Smoking Cessation Pharmacotherapy Use in Pregnancy

Area of Science:

• Reproductive Health
• Pharmacology
• Public Health

Background:

• Evidence gaps exist regarding the safety of smoking cessation pharmacotherapies during pregnancy, particularly concerning congenital malformations.
• Professional bodies recommend caution with nicotine replacement therapy (NRT) and advise against varenicline and bupropion during pregnancy.
• Current estimates of smoking cessation pharmacotherapy use in pregnant individuals are lacking.

Purpose of the Study:

• To quantify the prevalence of prescribed smoking cessation pharmacotherapy use during pregnancy.
• To specifically assess the proportion of use during the first trimester of pregnancy.
• To analyze usage patterns across four high-income countries.

Main Methods:

• A retrospective, population-based cohort study design was employed.
• Data were sourced from linked birth, hospital admission, and medication dispensing records.
• The study included all pregnancies resulting in birth between 2015 and 2020 in Australia, New Zealand, Norway, and Sweden.

Main Results:

• Overall prevalence of varenicline ranged from 0.02% to 0.14%, NRT from <0.01% to 1.86%, and bupropion from <0.01% to 0.07%.
• Among pregnant individuals who smoked, pharmacotherapy use was higher, with maximum prevalences of 1.25% for varenicline, 11.39% for NRT, and 0.39% for bupropion.
• First-trimester use was over 90% for varenicline, approximately 60% for NRT, and 80-90% for bupropion.

Conclusions:

• The low prevalence of varenicline and bupropion, and higher NRT use, aligns with current clinical guidelines for smoking cessation in pregnancy.
• The predominant use of these medications in the first trimester underscores the urgent need for robust evidence on the risk of congenital malformations.
• Further research is critical to inform safe and effective smoking cessation strategies for pregnant individuals.