Nicotine Replacement Therapy (NRT) in pregnancy

Nicotine Replacement Therapy (NRT) approximately doubles cessation rates, however, dependent on the brand and manufacturer, NRT is either contra-indicated or cautioned for use during pregnancy.

Research now however, suggest that the benefits of NRT to aid smoking cessation in pregnant women, who cannot stop smoking without such therapy, substantially outweighs the risks of continual smoking, or the risks of NRT.

For women who continue to smoke in pregnancy expert opinion is that NRT is considerably safer than continued smoking in pregnancy. NRT products are much safer than cigarettes, which have large amounts of other chemicals contained in the smoke, exposing the foetus and mother to many other toxins, such as carbon monoxide, as well as nicotine. NRT provides cleaner and lower doses of nicotine than smoking (typically around one third of the nicotine concentrations). The mother and child will also benefit from the long term health advantages associated with smoking cessation.

The decision about the appropriate use of NRT in pregnancy is a trade-off between the balance of risk and benefit. A document prepared for the World Health Organization recommends that regulators should license NRT products ‘available for use, under medical supervision, by pregnant women who have been unable to quit with non-pharmaceutical interventions’. This view is also supported by the Royal College of Physicians, who recommend that NRT products are able to be used by pregnant women when non-pharmacological interventions have failed.

This would have the maximum public health impact if health professionals made their assessment of this in the early stages of pregnancy, based on smoking history and previous attempts at quitting. Details of NRT in pregnancy are available from: A guide to smoking cessation in Scotland (NHS Health Scotland, 2010) and How to stop smoking in pregnancy and following childbirth (National Institute for Health and Care Excellance, 2010)

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