So there I was giving a lecture “somewhere” other than California. The organizers took me to dinner in a “fancy” French restaurant. The private dining room was booked for a wedding reception and as the bride arrived with her attendants I could not help but notice two young women who were visibly pregnant… and smoking. To make matters worse one held a nearly empty bottle of beer. I so wanted to go up to these women and suggest that they were increasing their risk of preterm labor, diminishing their progeny’s physical and mental growth and ultimately risking fetal and/or neonatal death, but of course, did not.

I strongly advise women to quit cigarette smoking before they conceive (or before they start to smoke, whichever comes first) for their own health. But if it’s too late, I should have a method to offer them on how to quit while they are pregnant. Although I have never been a smoker, I understand from many friends and family how difficult it can be. “Cold Turkey” describes my lack of cooking skills at Thanksgiving and is also the preferable way to quit while pregnant, but may just be too difficult.

Thank goodness, the data from a study of 100,000 pregnant women in Denmark and their offspring has shown a reasonable substitute, nicotine replacement therapy (NRT). Despite the fact that women who used nicotine replacement therapy were more likely to be over the age of 35 and drink two or more alcoholic drinks per week during pregnancy, they were NOT at increased risk of stillbirth compared to women that neither smoked nor used NRT. The women who continued to smoke throughout their pregnancy had a significantly increased rate of stillbirth as well as the risk of having a child with oral cleft, malformations of the circulatory system and/or digestive system. Those who stopped but used NRT were at reduced risk.

The important fact is that although NRT does contain nicotine, it doesn’t have the other 2999 chemicals that are present in cigarette smoke (yuck!). The American College of Obstetrics and Gynecology has stated in an official opinion that although, quitting cold turkey is best, women who cannot quit smoking without assistance may use NRT during pregnancy. They recommend that NRT products that provide intermittent nicotine — such as gum or lozenges– be tried before resorting to products that provide a constant dose (the nicotine patch)

Perhaps I should have offered one of these products to those pregnant and smoking women that were in the restaurant.