DOWNLOAD PDF ANTISMOKING EDUCATION FOR PREGNANT WOMEN

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1 Chapter 1 : Pregnancy and smoking - Tobacco In Australia Note: Citations are based on reference standards. However, formatting rules can vary widely between applications and fields of interest or study. The specific requirements or preferences of your reviewing publisher, classroom teacher, institution or organization should be applied. If you need help to quit smoking, tell your health care provider. Why is smoking during pregnancy harmful? Smoking during pregnancy is bad for you and your baby. Smoking harms nearly every organ in the body and can cause serious health conditions, including cancer, heart disease, stroke, gum disease and eye diseases that can lead to blindness. How can smoking affect your pregnancy? This is labor than starts too early, before 37 weeks of pregnancy. Preterm labor can lead to premature birth. This is when a fertilized egg implants itself outside of the uterus womb and begins to grow. An ectopic pregnancy cannot result in the birth of a baby. It can cause serious, dangerous problems for the pregnant woman. Bleeding from the vagina Problems with the placenta, like placental abruption and placenta previa. The placenta grows in your uterus womb and supplies the baby with food and oxygen through the umbilical cord. Placental abruption is a serious condition in which the placenta separates from the wall of the uterus before birth. Placenta previa is when the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. How can smoking affect your baby? Tobacco is a plant whose leaves are used to make cigarettes and cigars. Tobacco contains a drug called nicotine. Nicotine is what makes you become addicted to smoking. These chemicals are harmful to your baby. They can lessen the amount of oxygen that your baby gets. If you smoke during pregnancy, your baby is more likely to: This means your baby is born too early, before 37 weeks of pregnancy. Premature babies are more likely than babies born on time to have health problems. Birth defects are health conditions that are present at birth. They change the shape or function of one or more parts of the body. They can cause problems in overall health, in how the body develops or in how the body works. This means your baby is born weighing less than 5 pounds, 8 ounces. Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy. Stillbirth is when a baby dies in the womb after 20 weeks of pregnancy. Die of sudden infant death syndrome also called SIDS. This is the unexplained death of a baby younger than 1 year old. What is secondhand smoke? Being around secondhand smoke during pregnancy can cause your baby to be born with low birthweight. Secondhand smoke also is dangerous to your baby after birth. What is thirdhand smoke? It can include lead, arsenic and carbon monoxide. Babies who breathe in thirdhand smoke may have serious health problems, like asthma and other breathing problems, learning problems and cancer. Is it safe to use e-cigarettes during pregnancy? Electronic cigarettes also called e-cigarettes or e-cigs look like regular cigarettes. But instead of lighting them, they run on batteries. When you use an e-cigarette, you puff on a mouthpiece to heat up the liquid and create a mist also called vapor that you inhale. Using an e-cigarette is called vaping. More research is needed to better understand how e-cigarettes may affect women and babies during pregnancy. Some studies show that e-cigarette vapor may contain some of the harmful chemicals that are found in regular cigarettes. Just like regular cigarettes, you can become addicted to e-cigarettes. Signs or symptoms of nicotine poison include feeling weak, having breathing problems, nausea feeling sick to your stomach and vomiting. Nicotine poisoning can be deadly. Liquid nicotine in e-cigarettes comes in different flavors and is sold in small tubes that may be bright and colorful. Can you just cut down on smoking? Or do you have to quit? If you smoke, you may think that light or mild cigarettes are safer choices during pregnancy. This is not true. Or you may want to cut down rather than quit smoking altogether. But quitting is best. The sooner you quit smoking during pregnancy, the healthier you and your baby can be. Besides, when you quit smoking, you never again have to go outside and look for a place to smoke. You also may have: Cleaner teeth Fewer stains on your fingers Fewer skin wrinkles A better sense of smell and taste More strength and energy to be more active What are some tips to help you quit smoking? Try these tips to help you quit smoking: Write down your reasons for quitting. Look at the list when you think about smoking. Choose a quit day. On this day, throw away all your cigarettes or cigars, lighters and ashtrays. Ask your partner or a friend to help you quit. Call that person when you feel like smoking. Stay away from Page 1

