Smoking, I think we can all agree, is bad. It's bad anytime -- causing strokes, cancer, and heart disease -- but it's worse if you're pregnant. Smoking while pregnant is associated with birth defects, restriction of fetal growth, preterm labor and delivery, and stillbirth. Recognizing this, many women use pregnancy as a motivation to kick the habit.

But smoking is addictive, and the habit is not easy to quit. The nicotine delivered through cigarettes is physically addictive, and cravings can keep even the most determined person from quitting successfully.

Help is available. Nicotine replacement, delivered through gum, the patch or sprays, can help wean smokers from their dependence on cigarettes. Stop smoking programs are more successful when nicotine replacement is combined with counseling and support. People serious about stopping should ask their doctors about local support groups and programs.

As useful as nicotine replacement can be as an aid to stop smoking, some doctors may be reluctant to recommend it during pregnancy because nicotine may be associated with the birth of small babies and, potentially, some of the other effects of smoking on pregnancy. Years ago, nicotine replacement products were labeled category X, which meant there was evidence of risk to the fetus. More recent labeling suggests that these products should be used only on the advice of your doctor.

Here's what I tell my patients: If the choice is between smoking and using nothing, then it's best to use nothing. But, if you're like most smokers, and the choice is between smoking and using nicotine replacement, I'd rather you use the nicotine replacement with the goal of quitting. By using the replacement, at least you avoid the other toxins in cigarettes. To me that seems logical, but some doctors feel that recommending nicotine replacement makes them responsible for a potentially worrisome exposure that the patient would otherwise be responsible for by herself.

There are other alternatives you can use to help nicotine cravings during pregnancy. As mentioned above, counseling and behavioral therapy help some people. Others are helped by medicines such as bupropion (Zyban). You should consider these alternatives and nicotine together with your doctor.