SOUTH PORTLAND — Before Richard Windsor even spoke a word, his first slide said it all.

Flashed on the screen was a photograph of a fetus holding, of all things, a cigarette in its still-forming hands. Smoking during pregnancy is an epidemic among Maine women on Medicaid. Almost 40 percent of them continue to smoke during their pregnancies, compared with 10 percent of pregnant women who are not on Medicaid. Smoking during pregnancy can lead to low birth weights in babies, premature births and sudden infant death syndrome. "Would you give a cigarette to your unborn child?" the slide's caption said. "You do every time you smoke!" It's a message that Windsor, through his research, has already brought to hundreds of pregnant women who are on Medicaid. Windsor is chairman of the Department of Prevention and Community Health at the George Washington University Medical Center and is the nation's foremost authority on pregnancy and smoking among women who receive Medicaid. On Wednesday, he brought his message to the doctors, nurses and public health officials in Maine who are trying to convince women in this state that smoking during their pregnancies is dangerous. During a talk at the annual meeting of the American Lung Association of Maine, Windsor spoke about the perils of smoking during pregnancy and outlined a program he developed that seems to be helping pregnant women in Alabama to kick the habit. Smoking during pregnancy is an epidemic among low-income women in Maine. Almost 40 percent of Medicaid recipients continue to smoke during their pregnancies, compared with 10 percent of pregnant women who are not on Medicaid. Nationally, about 75 percent of pregnant smokers are Caucasian women on Medicaid. Cigarette smoke contains about 4,000 chemicals, including nicotine, which kills brain cells, Windsor noted. Smoking during pregnancy can lead to low birth weights in babies, premature births and sudden infant death syndrome. "I know you fully appreciate the risk," he said to the group of health professionals, "but I'm not fully certain the pregnant smoker, whether on Medicaid or not, does." But quitting can be difficult because of the strong addiction the women must fight, even as they struggle with other issues in their lives. Half of pregnant women are unlikely to quit and it's even harder for pregnant women on Medicaid, who are much more heavily addicted, Windsor said. The women who do manage to quit are likely to relapse after they give birth and start experiencing the stress of parenthood. Sixty to 70 percent of women relapse after their pregnancies; for women on Medicaid, the number jumps to 80 to 90 percent. "We don't call these patients quitters," Windsor said. "We call them stoppers." Stopping pregnant women from smoking could save an estimated $30 to $60 million in health-care costs nationwide, Windsor said. In Maine, it could save "hundreds of thousands, if not millions . . . and the intervention costs are like $10 a patient." Sarah Haggerty, director of the Partnership for a Tobacco-Free Maine at the Maine Bureau of Health, said that during the next few years the state plans to develop a new program to help pregnant women on Medicaid stop smoking. Windsor and his colleagues have already discovered one method that seems to work well. Their program was so successful with women in Alabama that it is now being disseminated statewide. Women in an experimental group watched a 10-minute "Commit to Quit" video and were given a 32-page self-help guide developed with the assistance of other pregnant smokers. The women received a brief counseling session and they had to commit to quitting within the next seven days. The researchers also checked the levels of cotinine, a breakdown product of nicotine, in the women's saliva to make sure they were being truthful about quitting. The results were impressive: 18 percent of the women in the experimental group quit smoking for the duration of their pregnancy, compared with only 8 percent in a control group. Windsor said the program works because it sends women a clear, strong message that quitting is essential and there are specific tools they can use to help them end their smoking habit. "Women who smoke have a generalized notion of risk," he said. "They're not quite as convinced, so we've got to spend more time, more forcefully, more directly, more assertively, saying 'OK, this is an important problem.' " For women who can't quit using this method, Windsor recommends helping them schedule their smoking so they cut down to five cigarettes or less a day. Nicotine gums and patches can help, but those must be prescribed and monitored by a physician and they still carry a risk. "There needs to be much larger-scale studies done before I can suggest that they're used," he said. In a panel discussion after Windsor's remarks, Dr. Susan Swartz, an internist and researcher from Maine Medical Center, said she thinks the cotinine test should be as much a part of a prenatal exam as checking blood pressure and testing for diabetes. "Somewhere along the way medical science said you test these things," she said. "And then you created the expectation that it happened, and women are going to be (upset) if you don't do it. We shouldn't need approval to be testing for either carbon monoxide or nicotine breakdown products in these women." Swartz also said she thinks there needs to be more research done to find new drug therapies and alternative treatments to help smokers quit. "These so-called hard-core smokers deserve all our scientific efforts," she said. Staff Writer Meredith Goad can be contacted at 791-6332 or at: [email protected]

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