2 places, activities or people that make you feel like smoking. Go for a walk to help keep your mind off smoking. Use a small stress ball or try some needlework to keep your hands busy. Snack on veggies or chew gum to keep something in your mouth. Drink lots of water. Ask your health care provider about things to help you quit, like patches, gum, nasal spray and medicines. Look for programs in your community or where you work that can help you stop smoking. These are called smoking cessation programs. Ask your health care provider about programs in your area. Ask your employer to see what services are covered by health insurance. Page 2

3 Chapter 2 : Stop smoking in pregnancy - NHS Smoking during pregnancy is bad for you and your baby. Quitting smoking, even if you're already pregnant, can make a big difference in your baby's life. Smoking harms nearly every organ in the body and can cause serious health conditions, including cancer, heart disease, stroke, gum disease and eye diseases that can lead to blindness. March Suggested citation: Cancer Council Victoria; In the period before they knew they were pregnant, The likelihood of smoking during pregnancy was higher among teenagers, women in disadvantaged circumstances and Indigenous women. Many of the constituents of cigarette smoke are potentially toxic to the developing foetus, including lead, nicotine, cotinine, cyanide, cadmium, mercury, carbon monoxide and polycyclic aromatic hydrocarbons PAHs. CO binds to haemoglobin with an affinity times that of oxygen, and also has an inhibiting effect on the release of oxygen to the cells. Chronic mild hypoxia of foetal tissue can persist for five or six hours after the mother has stopped smoking. Both smoking and nicotine by itself change hormone patterns, affecting the pregnancy outcome and the endocrine profile of the infant. Smoking and nicotine affect the functioning and structure of the oviduct fallopian tube in ways that could impair fertility i and complicate the pregnancy. Smoking disturbs the development of the placenta, disrupting the implantation process and interfering with the transformation of the uterine spiral arteries. Studies consistently show thickening of the villous membrane of the placenta in smokers, which decreases the ability of nutrients to diffuse through the placenta. Smoking and nicotine impair amino acid transport across the placenta, which the baby needs to make foetal proteins. Nicotine may decrease the pumping of fluid across the placenta, leading to lower oxygen levels in the foetus and acidosis excessive acid in the blood and tissues. Nicotine can alter embryonic movements that are important in the early development of the organs. Consistent evidence shows that smoking can affect the development of the foetal lung and brain. Smokers have lower levels of micronutrients that play a vital role in the health of the pregnancy, such as zinc in cord blood and vitamin C. Vitamin C is important for immune function and the formation of collagen. Genetic variation in enzymes that metabolise chemicals from tobacco smoke mediate the risk of adverse pregnancy outcomes. However there are multiple ways in which smoking could potentially increase the risk for miscarriage. Proposed mechanisms include placental insufficiency, chronic reduced oxygen to the foetus, and direct toxic effects of constituents of cigarette smoke. Smoking causes premature rupture of the membranes breaking of the amniotic sac before the onset of labour, placenta previa when the placenta is attached to the uterine wall close to or over the cervix, and placental abruption premature separation of the placenta from the wall of the uterus. Research indicates that stopping smoking between pregnancies reduces the risk of placental abruption, suggesting that, for this complication, the effects of smoking do not persist. Smokers are more susceptible to vaginal infection; for example they have two to three times the risk of bacterial vaginosis, which is a risk factor for preterm delivery. Some research suggests that smokers may be more sensitive to stimuli that lead to contractions. Smoking may affect collagen formation, leading to weakening and rupture of the membranes. Smokers are more likely to develop complications that are risk factors for preterm delivery, such as placental abruption and placenta previa. Last updated September i Refer to Section 3. Infant morbidity and mortality attributable to prenatal smoking in the US. American Journal of Preventive Medicine ;39 1: Perinatal statistics series no. The health consequences of smoking: How tobacco smoke causes disease: The health consequences of involuntary exposure to tobacco smoke: The health consequences of smoking - 50 years of progress. Smoking and reproductive life. The impact of smoking on sexual, reproductive and child health. British Medical Association, Page 3

