnancy. Am J Epidemiol. 2016;184(2):87–97. DOI: 10.1093/aje/kwv301.
13. Zhang D., Cui H., Zhang L. et al. Is maternal smoking during pregnancy associated with an increased risk of congenital heart defects among offspring? A systematic review and meta-analysis of observational studies. J Matern Fetal Neonatal Med. 2017;30(6):645–665. DOI: 10.1080/14767058.2016.1183640.
14. Maessen S.E., Ahlsson F., Lundgren M. et al. Maternal smoking early in pregnancy is associated with increased risk of short stature and obesity in adult daughters. Sci Rep. 2019;12;9 (1):4290–4292. DOI: 10.1038/s41598-019-39006-7.
15. Tappin D. The importance of permanent cessation for pregnant smokers. Addiction. 2016;111(6):991–992. DOI: 10.1111/add.13325.
16. Niemelä S., Räisänen A., Koskela J. et al. The effect of prenatal smoking exposure on daily smoking among teenage offspring. Addiction. 2017;112(1):134–143. DOI: 10.1111/add.13533.
17. Суховская О.А. Табакокурение: оценка распространенности и мотивации к отказу от курения. Новые Санкт-Петербургские врачебные ведомости. 2007;2:61–64. [Sukhovskaya O.A. Tobacco smoking, assessment of the prevalence and motivation to quit smoking. New St. Petersburg medical registers. 2007;2:61–64 (in Russ.)].
18. Bérard A., Zhao J.P., Sheehy O. Success of smoking cessation interventions during pregnancy. Am J Obstet Gynecol. 2016;21(5):611.e1–611.e8. DOI: 10.1016/j.ajog.2016.06.059.
19. Haddad A., Davis A.M. Tobacco smoking cessation in adults and pregnant women: behavioral and pharmacotherapy interventions. JAMA. 2016;315(18):2011–2012. DOI: 10.1001/jama.2016.2535.
20. Oncken C., Dornelas E., Greene J. et al. Nicotine gum for pregnant smokers: a randomized controlled trial. Obstet Gynecol. 2008;112(4):859–867. DOI: 10.1097/AOG.0b013e318187e1ec.
21. Leung L.W., Davies G.A. Smoking cessation strategies in pregnancy. J Obstet Gynaecol Can. 2015;37(9):791–797. DOI: 10.1016/S1701-2163 (15) 30149-3.
22. Chamberlain C., O’Mara-Eves A., Oliver S. et al. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst Rev. 2013;23(10): CD001055. DOI: 10.1002/14651858.CD001055.pub4.
23. Титова О.Н., Суховская О.А., Козырев А.Г. и др. Опыт оказания медицинской помощи при отказе от курения больным заболеваниями органов дыхания. Академический журнал Западной Сибири. 2015;11(3):35–38. [Titova O.N., Sukhovskaya O.A., Kozyrev A.G. et al. Experience in rendering medical assistance in quitting smoking to patients with respiratory diseases. Academic Journal of Western Siberia. 2015;11(3):35–38 (in Russ.)].
24. Яблонский П.К., Суховская О.А. Актуальные вопросы здорового образа жизни (по результатам опросов граждан России, обратившихся на горячую линию по здоровому образу жизни). Медицинский альянс. 2018;4:92–98. [Yablonsky P.K., Sukhovskaya O.A. Topical issues of a healthy lifestyle (based on surveys of Russian citizens who applied to the hotline for a healthy lifestyle). Medical Alliance. 2018;4:92–98 (in Russ.)].
25. Cahill K., Stevens S., Perera R., Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev. 2013;5: CD009329. DOI: 10.1002/14651858.CD009329.pub2.
26. Myung S.K., Ju W., Jung H.S. et al. Korean meta-analysis (KORMA) study group efficacy and safety of pharmacotherapy for smoking cessation among pregnant smokers: a meta-analysis. BJOG. 2012;119(9):1029–1039. DOI: 10.1111/j.1471-0528.2012.03408.x.
27. Coleman T., Chamberlain C., Davey M.A. et al. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev. 2015;12: CD010078. DOI: 10.1002/14651858.CD010078.pub2.
28. Coleman T., Cooper S., Thornton J.G. et al. Smoking, Nicotine, and Pregnancy (SNAP) Trial Team A randomized trial of nicotine-replacement therapy patches in pregnancy. N Engl J Med. 2012;366(9):808–818. DOI: 10.1056/NEJMoa1109582.
29. Vaz L.R., Aveyard P., Cooper S. et al. SNAP Trial Team The association between treatment adherence to nicotine patches and smoking cessation in pregnancy: a secondary analysis of a randomized controlled trial. Nicotine Tob Res. 2016;18(10):1952–1959. DOI: 10.1093/ntr/ntw080.
