Risk management of tobacco smoking during pregnancy: regional experience and global trends

Tobacco smoking (TS) during pregnancy and secondhand smoke to the fetus may cause numerous and serious adverse health effects. Healthcare costs associated with labor complications are much higher for women who smoke during pregnancy than for non-smokers. The paper presents the results of a motivational smoking cessation program in pregnant women with nicotine addiction. Objective. To study regional experience and global trends in risk management of TS during pregnancy. Subjects and methods. The data of the WHO pilot project in the Slobozia District, Transdniestria (as of December 31, 2017), were used as material for prospective cohort and retrospective comparative studies. Exhaled carbon monoxide (CO) concentration was measured using the EC50 Smokerlyser in 276 pregnant women; 320 childbirth and newborn histories were analyzed. The investigators examined health and demographic characteristics, social status, frequency of somatic diseases and pregnancy complications in women with nicotine addiction, and newborn physical development indicators. Studies in Russian, English, and French were comparatively analyzed using the Medline and Cochrane databases and the recommendations of international societies. Results. Active psychosocial intervention of healthcare personnel contributed to smoking cessation in the first weeks of pregnancy in 22.1% of pregnant women with a mean TS duration of 7.14±1.31 years who smoked <10 cigarettes per day before pregnancy. The frequency of somatic diseases and pregnancy complications, and newborn physical development indicators did not differ from those in never smokers. Exhaled CO measurement is the tobacco intoxication marker with a high correlation, which makes it possible to assess the degree of adherence of pregnant women to TS. The method is easy to use and non-invasive and can therefore be useful in everyday practice. Conclusion. Emphasis should be placed on the integration of services for TS cessation with other healthcare services, for the training of healthcare professionals and for the elaboration of guidelines.