Approximately 20% to 35% of pregnant women smoke during pregnancy (Albrecht et al., 2004). Smoking is an important risk factor contributing to poor birth outcomes. There are many risk factors to reduce preterm births, the most beneficial effect is stopping or reducing smoking or tobacco use. Successful treatment of tobacco dependence can result in a 20% decrease in low birth weight babies, a 17% decrease in preterm births and an average increase in birthweight or 28 grams.

Women who become pregnant are more likely to quit since they have an increased concern for their own health and for the health of their infants. This is especially true for moderate smokers smoking less than 20 cigarettes.day. The rate of cessation can be increased by 30% to 70% when evidence-based, pregnancy specific, smoking cessation interventions are implemented, compared to no intervention at all (Melvin, Dolan-Mullen, Windsor, Whiteside, & Goldenberg, 2000; Mullen, 1999). An evidence-based intervention known as the 5 A’s approach consists of 5-15 minutes of brief counseling delivered by trained clinicians at each visit for women wishing to quit (ACOG, 1997; Melvin et al., 2000), and the 5 R’s approach for women who are not interested in quitting (Fiore et al., 2000). Healthcare providers and systems have not consistently delivered appropriate smoking cessation interventions in the past. Therefore, the 5 A’s approach can be utilized to improve cessation rates during pregnancy (Lancaster et al., 2002; USDHHS, 2000).

The smoking status of women should be assessed at every healthcare encounter. By effectively training healthcare teams to intervene using the 5 A’s and 5 R’s approaches with pregnant smokers, positive healthcare outcomes will increase and costs reduced.