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Although the proportion of women who smoke during pregnancy in high-income countries has declined, it remains an international public health priority.The economic burden of tobacco-related morbidity and mortality is substantial [1,2], contributing significantly to socioeconomic inequalities in stillbirths and infant deaths (38% and 31% respectively), as shown in a retrospective cohort study of mothers with varying degrees of socioeconomic deprivation .It is imperative that health professionals acknowledge the difficulties encountered by underserved minority pregnant smokers when developing and implementing cessation strategies such as lack of childcare, transportation, psychosocial barriers , insufficient knowledge of health risks and cessation methods, and lack of culturally appropriate quit support .In order to so, anti-smoking interventions will need to adopt a positive rather than punitive approach and respect individual values, capabilities and circumstances to achieve compliance in women [13,14].Current health strategies and interventions designed to diminish smoking in pregnancy have adopted a simplified approach to maternal smoking—one that suggests that they have a similar degree of choice to non-pregnant smokers regarding the avoidance of risk factors, and overlooks individual predictors of non-adherence.
Cigarette smoking is a marker of social disadvantage in high-income countries and has been cited as one of the most important contributing factors of health inequality between the rich and poor .
Unfortunately, this is not uniform across all sectors of society.
Low socioeconomic groups have experienced a much slower rate of decline relative to those of higher socioeconomic standing .
Nevertheless, promising results were reported in a randomized trial in which a combination of cognitive behavioural therapy (CBT) and NRT increased cessation rates nearly threefold compared to CBT alone .
However, recruitment was stopped early due to higher risk of negative birth outcomes in the CBT NRT group, which was later reported to have resulted from a greater history of preterm births in the CBT NRT group.