Diamanti Athina, Papadakis Sophia, Schoretsaniti Sotiria, Rovina Nikoletta, Vivilaki Victoria, Gratziou Christina, Katsaounou Paraskevi A
School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Department of Midwifery, University of West Attica, Athens, Greece.
Tob Induc Dis. 2019 Aug 2;17:57. doi: 10.18332/tid/109906. eCollection 2019.
This paper provides an up-to-date summary of the effects of smoking in pregnancy as well as challenges and best practices for supporting smoking cessation in maternity care settings.
We conducted a qualitative review of published peer reviewed and grey literature.
There is strong evidence of the effects of maternal tobacco use and secondhand smoke exposure on adverse pregnancy outcomes. Tobacco use is the leading preventable cause of miscarriage, stillbirth and neonatal deaths, and evidence has shown that health effects extend into childhood. Women who smoke should be supported with quitting as early as possible in pregnancy and there are benefits of quitting before the 15th week of pregnancy. There are a variety of factors that are associated with tobacco use in pregnancy (socioeconomic status, nicotine addiction, unsupportive partner, stress, mental health illness etc.). Clinical-trial evidence has found counseling, when delivered in sufficient intensity, significantly increases cessation rates among pregnant women. There is evidence that the use of nicotine replacement therapy (NRT) may increase cessation rates, and, relative to continued smoking, the use of NRT is considered safer than continued smoking. The majority of women who smoke during pregnancy will require support throughout their pregnancy, delivered either by a trained maternity care provider or via referral to a specialized hospital or community quit-smoking service. The 5As (Ask, Advise, Assess, Assist, Arrange) approach is recommended for organizing screening and treatment in maternity care settings. Additionally, supporting smoking cessation in the postpartum period should also be a priority as relapse rates are high.
There have been several recent updates to clinical practice regarding the treatment of tobacco use in pregnancy. It is important for the latest guidance to be put into practice, in all maternity care settings, in order to decrease rates of smoking in pregnancy and improve pregnancy outcomes.
本文提供了孕期吸烟影响的最新综述，以及在产科护理环境中支持戒烟的挑战和最佳实践。
我们对已发表的同行评审文献和灰色文献进行了定性综述。
有充分证据表明，孕妇吸烟和接触二手烟会对不良妊娠结局产生影响。吸烟是导致流产、死产和新生儿死亡的主要可预防原因，而且有证据表明其对健康的影响会延续到儿童期。吸烟的女性应在孕期尽早得到戒烟支持，在怀孕第15周前戒烟有益。孕期吸烟与多种因素相关（社会经济地位、尼古丁成瘾、伴侣不支持、压力、心理健康问题等）。临床试验证据发现，提供足够强度的咨询能显著提高孕妇的戒烟率。有证据表明，使用尼古丁替代疗法（NRT）可能会提高戒烟率，而且相对于继续吸烟，使用NRT被认为更安全。大多数孕期吸烟的女性在整个孕期都需要得到支持，可由经过培训的产科护理人员提供，或通过转介至专科医院或社区戒烟服务机构来实现。建议采用5A法（询问、建议、评估、协助、安排）在产科护理环境中组织筛查和治疗。此外，产后支持戒烟也应成为优先事项，因为复发率很高。
近期在孕期吸烟治疗的临床实践方面有多项更新。在所有产科护理环境中实施最新指南非常重要，以便降低孕期吸烟率并改善妊娠结局。
