A 32-Year-Old Woman, Gravida 2 Para 0 Aborta 1, at 7

A 32-year-old woman, gravida 2 para 0 aborta 1, at 7 weeks gestation comes to the office to initiate prenatal care.  The patient has had nausea and vomiting unresponsive to an oral antiemetic but has not had abdominal pain or vaginal bleeding.  Her first pregnancy 2 years ago ended in a first-trimester spontaneous abortion.  The patient has a history of epilepsy that is managed with antiepileptic medication.  However, because she had been seizure free for 3 years, the medication was stopped prior to pregnancy.  She has smoked a pack of cigarettes daily for the past 14 years.  The patient has tried to quit several times and is unsure if she is ready to try again.  She does not use alcohol or illicit drugs.  Vital signs are within normal limits.  BMI is 27 kg/m².  Pelvic examination is normal.  Ultrasound reveals a 7-week intrauterine gestation with a normal heartbeat.  Which of the following is the best initial advice regarding smoking cessation for this patient?

A) Bupropion facilitates smoking cessation safely and prevents pregnancy complications from cigarette use.
B) I would recommend using e-cigarettes during pregnancy if smoking cessation is not possible.
C) Let's discuss any factors that may be preventing readiness for smoking cessation.
D) Once you are ready to stop smoking, options can be discussed in depth.
E) Smoking during pregnancy can cause congenital anomalies, and I would recommend varenicline.