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Smoking:Before,During&AfterPregnancy

Glendean BurtonRN,BSN,CLC,MPH

HarmfulEffectsofPrenatalSmokingonMom:

• Problemsconceiving• Ectopic(tubal)pregnancy• Miscarriage• PlacentaPrevia• PlacentalAbruption• Stillbirth• PROM

HarmfulEffectstoMom(cont.)

• Pre-eclampsia

• Chronichealthconditionslikegumdisease,respiratoryconditions

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HarmfulEffectsofPrenatalSmokingonFetus:

• ToxinspassfromMomtofetus• Riskofbirthdefectslikecleftpalate/lip• >riskofprematurity• >riskofLBW• >riskofSGAandIUGR

HarmfulEffectsofPrenatalSmokingonInfant:

• Long-termcognitivefunctionmaybe<• Chroniclow-gradehypoxia• Chronicrespiratoryconditionslikeasthma

SecondHandSmoke

Thesmokeyoubreatheinfromsomeoneelse’scigarette,cigar,pipe,etc..

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SecondHandSmokeEffectsonBaby:

• 3x’smorelikelytodiefromSIDS• >riskforupper/lowerrespiratoryinfections• >riskofearinfections• <rateoflunggrowthininfancyandchildhood• Laterbehavioralproblems• Learningdisorders

ThirdHandSmoke

• Toxicgases,particles,residueleftbehindfromsmoking

• Toxinsinclude:lead;arsenic;carbonmonoxide• Particlesclingtoeverything

ElectronicCigarettes:

• Looklikeregularcigarettes• Batteryoperated• Containliquidthatincludesnicotine,flavors,andotherchemicals

• Puffonmouthpiecetoheatupliquidintoavaporforinhalation

• Liquidmaycausepoisoningifdrank,sniffed,ortouched

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ElectronicCigarettes(cont.)

• Flavorsusedmaybeharmfultobaby• Canbeaddicting• NEVERleavedeviceswhereinfant/toddlercanpickthemup!!

MarijuanaSmoking&Pregnancy:

• Passesplacentalbarrier• Usein1st monthofpregnancycanleadtoanencephaly

• 2x’s>riskofstillbirth• >riskofprematurityandLBW• Infantjitteryand>fussiness• Childmorelikelytousemarijauna,havelearningdifficulties,behavioralproblems

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TheFagerstrom TestforNicotineDependence:

• Howsoonafteryouwakeupdoyousmokeyourfirstcigarette?

• Doyouhavedifficultyrefrainingfromsmokinginplaceswhereitisforbidden?

• Whichcigarettewouldyouhatemosttogiveup?

• Howmanycigarettesperdaydoyousmoke?

Fagerstrom Test(cont.)

• Doyousmokemorefrequentlyinthefirsthoursafterwakingthanintherestoftheday?

• Doyousmokeifyouaresoillthatyouareinbedmostoftheday?

StagesofChangeModel:

• Pre-contemplation

• Contemplation

• Action

• Maintenance

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Pre-contemplation:

• “Haveyouthoughtaboutquitting?”• “Doyoueverpictureyourselfbeingtobaccofree?”

• Providefeedbackonbenefit’sofcessation-whiterteeth,healthiergums,$saved,fewerfacialskinwrinklesasyouage,>energy,<likelihoodofheartdisease,stroke,lungcancer

• Babygetsmoreoxygen,lesslikelytobepremature

Contemplation:

• Recognitionofbenefits;movingtowardplanningforbehaviorchange

• “Whatisholdingyouback?”

• Openthedoorandprovidesupportindecisionmaking

ActionStage:

• Haveaplan• Chooseaquitdate• Recognizethatfewpeopleareabletoquiton1st attempt

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MaintenancePhase:

• Makeyourhomeandcarsmoke-free• Talktoyourpartneraboutkindofsupportneeded

• Avoidsmokingplaces/people• Knowyourtriggersforsmoking

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MotivationalInterviewingInterventions:The5R’s

1. Relevanceofquitting2. Risksofcontinuedsmoking3. Rewardsofquitting4. Roadblockstoquitting5. Repetition

The5R’sarerecommendedforpatientswhoarepresentlyunwillingtoquit.

The5A’s:

• Usewithclientswhoarepresentlywillingtoquit-

1. ASKabouttobaccouse2. ADVISEtoquit3. ASSESSwillingnesstoquit4. ASSISTinattemptingtoquit5. ARRANGEforfollow-up

ImpactofBriefIntervention:

• About40%ofpregnantsmokerswillquitontheirownduringpregnancywithoutanyintervention

• Abrief5minuteinterventioncanproduceanadditional30%quitrate

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ClientResourcesforSmokingCessation:

• Medicalprovider• 1-800-Quit-Now• Healthinsuranceprovider• WorkplaceSmokingCessationprograms• www.smokefree.gov• www.betobaccofree.hhs.gov• Smokefree TXT(adults);Smokefree Espanol TXT• Smokefree TeensTXT(13-19yearolds)

StaffResourcesonSmokingCessation:

• www.cdc.gov/reproductivehealth/TobaccoUsePregnancy

• www.smokingcessationandpregnancy.org• www.smokefree.gov• www.cdc.gov/ncbddd/birthdefects• www.cdc.gov/SIDS• www.cdc.gov/tobacco/campaign/tips