4 Chapter 3 : Anti-Smoking Campaign to Target Pregnant Women in Australia Smoking Cessation During Pregnancy A Clinician's Guide to Helping Pregnant Women Quit Smoking Self-instructional Guide and Tool Kit An Educational Program from the American College of Obstetricians and Gynecologists. Most people know that smoking causes cancer, heart disease, and other major health problems. Smoking during pregnancy causes additional health problems, including premature birth being born too early, certain birth defects, and infant death. Smoking makes it harder for a woman to get pregnant. Women who smoke during pregnancy are more likely than other women to have a miscarriage. For example, the placenta can separate from the womb too early, causing bleeding, which is dangerous to the mother and baby. Smoking during pregnancy can cause a baby to be born too early or to have low birth weightâ making it more likely the baby will be sick and have to stay in the hospital longer. A few babies may even die. SIDS is an infant death for which a cause of the death cannot be found. Babies born to women who smoke are more likely to have certain birth defects, like a cleft lip or cleft palate. Are they safer than regular cigarettes in pregnancy? The liquid typically contains nicotine, flavorings, and other chemicals. The battery-powered device heats the liquid in the cartridge into an aerosol that the user inhales. Although the aerosol of e-cigarettes generally has fewer harmful substances than cigarette smoke, e-cigarettes and other products containing nicotine are not safe to use during pregnancy. Also, some of the flavorings used in e-cigarettes may be harmful to a developing baby. Learn more about e-cigarettes and pregnancy. For more statistics on smoking during pregnancy see: What Are the Benefits of Quitting? Quitting smoking will help you feel better and provide a healthier environment for your baby. When you stop smoking Your baby will get more oxygen, even after just one day of not smoking. There is less risk that your baby will be born too early. There is a better chance that your baby will come home from the hospital with you. You will be less likely to develop heart disease, stroke, lung cancer, chronic lung disease, and other smoke-related diseases. You will be more likely to live to know your grandchildren. You will have more energy and breathe more easily. Your clothes, hair, and home will smell better. Your food will taste better. You will have more money that you can spend on other things. You will feel good about what you have done for yourself and your baby. For support in quitting, including free quit coaching, a free quit plan, free educational materials, and referrals to local resources, please call QUIT-NOW More free help and support resources are available for pregnant women and others who want to quit for good. Page 4

5 Chapter 4 : Tobacco Use and Pregnancy Reproductive Health CDC Smoking makes it harder for a woman to get pregnant. Women who smoke during pregnancy are more likely than other women to have a miscarriage. Smoking can cause problems with the placenta â the source of the baby's food and oxygen during pregnancy. Women considering using medical marijuana while pregnant should not do so without checking with their health care provider. Animal studies have shown that moderate concentrations of THC, when administered to mothers while pregnant or nursing, could have long-lasting effects on the child, including increasing stress responsivity and abnormal patterns of social interactions. The number of women who use marijuana while pregnant is unknown. However, this study also found that women were about twice as likely to screen positive for marijuana use via a drug test than they state in self-reported measures. This suggests that self-reported rates of marijuana use in pregnant females is not an accurate measure of marijuana use and may be an underestimation. One study suggests that moderate amounts of THC find their way into breast milk when a nursing mother uses marijuana. With regular use, THC can accumulate in human breast milk to high concentrations. Given all these uncertainties, nursing mothers are discouraged from using marijuana. All of these factors can affect a developing fetus, making it difficult to isolate the effects of cocaine. They also show symptoms of irritability, hyperactivity, tremors, high-pitched cry, and excessive sucking at birth. Their babies are more likely to be smaller and to have low birth weight. What research exists suggests that prenatal MDMA exposure may cause learning, memory, and motor problems in the baby. NAS occurs when heroin passes through the placenta to the fetus during pregnancy, causing the baby to become dependent on opioids. Symptoms include excessive crying, high-pitched cry, irritability, seizures, and gastrointestinal problems, among others. These