Requested info about smoking

[Guest guest]

HI,

I apologize, but I could not locate the article about lactation and

smoking. I did find this one about pregnancy, maybe it will be helpful. If

anything, continued breastfeeding obviously will reduce the risk of otitis

media and respiratory infections in the infant exposed to smoke. Good luck in

your efforts, try not to get too frustrated. Quitting smoking is a very

difficult task, and you are bound to experience some set-backs, so try to keep

a positive attitude ))

~~G

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Pregnancy. The AHCPR made the following recommendations regarding pregnant

smokers:

•Pregnant smokers should be strongly encouraged to quit throughout pregnancy.

Because of the serious risks of smoking to the pregnant smoker and to the

fetus, pregnant smokers should be offered intensive counseling. •Minimal

interventions should be used if more intensive interventions are not feasible.

•Motivational messages should be given regarding the impact of smoking on both

the pregnant smoker and the fetus. •Nicotine replacement should be used during

pregnancy only in the event that increased likelihood of smoking cessation,

with its potential benefits, outweighs the risk of future nicotine replacement

and potential concomitant smoking.

Smoking in pregnancy imparts risks both to the woman and to the fetus. Many

women are motivated to quit during pregnancy, and health care professionals

can take advantage of this motivation by reinforcing the notion that cessation

will be best for the fetus, with postpartum benefits for mother and child.

However, clinicians should be aware that some pregnant women may try to hide

their smoking status.

It is most beneficial to quit smoking prior to conception or early in the

pregnancy, but health benefits result from cessation at any time. Therefore, a

pregnant woman who still smokes should continue to be encouraged and helped to

quit. Women who quit smoking during pregnancy have a high rate of relapse in

the postpartum period. Relapse is common in the postpartum period even among

women who have maintained total abstinence from tobacco for 6 or more months

during pregnancy. Relapse postpartum may be decreased by continued emphasis on

the relationship between maternal smoking and poor health outcomes (sudden

infant death syndrome, respiratory infections, asthma, and middle ear disease)

in infants and children. Table 2 outlines clinical factors to address when

counseling pregnant women about smoking.

No clinical trials have assessed the benefits and risks of nicotine

replacement therapy as an aid to smoking cessation in pregnant women. In a

review of this topic, Benowitz (1991) concluded that, for pregnant women, the

benefits of nicotine replacement therapy outweigh the risks of both continued

smoking and nicotine replacement itself. Benowitz limited this conclusion,

however, to pregnant smokers who cannot stop without replacement therapy, and

suggested that benefits would be greatest for heavy smokers.

To assess the effectiveness of smoking cessation during pregnancy, the panel

used both a published meta-analysis (Mullen, , and Groff, 1994) and a

meta-analysis conducted by panel staff. The meta-analysis conducted by panel

staff was based on 6 studies evaluating the effectiveness of smoking-cessation

counseling in pregnant smokers. The effectiveness of counseling interventions

in these studies was compared with either " no treatment " or " usual care "

conditions. The latter usually consisted of a recommendation to stop smoking

that was often supplemented by provision of self-help material or referral to

a stop-smoking program. Because of the small number of studies available for

analysis, only the impact of counseling (greater than 10 minutes of person-to-

person contact) was examined in the meta-analysis. Less intense interventions,

such as those involving " minimal contact " or " brief counseling, " were not

examined because of a lack of relevant studies. Both the panel meta-analysis

and the published meta-analysis yielded essentially the same finding--smoking-

cessation interventions during pregnancy are effective and should be used to

benefit both the woman and the fetus.

Evidence. The following statements lend support to the aforementioned

recommendations:

•A published meta-analysis and a meta-analysis conducted by panel staff (n =

14 studies) suggest that counseling interventions during pregnancy increase

quit rates above those of pregnant smokers who do not receive such

interventions. •Because of the small number of studies examining minimal

counseling in pregnant smokers, no focused statistical tests were possible on

this topic. However, the panel concluded that minimal counseling has a

beneficial effect and should be used if more intensive counseling is not

feasible.

Table 2 - General Strategy 9: Clinical Issues When Assisting a Pregnant

Patient in Smoking Cessation

Clinical Issues Rationale

______________________________________________________________

Quit early in pregnancy if Early quitting provides the

possible. greatest benefit with regard

to the health of the fetus.

Quit anytime during pregnancy. Fetus benefits even when quitting

later in pregnancy.

Stress early benefits to quitting. Both woman and fetus will benefit

immediately.

Provide pregnancy-related Such messages are associated with

motivational messages. higher quit rates.

Be alert to patient's minimizing Minimizing or denying smoking is

or denying tobacco use. common among pregnant women who

smoke.

Assess for relapse and use Postpartum relapse rates are high

relapse prevention. even if a woman maintains

abstinence throughout pregnancy.

Relapse prevention may start

during pregnancy.