Study to evaluate prenatal smoking education efforts

MORGANTOWN, W.Va. –Though the number of pregnant women who smoke is decreasing nationwide, prenatal smoking in West Virginia has climbed dramatically. As more expectant mothers in the state are reaching for cigarettes, a West Virginia University researcher has received a competitive grant of $12,953 from the March of Dimes to study how midwives use a tobacco cessation program to encourage their patients to stop smoking.

Ilana Azulay Chertok, Ph.D., R.N., is an associate professor with the WVU School of Nursing and a maternal-child health researcher who has performed studies in both the United States and Israel. In the West Virginia March of Dimes-supported study, midwives caring for women in Monongalia and Preston counties will use the “5 A’s,” a five-step tobacco cessation process recommended by the United States Public Health Service and American Congress of Obstetricians and Gynecologists (ACOG).

The program consists of:
•    Asking the patient about tobacco use
•    Advising all smokers to quit smoking
•    Assessing smokers’ willingness to attempt to quit
•    Assisting smokers with treatment and referrals
•    Arranging follow-up contacts

Success of the 5 A’s among pregnant smokers has varied in past studies, but appears to produce favorable results, said Dr. Chertok.

“The ACOG 5 A’s has been documented to improve smoking cessation rates among pregnant women,” said Chertok.  “Pregnancy is a time when women are more motivated to make lifestyle changes. Prenatal health care providers are situated in an opportune position to facilitate this positive lifestyle change.”

The rate of prenatal smoking in West Virginia increased dramatically from 24.5 percent in 2000 to 31.9 percent in 2005. Nationally, the behavior decreased in the same time period, dropping from an overall 15.2 percent in 2000 to 13.8 percent in 2005. Though researchers do not know exactly what is behind the climbing numbers, certain indicators have been associated with an increased risk for prenatal tobacco use, said Chertok.

“Demographic characteristics have been identified that increase the likelihood that a woman smokes in pregnancy,” said Chertok, “including not being married, lower maternal education, younger maternal age, lower socioeconomic status, and rural location.” There’s also a higher risk of prenatal smoking among Medicaid recipients, she continued.

Women who smoke while pregnant place both themselves and their babies at great risk for serious health problems. Babies born to prenatal smokers are at increased risk of being born prematurely and often suffer from low birth weight. Birth defects such as cleft lip or palate are also more frequent. Pregnant women are more prone to ectopic pregnancies and placental problems, as well as stillbirths.

As the 5 A’s are implemented in the two counties, Chertok will evaluate midwives’ knowledge of the program, pregnant women’s use of smoking cessation resources, and pregnant women’s changes in smoking behavior. Chertok would like to see the method used on a larger scale.

“It is my hope that the 5 A’s program will be implemented into practice by all prenatal health care providers in the state to help reduce prenatal smoking and negative birth outcomes,” said Chertok.

For more information: Amy Johns, HSC News Service, 304-293-7087
lr: 01-03-11