Helping pregnant smokers quit: meeting the challenge in the next decade

Helping pregnant smokers quit: meeting the challenge in the next decadeThroughout the past decade, smoking has remained the single most important modifiable cause of poor pregnancy outcome in the United States.It accounts for 20% of deliveries of infants with low birth weights, 8% of preterm births, and 5% of all perinatal deaths. 1 New studies have found that maternal smoking during pregnancy contributes to sudden infant death syndrome and may cause important changes in fetal brain and nervous system development. [2]3][4][5][6][7] New economic estimates indicate that the direct medical costs of a complicated birth for a smoker are 66% higher than for nonsmokers, reflecting the greater severity of complications and the more intensive care required. 8Although quitting smoking early in pregnancy is most beneficial, important health benefits accrue from quitting at any time during the pregnancy. 1oreover, the health hazards and health care burden to women and their family members caused by smoking do not begin or end with pregnancy.Before pregnancy, smoking increases the risk of serious medical complications for women using oral contraceptives and can impair fertility. 1After pregnancy, in addition to adversely affecting women's health, smoking exposes infants and young children to environmental tobacco smoke.This exposure is linked to sudden infant death syndrome, respiratory tract illnesses, middle-ear infections, and decreased lung function. 3,4,9Currently, 27% of US children aged 6 years and younger are exposed to tobacco smoke at home, 10 the annual direct medical costs of parental smoking are estimated at $4.6 billion, and loss-of-life costs are estimated at $8.2 billion. 11ecent national survey data indicate that the goal of reducing smoking among pregnant women from 25% in 1985 to 10% by the 2000 was not met. 12Some reduction was achieved, but about 20% of US women currently smoke during pregnancy, based on the Substance Abuse and Mental Health Services Administration 's 1994, 1995, and 1996 national surveys (table). 13Rates are highest among unmarried women and among women with less than a high school education, with the smoking rate for low-income Medicaid enrollees estimated at approximately 35%.This translates to 1 in 5 US births or pregnancies, or 800,000 births per year. 146][17] Growing public aware-......