Nicotine replacement and behavioral therapy for smoking cessation in pregnancy

Pregnant women trying to quit smoking could find it easier with help from nicotine replacement therapy, a new study finds, despite safety concerns about the risk of early delivery.

“Every pregnant woman wants to quit smoking. Every woman knows it's bad for her baby,” said lead author Kathryn Pollak, Ph.D., an associate professor at Duke University Medical Center.

A group of 181 female smokers in the second trimester of pregnancy received cognitive behavioral therapy, including in-person and telephone counseling sessions, to help them deal with the stress of quitting smoking. Of those women, 122 also had the option to use nicotine replacement therapy (NRT), with their choice of the patch, gum or lozenges.

The study appears in the October issue of the American Journal of Preventive Medicine .

Seven weeks after starting NRT, 24 percent of women had quit, compared with only 8 percent of women receiving counseling only. At 38 weeks of gestation, 18 percent of women taking NRT remained smoke-free, compared with 7 percent of women in therapy only.

Women's reports of quitting were confirmed by analyzing saliva levels of cotinine, the main product of nicotine after it is broken down by the body.

“This is the first large trial that has shown that NRT helps pregnant women quit smoking above counseling alone,” Pollak said.

However, by three months after delivery, there were no significant differences in quit rates observed between the two groups.

“We can't say that our effects are sustained postpartum, but it's not because women in the NRT group went back to smoking — it's because more women in the counseling group quit postpartum,” Pollak said.

However, the authors urged caution when interpreting these results. An independent safety monitoring board suspended recruitment for the study because early analyses showed a greater rate of adverse events, namely premature delivery, among women in the NRT group.

Pollak said that many of the women in the NRT group had a history of premature delivery, a fact that researchers did not control for before the study. In addition, many of the premature deliveries took place at 36 weeks — just shy of full-term delivery.

“The message to providers here is that it's reasonable to consider NRT, especially for women who are having trouble quitting,” said Michelle Levine, Ph.D., at the University of Pittsburgh Medical Center. She was not involved with the study.

“If the possibility of prescribing NRT increases the likelihood that they'll be engaged in treatment or get more treatment, it's worth seriously thinking about,” Levine said.

American Journal of Preventive Medicine : Contact the editorial office at (858) 457-7292 or [email protected]

Pollak KI, et al. Nicotine replacement and behavioral therapy for smoking cessation in pregnancy. Am J Prev Med 33(4), 2007.