Making Smoking Cessation Stick: Nicotine-Replacement Patches in Pregnancy

Smoking during pregnancy is the leading preventable cause of maternal and neonatal morbidity. Although nicotine-replacement therapy has been demonstrated to be safe and effective in nonpregnant women, its role in promoting smoking cessation in pregnant women remain unclear. A multicenter, randomized controlled trial was conducted to compare the use of standard-dose nicotine patches or placebo patches among 1050 pregnant smokers in the U.K., who also received behavioral counseling.

Women assigned to nicotine or placebo patches were equally likely to abstain from smoking between their quit date and delivery (9.4% vs. 7.6%), as measured by self-report and validated by exhaled carbon monoxide and salivary cotinine concentrations. Abstinence rates 1 month after the quit date were higher in the nicotine group than the placebo group (21% vs. 12%), but rates of adherence beyond the first month were low in both groups (7.2% and 2.8%). Gestational age, birth weight, and occurrence of perinatal death did not differ between groups.