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Copia de REDUCING HARM

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PRESENTATION OUTLINE

SMOKING DURING PREGNANCY

MARGARET S. CHISOLM, MD    @WHOLE_PATIENTS

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1964 SURGEON GENERAL'S REPORT

ANNOUNCED HEALTH RISKS OF SMOKING & LAUNCHED MASSIVE PUBLIC HEALTH CAMPAIGN
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REPORT ALSO NOTED RISK OF LOW BIRTH WEIGHT

IN BABIES BORN TO MOTHERS WHO SMOKED

IN THE FACE OF DWINDLING SALES

COMPANIES INCREASINGLY FOCUSED ON FEMALE MARKET

AND ON PERCEIVED REDUCTION OF HARM

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IN THE 1990s, SMOKING PREVALENCE IN WOMEN INCREASED

FOR THE FIRST TIME SINCE THE 1960s
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SINCE THEN, LITTLE CHANGE IN SMOKING PREVALENCE

NOW CONCENTRATED IN WOMEN OF LOW SES &/OR WITH PSYCHIATRIC COMORBIDITY

6 MILLION WOMEN ANNUALLY

22% ARE SMOKERS
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LOW BIRTH WEIGHT PRETERM DELIVERY SPONTANEOUS ABORTION STILLBIRTHS NEONATAL MORTALITY INTRAUTERINE GROWTH RESTRICTION PREGNANCY COMPLICATIONS SUDDEN INFANT DEATH SYNDROME

50% OF WOMEN CONTINUE TO SMOKE DURING PREGNANCY

THIS 11% PREVALENCE HAS REMAINED UNCHANGED FOR >20 YEARS
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BEHAVIORAL TREATMENTS

SIGNIFICANTLY REDUCE MATERNAL SMOKING & IMPROVE NEONATAL OUTCOMES
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PHARMACOLOGICAL TREATMENTS

3 FIRST-LINE TREATMENTS SAFE & EFFECTIVE IN NON-PREGNANT ADULTS
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PHARMACOLOGICAL TREATMENTS

3 FIRST-LINE TREATMENTS SAFE & EFFECTIVE IN NON-PREGNANT ADULTS
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NRT, BUPROPION SR, VARENICLINE

NONE APPROVED FOR USE IN PREGNANCY
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NICOTINE REPLACEMENT THERAPY

A HARM REDUCTION STRATEGY
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4 RANDOMIZED CONTROLLED TRIALS IN PREGNANCY

NONE EFFICACIOUS AT ENHANCING QUIT RATES
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NRT INCREASES BIRTH WEIGHT

MAY REDUCE PREMATURE DELIVERY
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BUPROPION & VARENICLINE

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