are difficult issues for researchers to study because scientists cannot give potentially dangerous drugs to pregnant women. Here are some of the known facts about popular medications and pregnancy: There are more than 6 million pregnancies in the United States every year, and about 9 out of 10 pregnant women take medication. Food and Drug Administration issued rules on drug labeling to provide clearer instructions for pregnant and nursing women, including a summary of the risks of use during pregnancy and breastfeeding, a discussion of the data supporting the summary, and other information to help prescribers make safe decisions. This will allow her doctor to weigh the risks and benefits of a medication during pregnancy. In some cases, the doctor may recommend the continued use of specific medications, even though they could have some impact on the fetus. Others, such as some anti-anxiety and antidepressant medications, have unknown effects, so mothers who are using these medications should consult with their doctor before breastfeeding. These effects can last throughout life, causing difficulties with motor coordination, emotional control, schoolwork, socialization, and holding a job. Fetal alcohol exposure occurs when a woman drinks while pregnant. Alcohol can disrupt fetal development at any stage during a pregnancyâ including at the earliest stages before a woman even knows she is pregnant. This will minimize the amount of alcohol passed to the baby. Nicotine also readily crosses the placenta, and concentrations of this drug in the blood of the fetus can be as much as 15 percent higher than in the mother. In some cases, smoking during pregnancy may be associated with sudden infant death syndrome SIDS, as well as learning and behavioral problems and an increased risk of obesity in children. In addition, smoking more than one pack a day during pregnancy nearly doubles the risk that the affected child will become addicted to tobacco if that child starts smoking. Additionally, e-cigarettes or e-vaporizers sometimes contain nicotine. More research is needed. Similar to pregnant women, nursing mothers are also advised against using tobacco. There is also evidence that the milk of mothers who smoke smells and may taste like cigarettes. This page was last updated July Contents. Page 5

6 Chapter 5 : Campaign to help pregnant women stop smoking - Telegraph The latest statistics suggest one in seven Australian women smoke during pregnancy, and pregnant teens are most at risk - in, 37 per cent were reported to be smoking. Smoking while pregnant puts both you and your unborn baby at risk. Cigarettes contain dangerous chemicals, including nicotine, carbon monoxide, and tar. Smoking significantly increases the risk of pregnancy complications, some of which can be fatal for the mother or the baby. Learn about the risks of smoking while pregnant. Getting pregnant If you smoke and want to get pregnant, quitting the habit should be a priority. Smoking can prevent you from getting pregnant in the first place. Even in the first trimester smoking affects the health of your unborn baby. Both male and female smokers are about twice as likely to have issues with fertility compared to nonsmokers, according to the American Society for Reproductive Medicine. Secondhand smoke is just as dangerous to the fetus. The Environmental Protection Agency has classified secondhand smoke as a group A carcinogen. Miscarriage and stillbirth The unexpected loss of a pregnancy is a tragic event at any stage. Miscarriages typically occur in the first three months of pregnancy. On rare occasions, they can occur after 20 weeks of gestation. This is called a stillbirth. According to the U. Centers for Disease Control and Prevention CDC, smoking raises the likelihood of both early miscarriage and stillbirth. The dangerous chemicals in cigarettes are often to blame. Other complications from smoking can lead to problems with the placenta or slow fetal development. These issues can also cause a miscarriage or stillbirth. Ectopic pregnancy According to a study published in the journal PLoS One, nicotine can cause contractions in the fallopian tubes. These contractions can prevent an embryo from passing through. One possible result of this is an ectopic pregnancy. This happens when a fertilized egg implants outside of the uterus, either in the fallopian tube, or in the abdomen. In this situation, the embryo must be removed to avoid life-threatening complications to the mother. Smoking is a major risk factor for several complications linked to the placenta. One such problem is placenta abruption. This is a condition in which the placenta separates from the uterus before childbirth. Placenta abruption can cause severe bleeding and threaten the life of both the mother and the baby. Immediate medical attention may help increase the chance of a healthy birth despite placenta abruption. Placenta previa Smoking is also a risk factor for placenta previa. During pregnancy, the placenta normally grows in the uterus towards the top of the womb. This leaves the cervix open for delivery. Placenta previa is when the placenta stays in the lower part of the uterus, partially or fully covering the cervix. The placenta often tears, causing excessive bleeding and depriving the fetus of vital nutrients and oxygen. According to the CDC, smoking during pregnancy can cause preterm birth. There are numerous health risks associated with a preterm birth. Page 6

