Prenatal Smoking: It’s Never Too Late To Quit and Improve Outcomes
Denver, CO—It is never too late for pregnant women to quit smoking to improve neonatal outcomes, according to research presented at the 2011 meeting of the Association of Women’s Health, Obstetric and Neonatal Nurses.
“Even if women quit smoking during the second trimester in our study, they had significantly improved outcomes compared with women who continued to smoke,” said Beth A. Bailey, PhD, Associate Professor, Department of Family Medicine, East Tennessee State University, Johnson City.
“Obviously, those who quit earlier had the best outcomes, but we found big gains in outcomes up to 27 weeks,” she said in an interview.
Dr Bailey and colleagues recruited 1040 women entering prenatal care at 6 prenatal practices. Of these, 707 continued to smoke during pregnancy, 103 entered prenatal care as smokers but quit smoking by 27 weeks of gestation, and 230 were nonsmokers. Compared with women who continued to smoke, those who quit by the third trimester gave birth to babies who were significantly heavier (mean difference, 190 g), of longer length (mean difference, 2 cm), and had greater head circumferences (mean difference, 0.8 cm).
“In fact, babies born to women who quit were virtually identical in size to babies born to women who did not smoke at all,” she reported. For the intervention, women who expressed a desire to stop smoking (or even to diminish exposure to secondhand smoke) met with a case manager 4 times during prenatal care.
The “5 As” used in the intervention included Asking about smoking behavior, Assessing willingness to quit, Advising against smoking, Assisting with treatment and referrals, and Arranging follow-up.
“The findings are encouraging, as they suggest that efforts to intervene with pregnant smokers can lead to direct improvements in birth outcomes, and that quitting even later in pregnancy can be beneficial,” she said.</p>
Nurses may Need Smoking- Cessation Education
A second study targeted 41 neonatal nurses with a program aimed at enhancing their ability to deliver a smoking prevention intervention.
Because most women who quit smoking during pregnancy relapse within weeks of giving birth, smoking prevention services should be integrated along the continuum of care. Postpartum and neonatal hospitalization provides a window of opportunity for nurses to coordinate services and bridge the gap between the obstetric and outpatient pediatric settings, explained Sharron R. Forest, APRN, NNP-BC, DNP, Neonatal Intensive Care Unit, Women & Children’s Hos - pital, Lake Charles, LA.
The educational program she used was the state’s “Fax-to-Quit” program (also used by Dr Bailey). Patients desiring help to quit smoking provide consent to healthcare providers to allow a tobacco quit line counselor to contact them; the referrals are made via fax, and the healthcare providers receive periodic status reports.
After 4 live training classes, the instructional program was ultimately converted to interactive computerbased training to increase staff participation. The module was modified to incorporate videos of mock conversations between nurses and mothers to simulate the role-play experience of the live training.
Pre- and posttraining testing showed a substantial improvement in the nurses’ knowledge about smoking risks and smoking-cessation strategies. Overall, knowledge scores improved by 66%, and overall self-efficacy scores im - proved by 32%.
“Computer-based training is costeffective and eliminates the need for us to pay for speakers and to reimburse expenses related to nurses’ attendance. Most of the nurses received this instruction during their scheduled breaks,” Ms Forest said. Once the computer-based training was instituted, nurses’ participation rates increased by 128%.
“Participation with smoking prevention interventions is now a required competency for neonatal nurses,” she said. The greatest effect of the training was increasing the nurses’ confidence in broaching the topic with new mothers</p>