Smoking during pregnancy remains a major public health problem. Despite the well-known health risks associated with smoking during pregnancy, many women continue to smoke even after learning they are pregnant. 

Pregnant women who continue to smoke need help to quit smoking. The Louisiana Chapter of the March of Dimes and AmeriHealth Caritas Louisiana, a Medicaid managed care plan serving the state, recently collaborated to bring a smoking cessation program for pregnant women to Louisiana. The program, entitled Baby & Me - Tobacco Free©, is a direct service evidenced-based, incentive-based smoking cessation program to help pregnant women quit smoking and remain smoke-free postpartum.

“This is the first program of its kind in the state of Louisiana,” said Frankie Robertson, state director of the March of Dimes Louisiana Chapter. “The Baby & Me - Tobacco Free Program model has received national acclaim for its effectiveness in decreasing the number of women who smoke during and after pregnancy.  The partnerships we’ve established to spearhead this program locally are just one of the many ways the March of Dimes is engaging community stakeholders to reduce preterm birth rates in Louisiana.” 

Smoking during pregnancy is known to have an adverse effect on the health of the pregnancy. When pregnant women smoke, they inhale over 4,000 chemicals contained in cigarette smoke. Many of these chemicals, including nicotine, carbon monoxide and tar are passed on to their unborn child. These chemicals prevent the baby from receiving the essential nutrients and oxygen needed for growth and development, which leads to birth defects, premature births, low-birth-weight babies and sudden infant death syndrome. 

“Healthy communities begin with healthy babies,” said Rebecca Engelman, executive director of AmeriHealth Caritas Louisiana. “Programs like Baby & Me - Tobacco Free can go a long way toward ensuring more Louisiana babies arrive healthy and at full-term,” said Engelman. “Nearly 70% of Louisiana births are covered by Medicaid. So we share the goals of the March of Dimes to make those births healthy for both the mother and the baby.”

Premature birth is the leading cause of newborn death worldwide. According to the 2013 March of Dimes Premature Birth Report Card, Louisiana received an F for its preterm birth rate. One of the contributing factors in measuring the preterm birth rate is the percentage of women of childbearing age that smoke. According to the Report Card, 25% of Louisiana women of childbearing age smoke.

“DHH understands the strong correlation between smoking and premature birth, so I am extremely pleased to see the March of Dimes and AmeriHealth Caritas working specifically with pregnant smokers,” said DHH Secretary Kathy H. Kliebert. “There is approximately a 70% relapse rate among postpartum women, showing the need for thorough cessation treatment before, during and after pregnancy. Improving birth outcomes and reducing the premature birth rate remains a top priority for the Department. As a community, we must address the problems smoking creates in our state.”

What is secondhand smoke?

In addition to smoking during pregnancy, secondhand smoke during pregnancy is very harmful to the mom and baby. Secondhand smoke is breathing in someone else’s smoke, smoke from a burning cigarette or smoke being exhaled by a smoker—environmental tobacco smoke. Secondhand smoke during pregnancy can cause low birth weight.

According to the Child Trends Data Bank, infants who are born to mothers who smoke or infants who are exposed to second-hand smoke are at a high risk of developing acute respiratory infections, childhood asthma, childhood obesity and behavioral problems.

What is thirdhand smoke?

New research shows that thirdhand smoke is another health hazard. Thirdhand smoke is made up of the toxic gases and particles left behind from cigarette or cigar smoking. These toxins, which include lead, arsenic and carbon monoxide, cling to things like clothes, hair, couches and carpets well after the smoke from a cigarette or cigar has cleared the room. 

Breathing in these toxins at an early age may cause devastating health problems like asthma and other breathing issues, learning disorders and cancer. It is important that expecting moms and their children keep away from places and areas where people smoke.

Interventions for pregnant women

Smoking during pregnancy is the most modifiable risk factor for poor birth outcomes. The sooner an expectant mother quits smoking during pregnancy, the healthier the pregnancy will be. It is best for women to quit smoking before getting pregnant. However, if pregnant, pregnancy presents a great opportunity to kick the habit.

There are several interventional strategies available to help pregnant women quit smoking. Some interventional strategies work well in combination with others; however, all work best with some form of cessation counseling.   

Quitting Cold Turkey: This intervention provides no additional drug exposure to the infant. However, it is also the most difficult for the nicotine addictive patient. The effects and symptoms of withdrawal may prove impossible to control. The relapse rate is very high.

Quitting Gradually: Eliminates the number of cigarettes smoked over time down to zero. Although a good method, quitting gradually carries the same withdrawal possibilities and relapse rate as quitting cold turkey. Pregnant women should be smoke free by at least the 15th week of gestation.

Nicotine Replacement Therapy (NRT): Involves usage of nicotine patches, various substitutes, and medications to help individuals quit smoking. However, these methods may be harmful during pregnancy.

Cessation Counseling: Focuses on the woman’s motivation to quit smoking during pregnancy and provides postpartum follow-up to prevent relapse. Obstetricians, midwives and other medical professionals should initiate this counseling and inquire about ongoing success. 

Baby & Me Tobacco Free

The National Baby & Me - Tobacco Free Program has done significant research to create a program design that addresses many challenges and barriers to help pregnant women quit smoking. Baby & Me - Tobacco Free uses a unique approach combining cessation support specific to pregnant women, offering practical incentives and monitoring success. Pregnant women are referred by their physician, clinic, hospital, health department or through word of mouth to enroll into the program. 

Once enrolled, the program site arranges for her first appointment, during which she receives information about the program and an initial intake session is held. Each participant receives at least four prenatal cessation counseling sessions, support and carbon monoxide (CO) monitoring tests, usually coordinated with a regular prenatal visit. Cessation counseling sessions typically last approximately 15 minutes. 

After the birth of the baby, the mother returns monthly for up to 6-12 months postpartum to continue CO monitoring testing and postpartum cessation counseling. If smoke-free, the participant receives a $25 monthly voucher for diapers for up to 6-12 months. 

The National Baby & Me - Tobacco Free program was launched in 2002. In 2005, the program was awarded a “Model Practice Award” by the National Association of City and County Health Officials (NACCHO). The published results indicate a 60% quit rate for women enrolled in the program, six months postpartum. 

“Since launching this program in Louisiana during the summer of 2013 with the Cancer Association of Greater New Orleans, we have seen a 75% quit rate in the number of participants who quit smoking and remain smoke free postpartum,” said Makesha Judson, state director of program services for the March of Dimes Louisiana Chapter. “These are tremendous initial results and we are excited that this program is exceeding national standards.”

In 2014, March of Dimes and AmeriHealth Caritas funded a second Baby & Me Tobacco Free program in partnership with Family Road of Greater Baton Rouge. This site will enroll approximately 50 pregnant women and will provide cessation counseling for up to 12 months postpartum. 

Dangers of smoking during pregnancy:
• An ectopic (tubal) pregnancy
• Spontaneous miscarriage
• Vaginal bleeding
• Placental abruption
• Stillbirth

The Agency for HealthCare Policy and Research Guidelines, endorsed by ACOG, suggests “Motivational Interviewing” through the 5As:
• Ask about smoking history and current smoking pattern.
• Advise each and every woman who smokes of the value of stopping and the risks of continuing.
• Assess the woman’s motivation and thoughts related to smoking cessation or reduction.
• Assist in any attempt to quit—offer referral, literature, focus group, etc.
• Arrange follow-up and continued contact throughout pregnancy and post-partum.

March of Dimes  |  (225) 295-0655  |  marchofdimes.com/Louisiana

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