Pregnancy and smoking

More than one in 10 pregnant women smoke, and new research suggests many of them also may suffer from depression, making kicking the habit even harder.
The emerging science suggests that decades-old “quit for your baby” messages are too simplistic an approach for many women — and that perhaps prenatal checkups should include screening pregnant smokers for mental health disorders that themselves require care.
“These ladies all know, I promise you, about the health risks. That’s not what it is,” says Dr. Jan Blalock of the University of Texas M.D Anderson Cancer Center, which has begun a first-of-a-kind study, Project Baby Steps, to test whether non-drug depression therapy helps pregnant smokers quit. “We should at least understand more about why these ladies don’t quit. We should be looking more carefully.
Nearly 45 million Americans, or one in five adults, smoke. Quitting takes on average three to five attempts, and scientists know it’s harder if the smoker has depression or anxiety disorders.
Certainly learning how dangerous smoking is to their developing baby can prompt women to try to quit. It increases the risk of miscarriage, premature birth, low birthweight, death from SIDS, and learning and behavior disorders.
The government estimates about 12 percent of pregnant women smoke. But how to treat pregnant smokers? While many smokers turn to medication to ease quitting pangs, doctors hesitate to prescribe even nicotine patches during pregnancy. Studies so far haven’t proven the patches’ role in pregnancy, and some suggest pregnant women metabolize nicotine faster and thus need higher doses, raising fetal safety questions. Antidepressants haven’t been studied specifically in pregnant smokers. Generally, those drugs are reserved for severe symptoms during pregnancy, although recent studies suggest the risk of birth defects is low.