Nicotine replacement helps expectant women quit

Nicotine replacement therapy in the form of patches or gum or lozenges can help pregnant women quit smoking, a new study shows.

Among 181 pregnant smokers, those given the option of using some form of nicotine replacement along with counseling were three times more likely than their peers who received counseling alone to have quit seven weeks later.

However, the researchers say, more studies are needed on the safety of nicotine replacement therapy for the baby, as well as its benefits in pregnancy.

While the dangers of smoking in pregnancy—ranging from an increased risk of low birthweight to a greater likelihood of stillbirth—are well known, about half of women smokers don’t quit after becoming pregnant, Dr. Kathryn I. Pollak of the Duke Comprehensive Cancer Center in Durham, North Carolina and colleagues point out in the American Journal of Preventive Medicine.

Given that existing evidence shows that nicotine replacement therapy is no more harmful to a pregnant woman and her fetus than smoking, the researchers note, they set out to determine if the strategy could improve quit rates in pregnancy.

The team recruited 181 pregnant smokers to participate in the study. All received cognitive behavioral therapy, including five in-person counseling sessions at the time of their prenatal visits and one telephone session. Two-thirds were assigned to nicotine replacement therapy as well, and were allowed to choose a patch, gum or lozenges.

Seven weeks after beginning nicotine replacement therapy, 24 percent of the women remained abstinent from cigarettes, compared to 8 percent of women who had received counseling only during the same time period. At 38 weeks of pregnancy, 18 percent of the women in the nicotine replacement group were not smoking, compared to 7 percent of the women who received counseling alone.

Three months after delivery, however, 20 percent and 14 percent of the two groups, respectively, were abstinent—which was not a significant difference, statistically.

Recruitment for the study was halted early after the researchers observed that women in the nicotine replacement group were more likely to deliver their infants prematurely. This turned out to be a quirk, because when the researchers went back and accounted for whether or not women had delivered infants prematurely in the past, they found no harmful effect of nicotine replacement therapy.

Nevertheless, they conclude, more research is needed to confirm that nicotine replacement therapy during pregnancy is safe.

SOURCE: American Journal of Preventive Medicine, October 2007.

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