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Smoking Cessation During Pregnancy and Postpartum: Practice Patterns Among Obstetrician-Gynecologists

Coleman-Cowger, Victoria H. PhD; Anderson, Britta L. PhD; Mahoney, Jeanne BSN, RN; Schulkin, Jay PhD

doi: 10.1097/ADM.0000000000000000
Original Research

Objectives: To assess current obstetrician-gynecologist (ob-gyn) practice patterns related to the management of and barriers to smoking cessation during pregnancy and postpartum.

Methods: A smoking cessation questionnaire was mailed to 1024 American College of Obstetricians and Gynecologists Fellows in 2012. χ2 analyses were used to assess for categorical differences between groups, Pearson r was used to conduct correlational analysis, and analysis of variance was used to assess for mean differences between groups.

Results: The analyses included 252 practicing ob-gyns who see pregnant patients who returned a completed survey. Ob-gyns estimated that 23% of their patients smoke before pregnancy, 18% smoke during first trimester, 12% during second trimester, and 11% during third trimester. They approximated that 32% quit during pregnancy, but 50% return to smoking postpartum. A large majority of ob-gyns feel that it is important for pregnant and postpartum women to quit smoking, and report asking all pregnant patients about tobacco use at the initial prenatal visit. Fewer ob-gyns follow-up on tobacco use at subsequent visits when the patient has admitted to use at a prior visit. The primary barrier to intervention was reported as time limitations, though other barriers were noted that may be addressable through the provision of additional training and resources offered to physicians.

Conclusions: Compared with findings from a similar study conducted in 1998, physicians are less likely to adhere to the 5 As smoking cessation guideline at present. As we know that brief intervention is effective, it is imperative that we work toward addressing practice gaps and providing additional resources to address the important public health issue of smoking during pregnancy and postpartum.

From Chestnut Health Systems (VHCC), Normal, IL; and American College of Obstetricians and Gynecologists (BLA, JM, JS), Washington, DC.

Send correspondence and reprint requests to Victoria H. Coleman-Cowger, PhD, Chestnut Health Systems, Lighthouse Institute, 448 Wylie Dr, Normal, IL 61761. E-mail:

Supported by grant, UA6MC19010, through the US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program. Additional support was provided by the National Institute on Drug Abuse of the National Institutes of Health under grant number 1R34DA032683.

The authors declare no conflicts of interest.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the US Department of Health and Human Services or the National Institutes of Health.

Received April 11, 2013

Accepted September 08, 2013

© 2014 American Society of Addiction Medicine