Tobacco and nicotine use are associated with numerous adverse health effects including miscarriage, preterm birth, low birthweight, placenta previa, placental abruption, cleft lip and palate, and sudden infant death syndrome (SIDS). Babies exposed to secondhand smoke have increased risk of ear infections, asthma complications, and SIDS (Centers for Disease Control and Prevention [CDC], 2016). Prevalence of all forms of nicotine use among pregnant women in the United States is unknown; however, 8.4% of women report smoking at some time during pregnancy (Curtin & Matthews, 2016). Cigarette smoking has declined among adolescents, though use of electronic cigarettes and hookah has increased (CDC), thus screening for new and emerging tobacco products is increasingly important. Familiarity with the many types of tobacco and nicotine should guide screening questions, for example, instead of asking a woman if she smokes cigarettes, nurses might ask, "Do you use any type of tobacco or nicotine?" or "Do you smoke, vape, chew or sniff any tobacco or tobacco-like products?" Nearly all obstetricians report that they ask patients about smoking, but 40% note they never ask about use of smokeless tobacco products and 29% ask about these products inconsistently (Crowe, Gregg, & DeFrancesco, 2016). Many women of childbearing age seek healthcare only for pregnancy-related concerns; therefore, nurses and other perinatal care providers are in a unique position to counsel women about tobacco use and cessation.
The table lists the most common types of tobacco and nicotine-containing products available in the United States. Resources and toolkits to guide clinicians in screening and counseling women about tobacco cessation are available from the CDC (2016)https://www.cdc.gov/reproductivehealth/maternalinfanthealth/tobaccousepregnancy/ and American College of Obstetricians and Gynecologists ([ACOG], 2016) http://www.acog.org/About-ACOG/ACOG-Departments/Toolkits-for-Health-Care-Provide
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