Smoking in Pregnancy

I surprised a friend the other day by mentioning that my obstetrician had me reduce cigarette smoking but not quit during pregnancy with my son. That friend asked me to write a post about the benefits of smoking reduction  pregnancy, and why I think public policy messages should not exclusively recommend smoking cessation but encourage reduction as a viable strategy as well. 

I had an atypical pregnancy. I didn’t know I was pregnant until 19 weeks and had no prenatal before 20. By the time I got proof of pregnancy sorted out to enroll in Florida’s Medicaid program, and made my first appointment with a real doctor and not at a crisis pregnancy center, I was 21 weeks along. I’d stopped using street drugs and diet pills since discovering my pregnancy but not cigarettes. If anything the stress made me want cigarettes more. 

My OB was the perfect fit for me. An older, grandmotherly type who had been a mother and nurse before going back to medical school to be a doctor. I felt if anyone could have sympathy for a patient, for any side of a hospital room, it was her. She told me about fetal nicotine addiction and stress in pregnancy being a danger to us both. She said I didn’t have to quit, but that cutting back was good. The latest research at that time said I should cut my smoking in half. The menthol I sucked down on the way to the hospital between contractions was the best smoke of my life. 

The research has gotten more refined since then. This epidemiology study found the greatest health benefits when smoking was curbed to fewer than eight cigarettes per day, and when third trimester smoking in particular was kept low. This is very useful data. About 10% of pregnant Americans smoke and virtually none are able to quit, but almost all reduce how much they smoke. Clear goals and guidelines of how much to reduce by could help more. 

For example, a pack a day (20) smoker presenting at an 8 week appointment could be counseled on benefits of smoking reduction and offered Chantix or an SSRI to help them titrate down to 12 cigarettes a day by 12 weeks, and 8 cigarettes a day by 20 weeks. I was on 4 cigarettes a day throughout my third trimester, which is low enough to greatly reduce odds of maternal or fetal health complications. 

My son was born full term, at 6 lbs 7 oz, with healthy lungs and 9 and 10 APGAR scores. Far healthier than I could have dreamed of or hoped for when I first learned I was pregnant.

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