Читать книгу Protocols for High-Risk Pregnancies - Группа авторов - Страница 24

Smoking cessation interventions for pregnant women result in fewer low‐birthweight newborns and perinatal deaths, fewer physical, behavioral and cognitive problems during infancy and childhood, and important health benefits for the mothers. Women who discontinue smoking even as late as 30 weeks of gestation have infants with higher birthweight than those who continue smoking. In contrast, “cutting down” seems to improve fetal growth only slightly.

Smoking cessation interventions, whether it be for cigarette or e‐cigarette smoking, should be included as part of prenatal care. Women are more likely to quit smoking during pregnancy than at any other time in their lives. An office‐based cessation counseling session of 5–15 minutes, when delivered by a trained provider with the provision of pregnancy‐specific educational materials, increases rates of cessation among pregnant smokers. Trials have shown that a five‐step intervention program (the 5 As) is effective.

1 Ask pregnant women about smoking status using a multiple‐choice question method to improve disclosure.

2 Advise women who smoke to quit smoking, with unequivocal, personalized and positive messages about the benefits for her, the baby, and family.

3 Assess the woman’s willingness to try to quit smoking within the next 30 days. If the woman wants to quit, the provider should move to the next step, Assist. For women who are unwilling to attempt cessation, the advice, assessment and assistance should be offered at each future visit.

4 Assist women who are interested in quitting by encouraging use of problem‐solving methods and skills for cessation and addressing issues that the woman believes might adversely influence her attempt to quit. Provide self‐help smoking cessation materials that contain messages to build motivation and confidence in support of a cessation attempt. Avoid “trigger situations.” Arrange social support in the smoker’s environment by helping her identify and solicit help from family, friends, co‐workers, and others who are most likely to be supportive of her quitting smoking. Provide social support as part of the treatment.

5 Arrange follow‐up. Smoking status should be monitored throughout pregnancy, providing opportunities to congratulate and support success, reinforce steps taken toward quitting, and advise those still considering a cessation attempt.