Guideline No. 470: Nicotine and Pregnancy

Area of Science:

• Obstetrics and Gynecology
• Addiction Medicine
• Public Health

Background:

• Nicotine use during pregnancy is a significant, preventable cause of adverse maternal and neonatal outcomes.
• Includes use of combustible tobacco, electronic cigarettes, and smokeless tobacco.

Purpose of the Study:

• To provide evidence-informed recommendations for the screening, management, and cessation of nicotine use in pregnant and postpartum individuals.
• To improve maternal and neonatal outcomes and reduce nicotine exposure.

Main Methods:

• Comprehensive literature reviews on nicotine exposure, screening, cessation interventions, electronic cigarettes, and postpartum relapse prevention.
• Quality of evidence and strength of recommendations were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Main Results:

• Improved maternal and neonatal outcomes are associated with cessation interventions.
• Reduced nicotine exposure during pregnancy and improved cessation rates are key outcomes.
• Prevention of postpartum relapse is crucial for sustained benefits.

Conclusions:

• Routine screening for nicotine use in pregnancy is recommended.
• Behavioral counseling is the first-line therapy for nicotine cessation.
• Cautious use of pharmacotherapy and continued postpartum support are advised to prevent relapse.