[What smoking cessation interventions are effective in pregnant women?]

Tobacco smoking during pregnancy is the single largest modifiable risk for pregnancy-related morbidity and mortality. Tobacco smoke contains thousands of chemicals, many of which may contribute to reproductive toxicity. Carbon monoxide is the most biologically significant toxin for the fetus. The use of nicotine replacement therapy is probably not without risk, although the magnitude of risk to the mother and fetus is much lower than continuing smoking. Most pregnant women are motivated to stop. It is, therefore, a good time to initiate smoking cessation as early as possible during pregnancy, and to maintain abstinence during post-partum to protect the infant from passive smoking. If behavioral intervention fail to produce abstinence, a sign of high dependence, nicotine replacement therapy should be initiated promptly. Although bupropion is not recommended during pregnancy, this therapy should be considered when contraindications are carefully observed. It is recommended that all patients treated with nicotine or bupropion be reported to a pregnancy registry that collects pregnancy and obstetrical outcome data. This registry would allow health professionals to share their experience and should encourage them to use pharmacotherapy more frequently and lift psychological barriers concerning its use in pregnant women.