Tips on getting pregnant smokers to quit. (Nicotine Replacement, Support Groups).

SARASOTA, FLA. -- Only 20%-40% of smokers quit smoking during pregnancy, which means up to 25% of American women smoke while pregnant, Dr. Haywood L. Brown said at a perinatal symposium sponsored by Symposia Medicus.

Convincing smokers to stop during pregnancy can be a challenge, but there are smoking cessation methods that work so it's worth the effort, said Dr. Brown, who is professor and chair of the department of obstetrics and gynecology at Duke University in Durham, N.C.

One key to success is to address the psychological addiction as well as the physical addiction. Self-help interventions are the most commonly used methods for quitting smoking; 90% of successful quitters use these methods, which can include telephone calls from a supportive source, taped messages, and videotapes.

Physician interventions can also be useful. Patient education about the risks of smoking and the benefits of quitting, negotiation of a quit date, and behavioral support groups are among interventions that can be offered or recommended by physicians.

Keep in mind that physician training in smoking cessation methods can be very helpful: Patients of specially trained physicians are up to six times more likely to stop smoking than those of physicians who have no training in promoting smoking cessation, Dr. Brown said.

Clinical interventions might include nicotine tapering, aversion stimulation (rapid smoking and smoke holding to create an aversion to smoking), and nicotine replacement. While nicotine medications can double or even triple cessation success rates-with short-term success rates in the 20%-40% range-remember that nicotine gum is pregnancy category C and transdermal patches are category D because they cause vasoconstriction.

According to a 1993 technical bulletin (No. 180) from the American College of Obstetricians and Gynecologists, patches may be reasonable in pregnant patients who ...