Safety and Effectiveness of Bupropion for Smoking Cessation During Pregnancy: A Scoping Review

Smoking during pregnancy is associated with adverse maternal, fetal, and neonatal outcomes. Although behavioral counseling remains first-line treatment, pharmacotherapy may be considered when counseling alone is insufficient. This scoping review mapped the available evidence on the safety and effectiveness of bupropion for smoking cessation during pregnancy. The review was conducted according to Joanna Briggs Institute methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). MEDLINE (PubMed), Embase, the Cochrane Library, PsycINFO, and ClinicalTrials.gov were searched without date restrictions for English-language studies evaluating bupropion for smoking cessation during pregnancy. Two reviewers independently screened records, and the review team extracted data on smoking cessation, maternal safety, and fetal or neonatal outcomes. Of 599 records identified, 13 sources of evidence met the inclusion criteria. Maternal and fetal safety findings were generally reassuring, with no consistent increase in maternal adverse events, major congenital malformations, preterm birth, impaired fetal growth, or serious neonatal morbidity. Evidence for smoking cessation effectiveness was mixed. Some studies reported improved short-term abstinence, reduced cigarette consumption or tobacco exposure, and improvement in craving or withdrawal symptoms, whereas other randomized trials found no significant improvement in sustained abstinence compared with placebo or counseling. Interpretation was limited by small samples, few bupropion-exposed pregnancies, heterogeneous designs and outcomes, and restrictive trial eligibility criteria. Current evidence is more reassuring regarding maternal, fetal, and neonatal safety than it is conclusive regarding smoking cessation effectiveness. Larger, adequately powered studies involving more representative pregnant populations are needed to clarify efficacy and detect uncommon adverse outcomes.