7 Chapter 6 : Epilepsy and pregnancy: What you need to know - Mayo Clinic In this Patient Education Materials section, you can find helpful information about pregnancy and childbirth. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Any updates to this document can be found on www. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented. This Committee Opinion is updated as highlighted to reflect a limited, focused change in electronic nicotine delivery systems and in the pharmacotherapy references. Smoking is the one of the most important modifiable causes of poor pregnancy outcomes in the United States, and is associated with maternal, fetal, and infant morbidity and mortality. The physical and psychologic addiction to cigarettes is powerful; however, the compassionate intervention of the obstetricianâ gynecologist can be the critical element in prenatal smoking cessation. An office-based protocol that systematically identifies pregnant women who smoke and offers treatment or referral has been proved to increase quit rates. The use of alternative forms of nicotine, such as e-cigarettes and vaping, have increased substantially in recent years, but there are little data regarding the health effects of these agents, either in the general population or in pregnant women specifically. Epidemiology Increased public education measures and public health campaigns in the United States have led to a decrease in smoking by pregnant women and nonpregnant women of reproductive age 1. Although the rate of reported smoking during pregnancy has decreased from Smoking during pregnancy is a public health problem because of the many adverse effects associated with it. These include intrauterine growth restriction, placenta previa, abruptio placentae, decreased maternal thyroid function 4, 5, preterm premature rupture of membranes 6, 7, low birth weight, perinatal mortality 4, and ectopic pregnancy 4. The risks of smoking during pregnancy extend beyond pregnancy-related complications. Children born to mothers who smoke during pregnancy are at an increased risk of asthma, infantile colic, and childhood obesity 9â Researchers report that infants born to women who use smokeless tobacco during pregnancy have levels of nicotine exposure, low birth weight, and shortened gestational age as high as infants whose mothers smoked during pregnancy 12, Intervention Cessation of tobacco use, prevention of secondhand smoke exposure and prevention of relapse to smoking are key clinical intervention strategies during pregnancy. Inquiry into tobacco use and smoke exposure should be a routine part of the prenatal visit. Preventive Services Task Force USPSTF recommends that clinicians ask all pregnant women about tobacco use and provide augmented, pregnancy-tailored counseling for those who smoke Public Health Service recommends that clinicians offer effective tobacco dependence interventions to pregnant smokers at the first prenatal visit as well as throughout the course of pregnancy Addiction to and dependence on cigarettes is both physiologic and psychologic, and cessation techniques have included counseling, cognitive and behavioral therapy, hypnosis, acupuncture, and pharmacologic therapy. With appropriate training, obstetricianâ gynecologists, other clinicians, or auxiliary health care providers can perform these five steps with pregnant women who smoke Quit lines offer information, direct support, and ongoing counseling, and have been very successful in helping pregnant smokers quit and remain smoke free Many states offer fax referral access to their quit lines for prenatal health care providers. Health care providers can call the national quit line to learn about the services offered within their states. Examples of effective smoking cessation interventions delivered by a health care provider are listed in Box 2. Although counseling and Page 7

