Does the Use of Nicotine Replacement Therapy During Pregnancy Affect Pregnancy Outcomes?
Abstract
Objectives Although nicotine replacement therapies (NRT) may assist with smoking cessation, little is known about the safety of NRT use during pregnancy. Our purpose was two-fold: to determine characteristics of women prescribed or recommended NRT during pregnancy and to investigate whether NRT prescription/recommendation was associated with adverse pregnancy outcomes using data from the 2004 Pregnancy Risk Assessment Monitoring System. Methods Smoking and NRT referral was self-reported by 5,716 women. Information on pregnancy outcomes was obtained from birth certificates. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results Smokers <35 years of age and of Hispanic, Non-Hispanic Black, and Asian/Pacific Islander race/ethnicity were less likely to be prescribed or recommended NRT during pregnancy. After adjustment for age, marital status, education, and race/ethnicity, women recommended NRT had twice the risk of low birthweight as compared to nonsmokers (OR = 1.95, 95% CI: 1.10, 3.46) while smokers had 1.31 times the risk of low birthweight (95% CI: 0.92, 1.87). Results for preterm birth were similar after adjustment for the same confounding variables (NRT: OR = 2.04, 95% CI: 1.14, 3.63 and smoking: OR = 1.09, 95% CI: 0.74, 1.61). Conclusions Risks of low birthweight and preterm birth were highest for women prescribed or recommended NRT. These findings may be related to frequency of maternal smoking. While heavier smokers may be more likely to be recommended NRT, they also may have the most difficulty with cessation. Greater efforts should be made to ensure that these women do successfully cease smoking.
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Two of the studies reporting low birth weight had the lowest quality scores of all routine health-care studies.
“Two of these studies had the lowest quality scores of all routine health-care studies (see Table 4) [36,39].”
From Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis. (2021) · cites this paper as [36]
In a retrospective questionnaire study, 13.1% of NRT-exposed women delivered low birth weight infants, compared with 9.26% among women who smoked and 6.99% with neither exposure.
“A retrospective questionnaire study found that 13.1% of NRT-exposed women delivered low birth weight infants and rates were 9.26% within women who smoked and 6.99% with neither exposure [36].”
From Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis. (2021) · cites this paper as [36]
Women issued NRT in those cohorts very probably experienced higher-risk pregnancies, which may have substantially affected adverse outcomes.
“In three of the five birth cohorts which provided non-RCT studies' data, women issued with NRT had higher rates of comorbidities and lower socio-economic status than other women who smoked, and so very probably experienced 'higher-risk' pregnancies [10,33,36] which may have substantially affected adverse outcomes.”
From Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis. (2021) · cites this paper as [36]
In three of the five birth cohorts providing non-RCT data, women issued NRT had higher rates of comorbidities and lower socio-economic status than other women who smoked.
“In three of the five birth cohorts which provided non-RCT studies' data, women issued with NRT had higher rates of comorbidities and lower socio-economic status than other women who smoked, and so very probably experienced 'higher-risk' pregnancies [10,33,36] which may have substantially affected adverse outcomes.”
From Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis. (2021) · cites this paper as [36]
Women recommended or prescribed NRT by a health-care professional might be those who smoke more heavily and find it harder to quit.
“Smoking is well known to contribute to increased risk of pre-term birth [60], and one of the included studies in this meta-analysis acknowledges that the women recommended or prescribed NRT by a health-care professional might be those who smoke more heavily [36] and find it harder to quit [61].”
From Fetal safety of nicotine replacement therapy in pregnancy: systematic review and meta-analysis. (2021) · cites this paper as [36]
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References 27 · Cited by 39
- Authors
- Gaither, K. H., Huber, L. R. B., Thompson, M. E., & Huet-Hudson, Y. M.
- Affiliations
- University of North Carolina at Charlotte (US)
- Corresponding author
- Gaither, Kimberly H.
- Venue
- Maternal and Child Health Journal
- Published
- 2008-05-14
- Volume
- 13
- Issue
- 4
- Pages
- 497-504
- ISSN
- 1092-7875 (ISSN-L)
- 1573-6628
- OpenAlex
- W1971039090
- Cited by
- 39
- References
- 27
- Citations by year
- 2025: 1 · 2020: 5 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 3 · 2015: 2 · 2014: 3 · 2013: 4 · 2012: 3
- FWCI
- 2.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Maternal and Child Health Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Keywords
- nicotine replacement therapy, pregnancy, maternal smoking, smoking cessation, low birth weight, preterm birth, adverse pregnancy outcomes, drug safety in pregnancy, racial and ethnic disparities, Pregnancy Risk Assessment Monitoring System
- MeSH terms
- Smoking Prevention, Adolescent, Adult, Female, Humans, Nicotine, Pregnancy, Pregnancy Outcome, Surveys and Questionnaires, Tobacco Use Disorder, Odds Ratio, Nicotinic Agonists, Young Adult
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