Nicotine patch use in pregnant smokers: smoking abstinence and delivery outcomes

Abstract

Objective: To describe smoking abstinence and fetal effects of pregnant smokers who received 8 weeks of nicotine patch therapy.Methods: One-sample study of 21 pregnant women smoking ≥15 cigarettes/day during their third trimester of pregnancy despite physician advice to stop. Nicotine patch therapy (22 mg/24 h) was initiated during the first day of a 4-day in-hospital study and continuedfor a total of 8 weeks. Subjects returned weekly until delivery, at 4 weeks after delivery, and at 6 and 12 months after patch therapy. Fetal growth and well-being were assessed using ultrasound examinationsand non-stress tests.Results: Eight of 21 subjects completed all 8 weeks of patch therapy according to the protocol. Five subjects (24%) discontinued using the nicotine patch, owing to adverseskin reactions. There were eight subjects (38%) who were biochemically confirmed abstinent from smoking at the time of delivery; of these, seven were continuously abstinent from the start of patch therapy.Centile weight for gestational age did not change significantly over time for 12 subjects with serial ultrasound measurements available at baseline, 4 weeks and 8 weeks following initiation of patch therapy.In all cases, non-stress tests remained reactive or became reassuring with observation. No significant preterm deliveries occurred (gestational ages of 36.3-41.1 weeks). Three infants suffered severe neonatalmorbidity; however, these problems were unrelated to nicotine patch therapy.Conclusion: Nicotine patch therapy has potential benefit for pregnant smokers who continue to smoke despite physicianadvice to stop.