Pregnant smokers not helped by the patch

The nicotine patch has been found no more beneficial in helping pregnant women quit smoking than it is for smokers in general, according to a study just published in The New England Journal of Medicine. The study, which was intended to investigate both the efficacy and safety of nicotine patches during pregnancy, was able to assess only the former given the extremely low compliance rate of the study participants.

The research team, based at the University of Nottingham, England, began by randomly assigning 1,050 pregnant smokers to either a nicotine patch (15 mg per 16 hours) or a placebo patch. Ultimately, they found that there was no significant difference between the two groups when it came to abstaining from cigarettes: 9.4 percent of the nicotine-replacement group and 7.6 percent of the placebo group quit smoking for the duration of their pregnancies. Furthermore, compliance was very low in both groups: Only 7.2 percent of the women assigned to the nicotine patch and 2.8 percent assigned to the placebo patch actually used the patches for longer than one month. So, although the rates of adverse pregnancy and birth outcomes were similar in the two groups, the researchers admitted that these very low compliance rates limited their ability to accurately assess the safety of the patch. The low efficacy, or beneficial results, of the patch during pregnancy was a function of the very low compliance rate.

Why should nicotine patches work during pregnancy? They don t work any other time, ACSH s Dr. Elizabeth Whelan observes. And indeed, a major study published in January made waves with its finding that smokers trying to quit with the aid of nicotine patches, gum, inhalers, or nasal sprays were just as likely to relapse as smokers who had attempted to quit without them.

The most important point here, notes ACSH s Dr. Gilbert Ross, is that, even among pregnant women a population typically more careful about their health nicotine patches are rarely effective. He observes that reduced risk tobacco products such as snus and electronic cigarettes,both of which deliver nicotine without the carcinogenic combustion of tobacco smoke, would most likely be a reasonable option for pregnant smokers who have trouble quitting. Unfortunately, he points out, given how unwilling the majority of the public health community is to recognize tobacco harm reduction as a sensible method, it s more likely that the 10 to 12 percent of pregnant women in the U.S. who smoke will simply continue to do so, despite the harmful effects of smoking on the developing fetus.