Nicotine Patches May Not Help Pregnant Smokers Quit

Nicoderm Patch on ArmAlthough smoking during pregnancy is a known risk factor for pregnancy complications such as miscarriage and premature birth and long-term health problems for the child, many pregnant women continue to smoke. Unfortunately, a new study published in the journal BMJ suggests that nicotine patches do not appear to help pregnant smokers quit smoking.

For the present study, researchers at the Université Pierre et Marie Curie-Faculté de Médecine in Paris, France sought to determine the efficacy of 16-hour nicotine patches among pregnant smokers. Although nicotine replacement therapy appears effective among smokers in general, little research exists on the efficacy of the treatment among pregnant women.

A total of 402 pregnant smokers older than 18 years old and between 12 and 20 weeks of gestation who smoked at least five cigarettes a day participated in the study. The researchers divided the women into two group; 203 received nicotine patches and 199 received placebo patches. Data from 192 live births was available from each group.

Among the women who received the nicotine patches, the dose was individually adjusted daily according to saliva cotinine levels. Cotinine is a metabolite of nicotine.

The researchers assessed the women monthly and provided behavioral smoking cessation support. The primary outcomes of the study were complete abstinence from quit date to delivery and birth weight of the baby.

According to the study, nicotine patches did not offer any benefit over the placebo patch in terms of increasing smoking cessation or birth weight. Only 11 of the women stopped smoking in the nicotine group compared to only 10 in the placebo group. The average birth weight was 3065 grams in the nicotine group and 3015 grams in the placebo group.

Blood pressure was also significantly higher in the nicotine group, a result that warrants additional research on the safety of nicotine replacement therapy during pregnancy.

Conclude the researchers, “These are disappointing results and should encourage efforts to evaluate new approaches that are both drug and non-drug related. In the absence of evidence based drug interventions, behavioural support remains the core intervention to help pregnant smokers to quit.”

Adds Leonie Brose at the Institute of Psychiatry of King’s College London in an accompanying editorial, “It may be too early to abandon the option of NRT entirely. However, a much greater effort is still needed to identify, test, and deliver more effective treatments for pregnant smokers who struggle to quit.”

Two other recent studies have suggested a link between maternal smoking during pregnancy to an increased risk of nicotine dependence in daughters and the use of nicotine replacement during pregnancy to an increased risk of obesity and metabolic syndrome in children. Exposure to nicotine may also increase the risk of ADHD in future generations.


Helping pregnant smokers to quit – Behavioural support works, evidence on drug treatment still patchy:
Nicotine patches do not appear to help pregnant smokers to quit:
Nicotine patches in pregnant smokers: randomised, placebo controlled, multicentre trial of efficacy:

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