Abstract
Many countries, including the UK, recommend nicotine replacement therapy (NRT) for smoking cessation during pregnancy. However, adherence to NRT is generally low, smoking lapse or relapse is common and using NRT to reduce the harm from the number of cigarettes smoked is only advocated in non-pregnant smokers. Two focus groups were conducted with 13 professionals involved in antenatal stop smoking services (SSS). The data were analysed thematically. Two themes were extracted that describe health professionals’ attitudes towards using NRT either during lapses or to reduce smoking in women who cannot quit (harm reduction). These are presented around a social–ecological framework describing three hierarchical levels of influence within smoking cessation support: (1) Organizational: providing NRT during lapses could be expensive for SSS though harm reduction could result in services helping a wider range of clients. (2) Interpersonal: participants felt using NRT for harm reduction was not compatible with cessation-orientated messages practitioners conveyed to clients. (3) Individual: practitioners’ advice regarding using NRT during smoking lapses varied; many were generally uncomfortable about concurrent smoking and NRT use and had strong reservations about recommending NRT when smoking during all but the briefest lapses. Further evidence is required to guide policy and practice.
Highlights
Smoking during pregnancy is a significant, but preventable, cause of adverse prenatal outcomes [1,2,3] and a range of childhood health problems [4]
Pregnant smokers’ adherence to nicotine replacement therapy (NRT) is poor [10] and may be explained, at least partially, by an increase in nicotine metabolism in pregnancy which is likely to result in them needing higher doses to prevent cravings [11]
As no themes produced in the analysis sat within the societal or community levels, we present findings within organisational, interpersonal and individual levels of influence on smoking cessation support in an approach adopted elsewhere for this population [31]
Summary
Smoking during pregnancy is a significant, but preventable, cause of adverse prenatal outcomes [1,2,3] and a range of childhood health problems [4]. Excellence (NICE) guidance recommends that all pregnant women identified as smokers should be referred to specialist stop smoking services (SSS) [7]. Pregnant smokers’ adherence to NRT is poor [10] and may be explained, at least partially, by an increase in nicotine metabolism in pregnancy which is likely to result in them needing higher doses to prevent cravings [11].
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