Trying to stop smoking is difficult.  Pregnant women who smoke are often more motivated to quit.  Still, for all pregnant women, quitting is hard.  Most women are aware of the adverse effects of smoking, not only on themselves, but their developing fetus.  Low birth weight and developmental problems that develop after birth are just a few of the concerns.

The most recommended smoking cessation therapy for women is counseling, which can be done by their family physician, obstetrician, or a formal smoking cessation program.  Counseling is first-line therapy.  Many physicians do not always realize the power of counseling in helping anyone quit smoking.

Stopping smoking is the only goal for pregnant women.  Data does not recognize “cutting back” as having any substantial benefit and, in fact, may result in the patient smoking deeper and smoking their cigarette down to a lower butt length, which results in more “tar” exposure.

There are two pharmacologic options for pregnant women if counseling does not result in complete cessation.  The first is nicotine replacement therapy (NRT), and the second is the use of buproprion.  There are pros and cons associated with each form of drug therapy.  NRT seems to be the most common choice.  NRT may be used as patches, gums, nasal sprays, lozenges and inhalers.

The dosing of nicotine during pregnancy needs to consider the fact that nicotine is metabolized faster by pregnant women, which means she must use more to get the therapeutic effect.  Quit for your baby!