Pharmacological interventions for promoting smoking cessation during pregnancy

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Pharmacology

Background:

• Tobacco smoking during pregnancy poses significant risks to both fetus and mother.
• Pharmacotherapies like NRT and bupropion are effective for non-pregnant smokers but their safety and efficacy in pregnancy are largely unknown.
• Electronic cigarettes (ECs) are increasingly used, yet their role in pregnancy smoking cessation is unestablished.

Purpose of the Study:

• To evaluate the efficacy and safety of smoking cessation pharmacotherapies and ECs during pregnancy.
• To assess smoking cessation rates in late pregnancy and postpartum.
• To determine adherence to these cessation aids during pregnancy.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) involving pregnant smokers.
• Searched Cochrane Pregnancy and Childbirth Group's Trials Register, trial registers, and grey literature.
• Primary efficacy outcome: smoking cessation in late pregnancy; safety outcomes included birth and infant well-being.

Main Results:

• Eleven trials (2412 women) included NRT (9 trials) and bupropion (2 trials). No trials on varenicline or ECs.
• Low-certainty evidence suggests NRT may increase smoking abstinence in late pregnancy (RR 1.37), but this effect was not consistent across study types.
• No significant differences in major birth outcomes (miscarriage, stillbirth, birthweight) were observed with NRT or bupropion. Adherence to NRT was generally low.

Conclusions:

• NRT may modestly increase smoking cessation rates in pregnant women, though the evidence is of low certainty and potentially biased by study design.
• Current evidence does not indicate adverse effects of NRT or bupropion on birth outcomes, but data are limited.
• Further high-quality, placebo-controlled RCTs are needed to confirm efficacy and safety, especially for NRT, bupropion, and ECs, with long-term infant follow-up.