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The use of pharmacotherapies for smoking cessation during pregnancy
  1. Neal L Benowitza,
  2. Delia A Dempseyb,
  3. Robert L Goldenbergc,
  4. John R Hughesd,
  5. Patricia Dolan-Mullene,
  6. Paul L Ogburnf,
  7. Cheryl Onckeng,
  8. C Tracy Orleansh,
  9. Theodore A Slotkini,
  10. H Pennington Whiteside, Jrc,
  11. Sumner Yaffej
  1. aDepartments of Medicine, Psychiatry, and Biopharmaceutical Sciences, University of California-San Francisco, San Francisco, California, USA, bDepartment of Pediatrics, University of California-San Francisco, cSmoke-Free Families Program, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA, dDepartment of Psychiatry, University of Vermont, Burlington, Vermont, USA, eCenter for Health Promotion Research and Prevention, University of Texas-Houston Health Science Center, School of Public Health, Houston, Texas, USA, fDepartment of Obstetrics and Gynecology, Mayo Medical School, Rochester, Minnesota, USA, gDepartment of Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA, hResearch and Evaluation Unit, The Robert Wood Johnson Foundation, Princeton, New Jersey, USA, iDepartment of Pharmacology & Cancer Biology, Duke University Medical Center, Durham, North Carolina, USA, jCenter for Research on Mothers and Children, National Institute for Child Health and Human Development, Bethesda, Maryland, USA
  1. H Pennington Whiteside, Jr, MSPH, Smoke-Free Families National Program Office, University of Alabama at Birmingham, School of Medicine, Department of Obstetrics and Gynecology, 320 CIRC, 1530 3rd Avenue South, Birmingham, AL 35294-0021, USA; hpw{at}uab.edu

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A workshop entitled “The use of pharmacotherapies for smoking cessation during pregnancy”, sponsored by the National Institute of Child Health and Human Development (NICHD) and the Robert Wood Johnson Foundation (RWJF), was held in Rockville, Maryland, on 19 May 1999. The goals of the workshop were: (1) to determine the current state of knowledge related to the use of pharmacotherapies for smoking cessation during pregnancy; and (2) to outline a research agenda to determine the effectiveness and safety of these pharmacotherapies. Attending the workshop were many of the academic experts working in this area in the USA and representatives from NICHD, RWJF, the National Cancer Institute (NCI), the National Institute of Drug Abuse (NIDA), the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), the American College of Obstetrics and Gynecology (ACOG), the Society for Research on Nicotine and Tobacco (SRNT), and several pharmaceutical companies.

Background

In the USA, of the four million women who deliver babies each year, approximately 0.8–1 million smoke during their pregnancies. Smoking has a substantial adverse impact on pregnancy outcomes including growth retardation, preterm birth, perinatal mortality, sudden infant death syndrome (SIDS), and childhood behavioural problems. In developed countries, more than a third of all cases of growth retardation is caused by maternal smoking, and the more a woman smokes, the larger the effect on fetal growth. Stopping smoking is one of the major preventive measures likely to have a substantial impact on improving pregnancy outcome. Smoking most likely achieves its negative impact on pregnancy outcome through a number of mechanisms. These include the following: (1) nicotine is a toxin at the cellular level and also may act through its vasoconstrictive properties; (2) carbon monoxide—a major byproduct of cigarette smoking—binds to haemoglobin, resulting in a functional maternal anaemia; (3) carbon monoxide also …

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