8 pregnancy-specific materials are effective cessation aids for many pregnant women, some women continue to smoke These smokers often are heavily addicted to nicotine and should be encouraged at every follow-up visit to seek help to stop smoking. They also may benefit from screening and intervention for alcohol use and other drug use because continued smoking during pregnancy increases the likelihood of other substance use Clinicians also may consider referring patients for additional psychosocial treatment There is insufficient evidence to support the use of meditation, hypnosis, and acupuncture for smoking cessation Although quitting smoking before 15 weeks of gestation yields the greatest benefits for the pregnant woman and fetus, quitting at any point can be beneficial Successful smoking cessation before the third trimester can eliminate much of the reduction in birth weight caused by maternal smoking The benefits of reduced cigarette smoking are difficult to measure or verify. The effort of women who reduce the amount they smoke should be lauded, but these women also should be reminded that quitting entirely brings the best results for their health, the health of their fetuses, and ultimately that of their infants Pregnant women who are exposed to the smoking of family members or coworkers should be given advice on how to address these smokers or avoid exposure. Most pregnant former smokers indicate that they do not intend to smoke. To strengthen their resolve for continued smoking abstinence, a review of tobacco use prevention strategies and identification of social support systems to remain smoke free in the third trimester and postpartum is encouraged Preventive Services Task Force has concluded that current evidence is insufficient to assess the balance of benefits and harms of nicotine replacement products or other pharmaceuticals for smoking cessation aids during pregnancy There is conflicting evidence as to whether or not nicotine replacement therapy increases abstinence rates in pregnant smokers, and it does not appear to increase the likelihood of permanent smoking cessation during postpartum follow-up of these patients 23, Trials studying the use of nicotine replacement therapy in pregnancy have been attempted, yet many of those conducted in the United States have been stopped by data and safety monitoring committees for either demonstration of adverse pregnancy effects or failure to demonstrate effectiveness 15, 25, Therefore, the use of nicotine replacement therapy should be undertaken with close supervision and after careful consideration and discussion with the patient of the known risks of continued smoking and the possible risks of nicotine replacement therapy. If nicotine replacement is used, it should be with the clear resolve of the patient to quit smoking. Alternative smoking cessation agents used in the nonpregnant population include varenicline and bupropion. Varenicline is a drug that acts on brain nicotine receptors. Several small studies evaluating its safety in pregnancy do not find evidence of teratogenicity 27, 28 but data are limited. Bupropion is an antidepressant with only limited data, but there is no known risk of fetal anomalies or adverse pregnancy effects However, both of these medications have recently added product warnings mandated by the U. Food and Drug Administration about the risk of psychiatric symptoms and suicide associated with their use 30, Both bupropion and varenicline are transmitted to breast milk. There is insufficient evidence to evaluate the safety and efficacy of these treatments in pregnancy and lactation Furthermore, in a population at risk of depression, medications that can cause an increased risk of psychiatric symptoms and suicide should be used with caution and considered in consultation with experienced prescribers only. Electronic Nicotine Delivery Systems The use of alternative forms of nicotine, such as e-cigarettes and vaping, have increased substantially in recent years, but there are little data regarding the health effects of these agents, either in the general population or in pregnant women specifically. There is the perception that these products represent a safer alternative compared with cigarette smoking, because the products of tobacco combustion are not present. However, nicotine in any form poses considerable health risks and has known adverse effects on fetal brain and lung tissue Electronic nicotine delivery systems are being used by smokers in the belief that they will aid in smoking cessation efforts. In one survey of smokers who called a tobacco cessation help line, nearly two thirds were using electronic nicotine delivery systems and nearly all believed it helped them quit smoking or cut down the number of cigarettes smoked However, a recent review of the use of electronic nicotine delivery systems in nonpregnant patients found no robust evidence that these products aid in smoking cessation The quality of the available evidence is poor, and well-designed trials are needed to understand the health effects of these products; their role, if any, in smoking cessation; and their effects on pregnant women and their fetuses. Coding Office visits specifically addressing Page 8

