When a woman smokes during pregnancy she puts both herself and her baby at risk. It is best if expectant mothers stop smoking long before they try to conceive, but new research shows that using nicotine replacement therapy—such as gum or patches—during pregnancy eliminates the risks to the fetus that are associated with smoking.

It is well known that a person who smokes is at increased risk for a number of life-threatening diseases. A pregnant woman who smokes has all of those risks plus an increased risk of having a baby that weighs less than it should and pregnancy complications such as stillbirth (a baby who is born dead).

Smoking and stillbirth

Prior studies have shown nicotine replacement therapy use during pregnancy might increase the risk of birth defects, but the current study authors state that smoking during pregnancy may be more dangerous.

In this large prospective study, 87,032 pregnant women were interviewed about their smoking habits and use of nicotine replacement therapy during pregnancy. Among the 87,032 pregnancies, 495 were stillbirths, which equals a rate of 5.7 stillbirths for every 1,000 births. Among women who used nicotine replacement therapy the rate was 4.3 stillbirths for every 1,000 births.

“Use of nicotine replacement therapy during pregnancy was not associated with an increased risk of stillbirth,” said Katrine Strandberg-Larsen and her colleagues from the National Institute of Public Health at the University of Southern Denmark, Copenhagen, Denmark. Smoking during pregnancy, however, increased the rate of stillbirths to 8 for every 1,000 births.

The authors acknowledge that more research is needed to address the safety issues of using nicotine replacement therapies during pregnancy. Nicotine replacement therapies are not recommended for people with high blood pressure, heart disease, diabetes, and certain other conditions. A pregnant woman who wants to use such therapies should speak with her obstetrician or primary care doctor about safe options for kicking the smoking habit.

Kick the habit before pregnancy

The safest bet for both mom and baby is for a woman to stop smoking before she becomes pregnant. So it’s best not to smoke while trying to get pregnant. Consider these tips as a way to kick the habit for good:

• Seek help: See a doctor or nurse, or go to a smoking cessation program to find out about options that will help you stop. Some people quit “cold turkey”; others use medications, a nicotine patch or gum, and a prescribed program to help them quit.

• Pick a quit date: Putting the decision off is not helpful. After you have considered your options, it is important to pick a date to quit for good.

• Seek support: People trying to quit smoking have greater success if a friend or family member is actively supporting them in their efforts.

• Exercise and eat right: Replace time spent smoking with healthy lifestyle behaviors that help decrease cravings for nicotine and support efforts to take good care of your body.

• Learn to relax: People crave nicotine because it is an addiction but also because they are anxious. Learn to reduce anxiety through stress-reducing techniques such as deep breathing, meditation, yoga, and other mind-body therapies.

Jane Hart, MD

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