30. Swamy G.K., Roelands J.J., Peterson B.L. et al. Predictors of adverse events among pregnant smokers exposed in a nicotine replacement therapy trial. Am J Obstet Gynecol. 2009;201(4):354.e1–7. DOI: 10.1016/j.ajog.2009.06.006.
31. Bar-Zeev Y., Lim L.L., Bonevski B. et al. Nicotine replacement therapy for smoking cessation during pregnancy. Med J Aust. 2018;208(1):46–51. PMID: 29320660.
32. Cooper S., Taggar J., Lewis S. et al. Effect of nicotine patches in pregnancy on infant and maternal outcomes at 2 years: follow-up from the randomised, double-blind, placebo-controlled SNAP trial. Smoking, nicotine and pregnancy (SNAP) trial team. Lancet Respir Med. 2014;(9):728–737. DOI: org/10.1016/S2213-2600 (14) 70157-2.
33. Dhalwani N.N., Szatkowski L., Coleman T. et al. Nicotine replacement therapy in pregnancy and major congenital anomalies in offspring. Pediatrics. 2015;135(5):859–867. DOI: 10.1542/peds.2014-2560.
34. Chan B., Einarson A., Koren G. Effectiveness of bupropion for smoking cessation during pregnancy. J Addict Dis. 2005;24(2):19–25. DOI: 10.1300/J069v24n02_02.
35. Vlachopoulos C., Ioakeimidis N., Abdelrasoul M. et al. Electronic cigarette smoking increases aortic stiffness and blood pressure in young smokers. J Am Coll Cardiol. 2016;67(23):2802–2803. DOI: 10.1016/j.jacc.2016.03.569.
36. Turner E., Jones M., Vaz L.R., Coleman T. Systematic review and meta-analysis to assess the safety of buproprion and varenicline in pregnancy. Nicotine Tob Res. 2018. DOI: 10.1093/ntr/nty05.
37. Fokina V.M., West H., Oncken C. et al. Bupropion therapy during pregnancy: the drug and its major metabolites in umbilical cord plasma and amniotic fluid. Am J Obstet Gynecol. 2016;215: 497.e1–497.e7. DOI: 10.1016/j.ajog.2016.05.016.
38. Hendrick V., Suri R., Gitlin M.J., Ortiz-Portillo E. Bupropion Use During Pregnancy: A Systematic Review.Prim Care Companion CNS Disord. 2017;19(5): pii:17r02160. DOI: 10.4088/PCC.17r02160.
39. Richardson J.L., Stephens S., Yates L.M. et al. Pregnancy outcomes after maternal varenicline use; analysis of surveillance data collected by the European network of teratology information services. Reprod Toxicol. 2016;67:26–34. DOI: 10.1016/j.reprotox.2016.11.010.
40. McLafferty L.P., Becker M., Dresner N. et al. Guidelines for the management of pregnant women with substance use disorders. Psychosomatics. 2016;57(2):115–130. DOI: 10.1016/j.psym.2015.12.001.
41. Tousoulis D. Tobacco smoking and electronic cigarette: two sides of the same coin? Hellenic J Cardiol. 2017;58(4):253–255. DOI: 10.1161/JAHA.117.006353.
42. Ioakeimidis N., Vlachopoulos C., Tousoulis D. Efficacy and safety of electronic cigarettes for smoking cessation: a critical approach. Hellenic J. Cardiol. 2016;57(1):1–6. PMID:26856194.
43. Mark K.S., Farquhar B., Chisolm M.S. et al. Knowledge, attitudes, and practice of electronic cigarette use among pregnant women. J Addiction Med. 2015;9(4):266–272. DOI: 10.1097/ADM.0000000000000128.
44. Jones M., Lewis S., Parrott S. et al. Re-starting smoking in the postpartum period after receiving a smoking cessation intervention: a systematic review. Addiction. 2016;111(6):981–990. DOI: 10.1111/add.13309.
45. Alves E., Azevedo A., Correia S., Barros H. Long-term maintenance of smoking cessation in pregnancy: an analysis of the birth cohort generation XXI. Nicotine Tob Res. 2013;15(9):1598–1607. DOI: 10.1093/ntr/ntt026.
46. Harmer C., Memon A. Factors associated with smoking relapse in the postpartum period: an analysis of the child health surveillance system data in Southeast England. Nicotine Tob Res. 2013;15(5):904–909. DOI: 10.1093/ntr/nts221.
47. Kendzor D.E., Businelle M.S., Costello T.J. et al. Breast feeding is associated with postpartum smoking abstinence among women who quit smoking due to pregnancy. Nicotine Tob Res. 2010;. 12 (10):983–988. DOI: 10.1093/ntr/ntq132.
48. Stevens A.W.M.M., Goossens P.J.J., Knoppert van der Klein E.A.M. et al. Risk of recurrence of mood disorders during pregnancy and the impact of medication: A systematic review. J Affect Disord. 2019;249:96–103. DOI: 10.1016/j.jad.2019.02.018.
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