A critical review of smoking, cessation, relapse and emerging research in pregnancy and post-partum.
BACKGROUND
Smoking during pregnancy causes adverse health outcomes. Though the prevalence of smoking among pregnant women has declined, postpartum relapse rates remain high and smoking-related maternal, fetal and infant morbidity and mortality remains a public health burden.


METHODS
A comprehensive literature search on smoking in pregnancy was conducted to provide a practical review for health professionals.


RESULTS
Psychosocial support is an effective evidence-based treatment for pregnant women. Bio-psycho-socio factors that influence likelihood of quitting and remaining quit should be addressed.


RESULTS
Electronic cigarettes are marketed as a harm reduction tool, but research on safety and effectiveness are lacking for pregnant women.


CONCLUSIONS
The safety and efficacy of pharmacotherapy for use among pregnant women remains unclear. Clinicians should increase discussions regarding all resources for tobacco use treatment and secondhand smoke (SHS) exposure during pregnancy and postpartum and offer psychosocial support to all pregnant women.


CONCLUSIONS
Research on developing stronger tobacco control policies in low- and middle-income countries, increasing cessation and relapse prevention among pregnant smokers with mental health conditions and increasing the impact of evidence-based supports, such as the quitline, among pregnant women can decrease consumption of tobacco in pregnancy.
Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA cmeernik@email.unc.edu.
Clare
C
Meernik
Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Adam O
AO
Goldstein
D035843:Biomedical Research / Q000379:methods; D005260:Female; D006801:Humans; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy / Q000523:psychology*; D011295:Prenatal Care / Q000379:methods; D011297:Prenatal Exposure Delayed Effects; D012008:Recurrence; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D012944:Social Support
postpartum period; pregnancy; smoking; smoking cessation; tobacco