| Routes |
| > Smoking (inhaling); mucosal absorption (chewed); snorting (rare) |
| Harmful Effects |
| > Fetal effects: first trimester - increased risk of spontaneous abortion, third trimester - increased risk of intrauterine growth restriction and prematurity > Obstetrical complications: increased risk of placental abruption, placenta previa, premature rupture of membranes > Neonatal effects: increased irritability and hypertonia in newborns – resolve with no treatment, 20% increase in perinatal morality rate, doubled incidence of low birth weight (LBW) infants (<2500 g), increased risk of sudden infant death syndrome (SIDS) > Second-hand smoke effects: increased risk of SIDS, increased incidence of bronchitis, pneumonia, otitis media, asthma, allergies and behavioural difficulties |
| Symptoms of Intoxication |
| > Mild euphoria (or feeling of well-being), increased arousal (increased heart rate, blood pressure), enhanced ability to concentrate, relaxation > Decreased appetite, increased metabolic rate, lower body weight set point |
| Symptoms of Overdose |
| > Nausea, salivation, abdominal pain, sweating, headache, dizziness > Occurs with ingestion of nicotine |
| Symptoms of Withdrawal |
| > Irritability, restlessness, anxiety, insomnia, fatigue, lack of concentration > Symptoms are worse in first 3-4 days, may persist for a week or longer > Cravings may persist for months or years |
| Smoking Cessation Therapy |
| > Offer brief interventions (simple advice), group or individual counseling and self-help materials before pharmacotherapy > Behavioural interventions: self-help guide, group interventions > Less success quitting if partner smokes and increased risk of resumption after birth > Encourage smoking reduction as an alternative to smoking cessation for those unable to quit > Consider pharmacotherapy – weigh benefits and risks |
| Pharmacotherapy |
| > Nicotine Replacement Therapy (NRT) (e.g. gum, lozenge, patch, inhaler) indicated for heavily nicotine-dependent women and women unable to quit with behavioural intervention. > NRT safer than smoking for pregnant woman and fetus because other toxins of cigarettes are eliminated > Start with 21 mg nicotine patch if smoking >10 cigarettes daily; patch can be taken off at bedtime > Look at www.pregnets.com for more details on specific doses of different NRT products > Bupropion (Zyban) not contraindicated during pregnancy, but further research is needed; only use if benefits outweigh risks – decreases cravings and moderates withdrawal symptoms > Verenicline (Champix) not studied or indicated in pregnancy – decreases withdrawal and blocks benefits from nicotine exposure |
| Breastfeeding |
| > Nicotine and its metabolite are detected in breast milk > Heavy smoking may decrease quantity and quality of breast milk by one third > Cigarette smoking should be minimized while breastfeeding > Nicotine Replacement Therapy (NRT) poses no problems for breastfeeding infant > Risks to baby of not breastfeeding greater than risks of breastfeeding and smoking |
| Resources |
| Provincial Smoker's Helplines: > BC 1-877-455-2233 > PEI 1-888-818-6300 > NS 1-877-513-5333 > NB 1-877-513-5333 > QC 1-866-527-7383 > ON 1-877-513-5333 > MB 1-877-513-5333 > SK 1-877-513-5333 > AB 1-866-332-2322 (or 1-866-33AADAC) > NFLD 1-800-363-5864 > NNV 1-866-877-3845 > YK 1-800-661-0408 (x8393) > NWT No line > Motherrisk Alcohol and Substance Use Helpine: 1-877-327-4636 |
