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Smoking during pregnancy is a common problem in the Netherlands (10% of all pregnancies) and is associated with neonatal complications and health problems later in life. Pregnant women who have a depressive disorder are four times more likely to smoke. Although cessation may be more difficult in these women, cessation of smoking does not lead to an increase of psychiatric symptoms.
The first patient, a 28-year-old female in her first pregnancy, had a history of recurrent depressive disorder. She was free of symptoms since on paroxetine. Because of her pregnancy, she ceased smoking and halved her paroxetine. She started smoking again when her depression relapsed during pregnancy. She was advised to treat the depression with an adequate dosage of paroxetine and she quit smoking with her midwife’s support.
The second patient, a 35-year-old female in her second pregnancy, had a history of PTSD for which she was treated with cognitive behaviour therapy. She had ceased smoking before pregnancy. During pregnancy she experienced an increase in depressive and panic symptoms, and she resumed smoking to feel more at ease. She was advised to start on bupropion and she ceased smoking with an online support program.
Although women with psychiatric problems may have more difficulties with cessation of smoking, they are no less motivated to cease smoking. In this paper we argue that cessation is not only desirable but also necessary and, more important, possible.
There are several effective methods for smoking cessation in pregnant women.
We advise treating every smoking pregnant woman with psychiatric problems for both the psychiatric illness and smoking at the same time, to achieve a favourable outcome for both mother and child.