Tobacco and Preterm Birth

Smoking is a modifiable risk factor associated with preterm birth, low birth weight, and perinatal death. Smoking cessation in pregnancy reduces preterm birth, low birth weight, and perinatal death. Major compounds found in smoking tobacco affect placental pathophysiology. The use of a brief office based intervention (the 5 As) is an effective method to increase smoking cessation. Behavioral intervention is effective in increasing cessation rates. Smoking cessation in pregnancy can prevent up to 16% of preterm birth, and as such is the single, best evidence-based, successful intervention for the prevention of preterm birth. The use of nicotine replacement or antidepressant therapy for smoking cessation has yet to demonstrate sufficient safety and efficacy data to recommend routine use in pregnancy. The risk of relapse after smoking cessation in pregnancy is greatest in the postpartum period. There is insufficient data to make recommendations for interventions to reduce the risk of relapse.