Rates of tobacco use during pregnancy have been declining, but, due to under-reporting, it is likely that use of nicotine containing products is increasing. Nicotine is still the most common type of substance use disorder in pregnancy, complicating an estimated 7.2% of US deliveries in 2016. There are many types of tobacco and nicotine products available including e-cigarettes and vaping products, hookah, chewable and sublabial products, and patches. All of these products pose a threat not only to maternal health, but also to fetal and infant health. Tobacco and nicotine products expose the fetus to toxins, alter fetal oxygenation, and may result in fetal developmental changes. All patients should be screened for nicotine use disorder in pregnancy and counseled about risks of use. The USPSTF recommends that “clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant persons who use tobacco.”
Note: This medication was previously marketed by Pfizer under the brand name Chantix | It was recalled 7/2021 for the presence of a contaminant which can increase the risk of cancer for long-term users | Currently, generic varenicline is available and safe for use in the US
DSM-V Criteria and sub-features of Tobacco Use Disorder
A problematic pattern of tobacco use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period
ACOG CO 807: Tobacco and Nicotine Cessation During Pregnancy
Smoking cessation in pregnancy: An update for maternity care practitioners
FDA Updates and Press Announcements on Nitrosamine in Varenicline (Chantix) | FDA
Infant morbidity and mortality attributable to prenatal smoking in the US. American journal of preventative medicine
Bupropion sustained release for pregnant smokers: a randomized, placebo-controlled trial
USPSTF: Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons
SmokeFree Women (For Patients)
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