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story.lead_photo.caption Megan Horstman

Smoking cessation is an important topic and a conversation health care providers should be having with all women of childbearing age in an effort to promote healthy pregnancies and outcomes for both the mothers and babies of Missouri.

The Centers for Disease Control and Prevention states that based off a 2018 study, between 15-19 percent of Missouri women report having smoked during their pregnancy, with the highest percentage of that population being between the ages of 20-24 years old. Statistics show in Missouri between 18-23 percent of women of childbearing age report smoking daily.

There are many risk factors and socio-economic disparities that have been shown by research to play a role in the likelihood of a woman smoking. Race is a leading disparity for smoking in women, with 45.7 percent of American Indians/Alaska Native women reporting smoking, 22.6 percent of African American women, 18.3 percent of Hispanic women and 18.8 percent of Caucasian women smoking.

Another major risk factor is education level. Studies show 39.3 percent of women with below a high school education level reported smoking, and that number decreased to 24.2 percent of women with a high school diploma, 22.3 percent of women with an education level of some college, and only 7.3 percent of women who are college graduates reported smoking. Another major disparity exists amongst smoking rates in women across different income levels. The rate of women with an income of less than $25,000 who smoke is 36.5 percent, and that number decreases to just 11.7 percent of women making $75,000 or more.

With all these risk factors and disparities, it is incredibly important for health care providers and local health organizations to reach out to as many women across these different socio-economic classes by as many means as possible to improve health outcomes in our community.

According to American College of Obstetrics and Gynecologists, the greatest benefit of smoking cessation during pregnancy is if it is done before 15 weeks of gestation, although there is still risk associated with any tobacco consumption during pregnancy. However, many challenges to smoking cessation may arise during that time frame such as the woman not knowing she was pregnant, delays in getting care established with a new health care provider, limited access to transportation and limited access to smoking cessation resources. These challenges to smoking cessation in early pregnancy highlight the importance of smoking cessation for all women of childbearing age before they become pregnant for best possible outcomes.

Smoking during pregnancy has been linked to a number of serious complications including, but not limited to:

Preterm delivery, low birth weight, various birth defects including cleft lip and cleft palate, abnormal bleeding during pregnancy and increased risk of miscarriage, placental abruption (where the placenta separates from the uterus), and long-term damage to baby's brain and lungs.

Smoking during pregnancy also poses risks to mothers as well. Smoking causes decreased oxygen and increased carbon monoxide levels in the bloodstream. This can lead to increased feelings of fatigue and shortness of breath, which can already be troublesome during pregnancy. Smoking increases risk of miscarriage and abnormal bleeding during pregnancy, which can pose risk to the mother as well as baby.

Other risks to mother associated with smoking can include but are not limited to: various types of cancer, heart disease, lung disease, stroke, Chronic Obstructive Pulmonary Disease, emphysema and bronchitis.

OB/GYN providers are in a great place to promote smoking cessation and provide resources during pregnancy but are limited to how many women they can reach prior to pregnancy. For this reason, it is so important that smoking cessation information be readily available to all women of childbearing age by different means and platforms. Some smoking cessation resources are available to women in Missouri include:

- MO Quitline: 1-800-QUIT-NOW or YouCanQuit.org;

- American Cancer Society: 1-800-227-2345 or www.cancer.org/healthy/stay-away-from-tobacco;

- American Heart Association: 1-800-AHA-USA1 or www.heart.org;

- American Lung Association: 1-800-LUNGUSA or www.lung.org/stop-smoking;

- Primary care providers and OB/GYN providers; and

- Local health organizations such as health departments and WIC programs.

Megan Horstman is a registered nurse who has been practicing nursing for seven years and recently joined the Cole County Health Department in July. Her focus is on promoting health education for the maternal and child populations of the community.

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