Clinical Practice: Guidelines Address Patient Tobacco Use

November is Lung Cancer Awareness Month. Smoking cessation in pregnancy is addressed in the just-published Guidelines for Perinatal Care, Eighth Edition by ACOG and the American Academy of Pediatrics.

Inquiry into tobacco use, including smoked, chewed, electronic nicotine delivery system (ENDS), and vaped, and smoke exposure should be a routine part of the prenatal visit. Women should be strongly discouraged from tobacco use, including smoking. Multiple studies have demonstrated a clear association between maternal smoking and perinatal morbidity and mortality. Smoking is a risk factor for perinatal depression. There is a strong association between tobacco use during pregnancy and sudden infant death syndrome.

A protocol that systematically identifies pregnant women who use tobacco and offers treatment or referral has proven to increase tobacco cessation rates. A short counseling session with pregnancy-specific educational materials and a referral to the smokers quit line is an effective smoking cessation strategy.

The Five A’s Intervention

Women who wish to quit tobacco use benefit from a brief counseling session, such as the 5 A’s intervention. Training in the use of the 5 A’s tobacco cessation tool and knowledge of health care support systems, including the National Cancer Institute’s Smoking Quit line (1-877-44U-QUIT or 1-877-448-7848), and pharmacotherapy add to the techniques health care providers can be used to support tobacco cessation.

The Five A’s are an intervention that can be used in the office or clinic under the guidance of trained practitioners:

  1. Ask about tobacco use
  2. Advise to quit through clear, personalized messages
  3. Assess willingness to quit
  4. Assist to quit
  5. Arrange follow up and support

See more on the Five A’s Intervention.

ACOG Resources on Smoking Cessation

Cessation of tobacco use (i.e., smoking, chewing, electronic nicotine delivery system, vaping) is recommended before pregnancy. Women who smoke cigarettes or use any other form of tobacco product should be identified and encouraged and supported to quit before becoming pregnant.

View ACOG Committee Opinions and other resources below:


American College of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188
Mailing Address: PO Box 96920, Washington, DC 20024-9998