Progesterone for smoking relapse prevention following delivery: A pilot, randomized, double-blind study

Area of Science:

• Reproductive Endocrinology
• Addiction Medicine
• Clinical Pharmacology

Background:

• Many women who smoke prior to pregnancy quit during gestation due to high progesterone levels.
• However, smoking relapse is common postpartum as progesterone levels decline.
• This pilot study investigated postpartum progesterone replacement to prevent smoking relapse.

Purpose of the Study:

• To test the feasibility of postpartum progesterone replacement therapy.
• To assess the preliminary efficacy of progesterone in preventing postpartum smoking relapse.
• To evaluate effects on smoking cessation, time to relapse, and nicotine cravings.

Main Methods:

• An 8-week, double-blind, randomized, placebo-controlled pilot trial.
• 41 women with a history of pre-pregnancy smoking, abstinent by 32 weeks gestation.
• Randomized to oral micronized progesterone (200mg BID) or placebo immediately postpartum.

Main Results:

• The trial was feasible, with recruitment (64%) and retention (78%) rates adequate.
• Progesterone group showed a trend towards higher abstinence rates (1.8x) and longer time to relapse (10 vs. 4 weeks).
• Significant reduction in weekly craving ratings (10% greater decline) in the progesterone group; no serious adverse events.

Conclusions:

• Postpartum progesterone replacement shows promise as a safe and effective smoking relapse prevention strategy.
• Preliminary findings suggest a potential therapeutic breakthrough for postpartum smokers.
• Larger, powered studies are needed to confirm efficacy and establish this as a viable lactation-compatible treatment.