Pharmacotherapy for Smoking Cessation in Pregnant Women

New evidence shows that pregnant smokers may benefit from pharmacotherapy for smoking cessation. In a study investigating the safety and effectiveness of pharmacotherapy for smoking cessation, researchers analyzed data from 7 seven studies that included 1386 pregnant smokers.¹ Considered among the most important modifiable causes of adverse pregnancy outcomes, smoking during pregnancy can increase risk of ectopic pregnancy, vaginal bleeding, placental abruption, placenta previa, premature birth, low birth weight, birth defects, and stillbirth.²

Available data showed that the number of cigarettes smoked daily ranged from 13.4 to 25.4 in the intervention groups (n=732) and 14 to 24.5 in the control groups (n=654). Two studies showed that bupropion or counseling in combination with NRT (eg, nicotine patch, gum, and lozenge) significantly affected smoking cessation, whereas 5 studies showed that NRT had no significant effect on smoking cessation.

Overall, the abstinence rate for the intervention group was 1.8 times higher than that for the control group. In late pregnancy, the mean abstinence rates were 13.6% and 8.1%, respectively-a statistically significant difference. Compared with the general population, however, fewer pregnant women were able to quit smoking by late pregnancy (13% of pregnant women at 4 to 5 months follow-up vs 15.4% of the general population at 6 to 12 months follow-up). Further study is needed to determine whether this finding has any significance. The mean birth weight, mean gestational age at birth, and rates of low birth weight and preterm delivery were similar between study groups.

Adverse events, such as skin irritation, dizziness, headache, and nausea, were reported, but there was no evidence that they were directly associated with the intervention. Of interest, pharmacotherapy was significantly effective in studies that verified reports of abstinence with salivary cotinine or exhaled carbon monoxide but had no significant effect when studies relied on self-reported claims, found the study authors.

Although pharmacotherapy for smoking cessation, such as nicotine replacement therapy (NRT), bupropion SR, and varenicline, is safe and effective in the general population, the findings of previous studies evaluating pharmacotherapy for smoking cessation in pregnancy have been inconsistent, say the study authors. To date, pharmacotherapy for smoking cessation in pregnant women has not been recommended because there has been insufficient evidence to support its use.³

Pertinent Points:
- Clinical evidence shows some benefit of using pharmacotherapy for smoking cessation in pregnant women.
- In general, pharmacotherapy for smoking cessation in pregnancy is safe and has no affect on birth outcomes.
- Additional studies are needed to confirm these findings, which should be interpreted cautiously, according to the study authors.

References:

1. Myung S-K, Ju W, Jung H-S, et al, for the Korean Meta-Analysis (KORMA) Study Group. Efficacy and safety of pharmacotherapy for smoking cessation among pregnant smokers: a meta-analysis. BJOG. 2012;119:1029-1039.
2. March of Dimes. Smoking during pregnancy. April 2010. Available at: http://www.marchofdimes.com/pregnancy/alcohol_smoking.html. Accessed August 13, 2012.
3. Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: US Department of Health and Human Services, Public Health Service; 2008.