Q&A: Is it safe to use products like Nicorette® during pregnancy?

Quitting smoking is one of the best things a mom can do for her developing baby. Very few common activities are as hazardous to a fetus as smoking. Babies born to moms who smoke weigh less, are more likely to be stillborn or premature, have a higher chance of asthma, and have three times the risk of SIDS (crib death). The risks from smoking are proportional to the number of cigarettes smoked per day.

Of course if it were easy to quit almost no one would smoke. Smoking is emotionally addicting and also physically addicting. So, what is effective to help moms-to-be quit? Should a pregnant woman take nicotine replacement—Zyban® or Chantix®—or just go cold turkey? And what if she can't quit?

Quitting

• Stopping smoking is the best option for moms who smoke. Sometimes early pregnancy nausea makes cigarettes taste bad—a positive effect from the baby's view. Some moms find it helpful (in an awful sort of way) to focus on an image that they are giving the cigarette directly to their baby. Quitting in the first trimester reverses almost all the risks to the baby.

• Cigarettes meet certain needs, like an excuse for a break, and a calming of nervousness. Many smokers describe feeling that they are giving themselves a little gift when they light up. Find alternatives to meet those needs! Drinking uncaffeinated tea, chewing sugarless gum, going for a walk, and listening to music may all be useful. Plan ahead for which times of the day are particularly challenging, and have a plan for what you will do when you want to smoke.

• In my experience, most moms-to-be who smoke less than a half pack a day can quit without medications, just by force of will and concern for the baby. Moms who smoke more heavily often quit successfully, but may have more symptoms of nicotine withdrawal, and more habits to break. Some moms cut down slowly and then quit, while others quit cold turkey when they find out they are pregnant or when they start to learn about the risks of smoking for their growing baby.

Nicotine Replacement

• On one hand, nicotine is clearly bad for a developing fetus. Nicotine causes spasm of the mother's blood vessels, decreasing the supply of oxygen and nutrients to the baby. On the other hand, cigarette smoking is worse than just taking nicotine, because other components of the smoke, such as carbon monoxide, also compromise oxygen flow to the placenta. Nicotine replacement in the form of gum, patch, inhalator, tablets, or nasal spray takes away the nicotine cravings and may help a person quit smoking. In research studies of non-pregnant adults, nicotine replacement increased the success of quitting by 50 to 70 percent. If you are going to use nicotine replacement the goal should be to get off cigarettes, and then eventually to also get off the nicotine. Do not use nicotine replacement without first discussing it with your doctor or midwife.

• Zyban®—Zyban® (bupropion) is an antidepressant/anti-anxiety medication that also goes by the brand name Wellbutrin®. Zyban® decreases nicotine withdrawal and cravings even in those who don't have depression, and can help people get out from under their addiction to cigarettes. The safety of Zyban® during pregnancy is unclear. It doesn't seem to cause birth defects, but there are no long term safety studies. It is clear though that smoking causes short and long-term risks. Talk to your doctor to determine if the benefits of Zyban® outweigh the risks for you and your baby.

• Chantix®—Chantix® (varenicline) is a relatively new medication that blocks nicotine receptors in the brain and makes smoking less pleasant. Unfortunately, at the current time we don't have enough information about Chantix® in pregnancy to say that it is safe. A physician may decide with the mom that theoretical benefits outweigh the risks but the risks are really not known.

• Complementary and alternative medicine—Hypnosis is safe for use during pregnancy and can aid in quitting smoking. Acupuncture has also been used as an adjunct to smoking cessation.

Some smokers find that they can cut down, but have difficulty quitting. Smoking less is clearly better than smoking more, so all moms should try to cut down if they can't quit. And sometimes you can try to quit again a few weeks later and have more success. Using nicotine replacement AND smoking is not recommended.

Talk to your doctor or midwife about your desire to quit smoking so you can work together for the best approach. Lots of resources for quitting smoking are available online, including www.smokefree.gov. A free telephone support service is also available at 1-800-QUITNOW. Good luck!