State Has Nation's Highest Rate of Pregnant Women Who Smoke by Mary Wade Burnside
Evan Osborn, March of Dimes, (681) 427-7977, email@example.com
State Has Nation’s Highest Rate of Pregnant Women Who Smoke. By Mary Wade Burnside. 1/31/2011 © The Times West Virginian.
Fairmont, West Virginia, January 31, 2011
Kathy Danberry has interviewed pregnant women who smoke as part of her job as the cessation program manager for the West Virginia Division of Tobacco Prevention, and when she heard some of their reasons for not quitting, “I about fell out of my chair.” “I heard, ‘My doctor said if I quit smoking, I will miscarry,’” she said. Another woman insisted that her doctor told her that nicotine was good for the baby. “We’ve heard so many stories,” Danberry said. It’s a story that health officials in the state want to change, especially because the rate of expectant mothers who smoke in West Virginia — 28.6 percent in 2009 — is nearly three times that of the national rate of 10.2 percent.
West Virginia has the highest rate of pregnant women who smoke in the United States. Danberry heard those responses during a focus group she helped conduct a year ago, and she was discouraged. “If the ladies do quit, they start right back up after they have the baby,” Danberry said. “It’s not going to help. Secondhand and third-hand smoke is just as hard on the babies and newborns.” Danberry compares the attitudes she has encountered to the reasons boys and young men say they use spit tobacco. “It’s a culture thing here in West Virginia,” she said. “‘My mom smokes and I’m fine. Her mom smoked and she’s fine.’ It’s like spit tobacco in West Virginia. It’s the culture.”
Dr. Ilana Chertok also wants to do something to reduce the number of pregnant women who smoke. Chertok, an epidemiologist and associate professor at the West Virginia University School of Nursing, will be working with certified nurse-midwives in Monongalia and Preston counties who will counsel their patients about the effects of smoking and provide encouragement for them to quit in a study funded by the March of Dimes and supported by the WVU School of Nursing. “In the end, we’ll do an evaluation of the whole program and see how successful it was and examine what the outcomes were,” Chertok said.
Statistics on smoking and expectant mothers fluctuate somewhat, but in West Virginia figures have remained in the 25-28 percent range recently, according to West Virginia Vital Statistics reports used by the state Division of Tobacco Prevention. That’s in stark contrast to the rate in the United States, which has declined steadily during the same period from 18.4 percent in 1990 to 10.2 percent in 2005. The Centers for Disease Control and Prevention not only has rated the state the highest in expectant mothers who smoke, Chertok noted, but also, between 2000 and 2005, the rate rose and in 2005 was 32 percent, nearly one-third of all pregnant women in the state. Those percentages fluctuate much more among the different counties, Chertok and Danberry both noted. On the lower end, according to 2006 figures from the state Department of Health and Human Resources, are Berkeley, 20.5 percent; Hardy, 20.4 percent; Jefferson, 14.5 percent; Monongalia, 17.4 percent; Pendleton, 18.9 percent; and Putnam, 19.6 percent. On the higher end are Boone, 35.6 percent; Calhoun, 35.7 percent; Clay, 36 percent; Doddridge, 42.6 percent; Lincoln, 43.3; Logan, 38.5; McDowell, 43.6; Mingo, 37.3 percent; Ritchie, 35.1 percent, Summers, 39.1 percent; Webster, 38.1 percent; and Wyoming, 39.2 percent. Locally, Marion County was at 22.8 percent and Harrison County was at 24.3 percent in 2006. In the study Chertok will lead, the certified nurse-midwives will ask their patients if they smoke, and if they respond in the affirmative and agree to be part of the study, the women will be given counseling and other tools to help them stop. They will be directed to the West Virginia Tobacco Quitline at (877) 966-8784 as well as counseled in the “five A’s” method of quitting recommended for clinicians. This means they will “ask, advise, assess, assist and arrange.” Breaking that down, after the certified nurse-midwives inquire about a woman’s smoking status, they will advise those who do smoke of the risks to their unborn baby if they continue to use cigarettes and “personalizing the benefit of quitting,” Chertok said. If they do not quit, the risks include low birth weight, the slowing of brain development and increased likelihood of prematurity.
“There are many problems associated with smoking in pregnancy,” Chertok said. “Research has found that smoking in pregnancy has been associated with decreased placental function, decreased oxygen and nutrient transfer to the fetus, decreased oxygen levels of the fetus, poor fetal growth including brain growth, neurobehavioral problems in the infant, increased risk of behavior and learning disabilities, and general increased risk of infant illnesses, just to name some of the problems.” Clinicians also will “assess the readiness to make a change,” Chertok said. “Women in pregnancy are often very motivated to make lifestyle changes,” she added. “And assist — that’s where we will be providing resources and helping problem solve. Arrange” means to provide follow-up care, during which the clinicians continue to drive home the non-smoking message. Stacey Archer, a certified nurse-midwife and the director of nurse-midwives at the WVU School of Medicine, will be one of the practitioners working with Chertok in the study. As someone who delivers babies, she has seen the effects of smoking first-hand when a baby is born and the placenta, which helps get nutrients to the baby, follows. “You can see it in the placenta chord,” Archer said. “It has a different appearance. It looks like what we say is calcified. Many calcifications constrict the blood vessels.” That means the fetus does not get as many nutrients as a baby delivered by a non-smoking mother. The placenta of a smoking mother also does not always deliver as easily and sometimes requires manual removal or additional medications, Archer said. Babies of smoking mothers then are sometimes smaller, but genetics also can play a factor in that, Archer said. They also can be irritable because the babies then can experience symptoms of withdrawal from nicotine after they are born and no longer connected to the mother. If the smoking mother then breastfeeds, however, the baby will continue to get the nicotine through the mother’s milk. Archer’s plan is to lay out these facts to the expectant mothers “in a very respectful manner. But it is an addiction,” she added. “I don’t find mothers being flippant. Many try to quit altogether.” There are some medications that aid smokers in quitting, but not all clinicians agree on what should be prescribed for pregnant women. Archer has prescribed Wellbutrin, an antidepressant known for its ability to help in smoking cessation, in which context it is called Zyban. “For me, that would be the choice,” Archer said. “Some people prescribe Chantix.” Dr. Tyler Prouty, an obstetrication with Women’s Health & Wellness Center in Fairmont, also has prescribed the nicotine patch for some expectant mothers. Some physicians avoid this because the patch delivers a dose of nicotine into the woman’s system. The patch has been classified as Category D, which means it can be a risk to the fetus; with Category A through C posing less risk and Category X classified as not worth the risk. “It’s a Category D, but smoking is Category X,” Prouty said. “That’s my rationale.”
Even though Prouty is not part of Chertok’s study, as a health provider, he tries to get his pregnant smoking patients to quit. “Anecdotally, in my clinic, it seems like 60 percent of the patients smoke,” Prouty said. “Of that 60 percent, I’m usually able to convince, on a good month, 15 percent, but probably about 10 percent, to quit smoking.” Chertok does not know how many pregnant women ultimately will be part of the study, but she hopes to have at least 51 participants. The goal will be to get the women to quit smoking on a permanent basis so that they not only will lead a healthier lifestyle, but they also will not pose a risk to their babies after they are born through secondhand smoke. She believes the counseling method that will be employed can be effective to the tune of a 30-70 percent rate, based on previous use. If they can get the women to at least reduce the amount of cigarettes smoked, that will be beneficial. “But absolutely, the preference is for the mother to quit smoking,” Chertok said. “But the one thing you have to be realistic about is that smoking is an addiction. It does take time to reduce the addiction.”