Chapter 12 (p. 249). Notable among these are greater rates of miscarriage, stillbirth, low birthweight, and preterm delivery (Man, 2006; Tong, 2013). here is also a twofold risk of placenta previa, placental abruption, and premature membrane rupture compared with nonsmokers. hus, the U.S. Preventive Services Task Force recommends that clinicians ofer counseling and efective intervention options to pregnant smokers at the irst and subsequent prenatal visits (Siu, 2015). Although beneits are greatest if smoking ceases early in pregnancy or preferably preconceptionally, quitting at any stage of pregnancy can improve perinatal outcomes (Fiore, 2008).
Person-to-person psychosocial interventions are signiicantly more successful in achieving smoking abstinence in pregnancy than is simply advising the woman to quit (Fiore, 2008). One example is a brief counseling session covering the "5As" of smoking cessation (Table 9-2). This approach can be accomplished in 15 minutes or less and is efective when initiated by health-care providers (American College of Obstetricians and Gynecologists, 20 17i).
Behavioral interventions and nicotine replacement products are successful in reducing smoking rates (Patnode, 2015). hat said, nicotine replacement has not been suiciently evaluated to determine its efectiveness and safety in pregnancy. Trials evaluating such therapy have yielded conflicting evidence (Coleman, 2015; Pollak, 2007; Spindel, 2016). Two recent randomized trials also produced nonconclusive results. In the Smoking and Nicotine in Pregnancy (SNAP) trial, Cooper and associates (2014) reported a temporary cessation of smoking that may have been associated with improved infant development. In the Study of Nicotine Patch in Pregnancy (SNIPP) trial, Berlin and coworkers (2014) found no diferences in smoking cessation rates or birthweights.
Because of limited available evidence to support pharmacotherapy for smoking cessation in pregnancy, the American College of Obstetricians and Gynecologists (2017i) has recommended that if nicotine replacement therapy is used, it should be done with close supervision and after careful consideration of the risks of smoking versus nicotine replacement.
Alcohol. Ethyl acohol or ethanol is a potent teratogen that causes a etal syndrome characterized by growth restriction, acial abnormalities, and central nervous system dyunction. s discussed in Chapter 12 (p. 239), women who are pregnant or considering pregnancy should abstain from using any alcoholic beverages. The CDC analyzed data from the Behavioral isk Factor Surveillance System from 2011 to 2013 and estimated that 10 percent of pregnant women used alcohol. It is estimated that 3.3 million women are at risk for such exposure (Green, 2016). he American College of Obstetricians and Gynecologists (2016b) in collaboration with the CDC has developed the Fetal Acohol Spectrum Disorders (FASD) Prevention Program, which provides resources for providers and is available at: http://www. acog.org/ alcohol.