Clinical Review ABC of smoking cessation

Special groups of smokers

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7439.575 (Published 04 March 2004) Cite this as: BMJ 2004;328:575
  1. Tim Coleman, senior lecturer in general practice
  1. School of Community Health Sciences in the Division of Primary Care at University Hospital, Queen's Medical Centre, Nottingham

    Introduction

    Earlier articles in this series have provided general guidance on delivering smoking cessation interventions. This chapter investigates issues relevant to several special groups of smokers.

    Pregnant women

    In the United Kingdom over a quarter of pregnant women who smoke continue to do so during pregnancy. These women tend to be young, single, of lower educational achievement, and in manual occupations. If they have a partner, their partner is also more likely to smoke. Smoking has substantial adverse effects on the unborn child, including growth retardation, preterm birth, miscarriage, and perinatal mortality. Most of this harm is probably caused by toxins in cigarette smoke, such as carbon monoxide, nicotine, cyanide, cadmium, and lead. Nicotine itself may cause harm, however, through placental vasoconstriction and possible developmental effects on the fetus.

    Prevalence of smoking in women before and during pregnancy, 1992-9. Adapted from Owen and Penn, 1999 (see Further Reading box)

    Ideally, women should stop smoking before getting pregnant. In practice, however, few do, and it is pregnancy itself that seems to be the key motivator to stop. About a quarter of women who smoke manage to stop for at least part of their pregnancy, mostly within the first trimester, but most of these start smoking again after their child is born.1

    View this table:

    Clinical issues to highlight or be aware of in relation to pregnant women who smoke*

    Most pregnant women (80% in UK surveys) accept that stopping smoking is the most important lifestyle change that they can make during pregnancy, and consequently most women will be receptive to discussion of their smoking and the possibility of stopping. Those who continue to smoke, however, tend to hold rather different views from those who give up—for example, only about 30% of those who continue to smoke believe that smoking during pregnancy is “very dangerous” to their …

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