9 smoking cessation may be billed, but not all payers reimburse for counseling outside of the global pregnancy care package and some do not cover preventive services at all. Under the health care reform, physicians will be reimbursed for the provision of smoking cessation counseling to pregnant women in Medicaid and in new health plans with no cost sharing for the patient. Health care providers are encouraged to consult coding manuals regarding billing and be aware that reimbursements will vary by insurance carrier. Smoking cessation during pregnancy: The guide, pocket reminder card, and slide lecture can be ordered by writing to smoking acog. American College of Obstetricians and Gynecologists. Need help putting out that cigarette? This pregnancy-specific smoking cessation workbook for patients is available in English and Spanish from the ACOG bookstore at http: Other Resources Dartmouth Medical School. Smoking cessation for pregnancy and beyond: Retrieved July 6, National Alliance for Tobacco Cessation. All states offer free smoking cessation telephone quit line services. Trends in smoking before, during, and after pregnancy in ten states. Am J Prev Med ; Natl Vital Stat Rep ;57 7: Department of Health and Human Services. The health consequences of smoking: The effect of tobacco exposure on maternal and fetal thyroid function. Effects of smoking during pregnancy. Epidemiological correlates of preterm premature rupture of membranes. Int J Gynaecol Obstet ; Infant morbidity and mortality attributable to prenatal smoking in the U. Maternal and grandmaternal smoking patterns are associated with early childhood asthma. Smoking during pregnancy and infantile colic. Maternal smoking during pregnancy and childhood obesity. Am J Epidemiol ; Iqmik--a form of smokeless tobacco used by pregnant Alaska natives: J Matern Fetal Neonatal Med ; Smokeless tobacco use, birth weight, and gestational age: The effect of environmental tobacco smoke during pregnancy on birth weight. Acta Obstet Gynecol Scand ; Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: Preventive Services Task Force. Ann Intern Med ; Treating tobacco use and dependence: Page 9

10 Chapter 7 : Substance Use While Pregnant and Breastfeeding National Institute on Drug Abuse (NIDA) The resource will help you learn how to eat healthy during pregnancy, including how to choose a variety of healthy foods, maintain healthy weight gain during pregnancy and stay food safe. Sign up now Epilepsy and pregnancy: What you need to know If you have epilepsy becoming pregnant might seem risky, but the odds are in your favor. Find out how to promote a healthy pregnancy. Epilepsy during pregnancy raises special concerns. While most women who have epilepsy deliver healthy babies, you might need special care during your pregnancy. Does epilepsy make it more difficult to conceive? Some drugs used to treat seizures might contribute to infertility. However, certain anti-seizure medications can also reduce the effectiveness of hormonal birth control methods. How does epilepsy affect pregnancy? Seizures during pregnancy can cause: Slowing of the fetal heart rate Decreased oxygen to the fetus Fetal injury, premature separation of the placenta from the uterus placental abruption or miscarriage due to trauma, such as a fall, during a seizure Preterm labor Premature birth Does epilepsy change during pregnancy? For most pregnant women who have epilepsy, seizures remain the same. For a few, seizures become less frequent. Medication you take during pregnancy can affect your baby. Birth defects â including cleft palate, neural tube defects, skeletal abnormalities, and congenital heart and urinary tract defects â are a few potential side effects associated with anti-seizure medications. The risk seems to increase with higher doses and if you take more than one anti-seizure medication. Talk to your health care provider before discontinuing your medications. What does my epilepsy mean for my baby? Beyond the effects of medications, babies born to mothers who have epilepsy also have a slightly higher risk of developing seizures as they get older. How should I prepare for pregnancy? Also meet with other members of your health care team, such as your family doctor or neurologist. If you have frequent seizures before you conceive, you might be advised to wait to get pregnant until your epilepsy is better controlled. Take your anti-seizure medication exactly as prescribed. Uncontrolled seizures likely pose a greater risk to your baby than does any medication. Eat a healthy diet. Chapter 8 : Smoking during pregnancy March of Dimes Background. Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, stillbirth, low birthweight and preterm birth and has serious long-term implications for women and babies. Chapter 9 : Using Illegal Drugs During Pregnancy Food Safety for Moms-to-Be What you need to know about food safety before, during, and after pregnancy. Preventing Listeriosis In Pregnant Hispanic Women in the U.S. Page 10