Considering Smoking Cessation Options for Pregnant Women

Smoking continues to be 1 of the leading preventable causes of poor maternal and fetal health outcomes. However, pregnant women tend to use cessation pharmacotherapies infrequently.

In a recent study, researchers hypothesize providers’ safety concerns about treatment as a potential barrier. For example, the prevalence of nicotine replacement therapy (NRT)—1 of the 3 studied cessation pharmacotherapies—among pregnant smokers in the United States is low (1.2%) compared to the United Kingdom (11%), and Canada (24.5 %).¹

The Australian Professional Society on Alcohol and other Drugs recently published the retrospective, cross-sectional study in The Drug and Alcohol Review. The report analyzed providers’ concerns about pharmacotherapies in smoking cessation in pregnant women compared to other medications in similar risk categories.¹ Their concern was measured in the frequency and basis of calls made to MotherSafe, a teratology information resource in Australia. The study analyzed and compared 66,687 calls.

Despite NRT having the most evidence for use during pregnancy, the study findings revealed the level of concern from health care providers regarding its use was similar to those of medications in Category D. This finding suggests that though it is hard to classify a true category for NRT, providers have unofficially placed it in Category D, which may not be a fair comparison. This discounts the harm risk associated with smoking during pregnancy. If pregnant women continue to smoke, cigarette use risk is similar to NRT risk with regard to nicotine, but cigarettes also contain other substances creating additional harm.

In addition to these findings, providers made more calls to MotherSafe about bupropion and varenicline compared to other medications in equal risk categories. This, however, was unsurprising considering antenatal care guidelines, and recommendations against use of either during pregnancy.

Current guidelines recommend behavioral counseling and nonpharmacologic interventions for pregnant smokers. If inadequate, the investigators recommend provider referrals, and discussions of benefits and risks of NRT or bupropion.²

Overall, researchers concluded that more robust safety studies on pharmacotherapies for cessation in pregnant smokers are needed. When providers overestimate risk associated with therapies, it tends to reduce their willingness to prescribe them. It also contributes to the low usage rates of cessation pharmacotherapies like NRT in pregnant women.

Chevannah Hardie is a 2020 PharmD Candidate at the University of Connecticut in Storrs.

REFERENCES

• Lee ML, Tran DT, Welsh A, Kennedy D, Havard A. Health-care providers' concern regarding smoking cessation pharmacotherapies during pregnancy: Calls to a teratology information service. Drug Alcohol Rev. 2020 Jan 26. Doi: 10.1111/dar.13033. [Epub ahead of print]
• Cressman AM, Pupco A, Kim E, Koren G, Bozzo P. Smoking cessation therapy during pregnancy. Can Fam Physician. 2012;58(5):525—527.